Importance Of Golden Hour In Acute Coronary Syndrome

Importance Of Golden Hour In Acute Coronary Syndrome

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Importance Of Golden Hour In Acute Coronary Syndrome

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Importance Of Golden Hour In Acute Coronary Syndrome

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The ‘Golden Hour’ in Acute Coronary Syndrome is vital. Research has demonstrated that time is a fundamental factor in reducing morbidity and mortality from AMI and cardiac arrest. Explain this statement in terms of initial emergency management, pharmacological management and appropriate nursing care and management for these patients.

Acute coronary syndrome can be described as the range of the conditions that associates with sudden and reduced flow of the blood to the heart that affects the functioning of the heart muscles of the individuals. Researchers are of the opinion that this blockage can be sudden and might occur at any instant with even the possibilities for the blockage occurring and resolving and going away over a period (Ibanez et al., 2017). The condition is mainly seen to occur due to the building up of the plaques or the fatty deposits in and on the walls of the coronary arteries in the affected individuals. The coronary arteries are mainly responsible for the delivering of the oxygen and nutrients to the different parts of the muscles of the heart through the flow of the blood (Simeone et al., 2015). These heart muscles need a continuous supply of the oxygen rich blood for effective functioning. When the clotting in the blood occurs, it hampers the smooth flow of the blood and the muscles of the heart get deprived of oxygen resulting in severe life threatening symptoms. This assignment would reflect how professionals could take effective care in such strenuous time so that the patients can be saved.
Three different types of acute arterial disorders can be included in the acute coronary syndrome. These are the unstable angina, heart attack or the ST-segment elevation myocardial infarction and the non-ST-segment elevation myocardial infarction or the heart attack. When the supply of the oxygen to the different cells of the heart becomes very low, the muscles of the cells face a risk of death (Han et al., 2015). The lack of supply of blood to the tissues is called ischemia. The death of the cells may result in the damaging of the muscles tissue and this raises a concern of heart attack as well as ischemic infarction. In many of the cases, it is seen that cells do not die but they become damaged due to inadequate supply of oxygen to the heart muscles, as they cannot work efficiently.  This problem might be temporary as well as permanent. Unstable angina is the main term that is used in describing the condition when the acute coronary syndrome does not result in death of the cells.
The location of the blockage, the length duration of the time when the flow of the blood is blocked as well as the amount of damage that occurs during this time determine the type of the acute coronary syndrome as well as the extend to the damage caused by the condition to the individual (Chew et al., 2016). It is important for the healthcare professionals to be efficient and active during this emergency hour and identify the coronary syndromes based on three important aspects. The first one aspect is the presence of certain substances that are present in the blood as released by the damaged heart muscles; the second one aspect is the symptoms of the condition as well as the results of the electrocardiography or the ECG being the third aspect. Identifying these aspects is crucial for the healthcare professionals in the emergency as these identifications would help them to develop to take the correct decisions in choosing the appropriate an correct treatment (Nikoloau et al., 2015).
“Time is muscle and muscle is time” is the famous statement that provides the main rationale of calling the diagnosing and treatment of acute myocardial infarction as the emergency and the first few hours as the golden hour. Once the clot occurs in individuals, flow of the blood gets restricted and gradually the muscles start becoming deprived of oxygen. Hence, they begin to die resulting in emergency. Moreover, the more time is spent before diagnosing and initiating the treatment, the more the chances remain of damage more muscles cells and death of the heart (Reuter et al., 2015). Therefore, it is important for healthcare professionals to be highly careful and take immediate actions in the emergency when acute coronary syndromes are identified in affected individuals. Researchers are of the opinion that each minute of the delay in the first three hours can confer 10 lost days of the survival. This shows that how the first three hours from the onset of the blockage of the coronary arteries can be crucial in saving the life of the patient and determining the quality of the life that the patient will lead in the future. Therefore, survival would be only ensured by the onset of Thrombolytic treatment that the nursing professional should undertake (Dumas et al., 2016).
To make a quick as well as accurate diagnosis, a healthcare professional will first perform some important tests and need to inquire about different symptoms of the patients and understand the previous medical history of the patient. Some of the important tests that the professionals should include are the electrocardiogram. This test mainly helps in measuring the various types of electrical activities of the heart via different elcetrodes, which are attached to the skin of the affected patient (Shah et al., 2015). Abnormal and any form of irregular impulses mainly help in indicating about the poor functioning of the heart because of the lack of the oxygen to the heart. Different types of electrical signal patterns would be helping in indications of the location of the blockage as well. Another important diagnostic test is the blood tests. When cell deaths  occur resulting in the damage of the heart tissues, different types of particular enzymes are also found in the blood. The positive results of the presence of certain enzymes help in the indication that heart attack might have occurred (Quinn et al., 2014). Another test can be cardiac perfusion scan. That type of scan that helps in showing whether the heart is getting enough blood. It also helps in checking these areas of the heart are damaged after the heart attack has occurred. From the information of these tests as well as from the actual signs and symptoms of the affected patient, the healthcare professionals need to diagnose the acute coronary heart syndromes and thereby determine whether it should be considered as the unstable angina as well as heart attack has occurred (Hao et al., 2015). Therefore, one important aspect in the golden hours is the proper diagnosis of the cause of symptoms and signs and thereby concluding about the presence or absence of acute coronary syndromes and accordingly classifies the cause and implements interventions.
The acute coronary syndrome disorders are considered as medical emergency where immediate treatment is needed for saving the life of the patients. In such situations professional need to follow and finalize a set of short-term goals and a set of long term goals. The short term goals are mainly seen to include relieving of the pain and improving the flow of the blood. This helps in the restoration of the heart function as quickly as possible (Ho et al., 2014). The ling terms goals would mainly include improvement of the overall heart functions, management of the risk factors as well as lowering of the chances of heart attack.
The most dangerous time for a patient who is having a heart attack is mainly during the first few hours and before they are transferred to the hospitals. Often it is seen that during this time 20 to 30% of the patient dies. Therefore, it is important for seeking medical help immediately when the people suspect that they are having heart attacks. The sooner the treatment begins, the better the chances of the survival. Heart rhythm, blood pressure as well as the amount of the oxygen in the blood needs to be considered by the healthcare professionals so that heart damage can be assessed (Foy et al., 2015). Nursing professionals often find the need to give oxygen through the nasal prongs or that of the facemask. Researchers are of the opinion that providing more oxygen to the heart helps in keeping the heart tissue damage to that of the minimum.
The most important intervention that the professionals should incorporate in the early treatment phase is the administration of aspirin. The significant part of this is that it helps in the reduction of the size of the clot and helps in increasing the chances of the survival of the patient. People who are having allergy to that of the use of aspirin might also intake clopidogrel or ticlopidine. People are to be given drugs for the prevention of the formation of the blood clots for the reduction of the anxiety as well as for the reduction of the size of the heart. Drugs mainly help in reducing the workload of the heart during as well as after the occurrence of the heart attack (VenDanthan et al., 2014). Decreasing the workload of the heart helps in limiting the tissue damage and therefore a beta-blocker is mainly administered for slowing down the rate of the heart. This slowing down of the heart would help the work to less hard and thereby this helps in reduction of the area of the damaged tissue. Many of the patients are also given an anticoagulant drug like that of heparin. This helps in the prevention of the formation of additional blood clots. Researchers are of the opinion that people who suffer from heart attack are also seen to go through experiences of severe discomfort as well as anxiety. In such situations, nursing professionals should mainly administer morphine (Khonsari et al., 2015). This drug mainly helps by calming effect and helps in the reduction of the workload of the heart. In such situations, nitroglycerin should be provided in order to relieve pain by the reduction of the heart load of the heart and by the possible dilation of the arteries. Usually, this medication is first given under the tongue of the patient and then it is given intravenously. The nursing professionals nowadays also give ACE inhibitors as they are found to reduce the enlargement of the heart and helps in increasing the chances of the survival of the heart. These are mainly given starting from the heart attack conditions to a few days after the heart attack and are prescribed indefinitely.
The decision on the timing as well as method of opening of the blocked coronary artery mainly depends on the type of the acute coronary syndrome and how quickly the person is seen to be admitted in the hospital. Percutaneous cardiac interventions such as angioplasty as well as stent placement appears for the best ways of opening  blocked arteries  during the cases of the ST-segment elevation MI if they can be done within 90 minutes of the time the person arrives at the hospitals (Anderson et al., 2017).  Clot dissolving drugs are mainly given intravenously for opening of the arteries if the above-mentioned PCI procedures are not done within the 90 minutes period. Different types of thrombolytic drugs like that of the streptokinase, tenecteplase (TNK-tPA), alteplase, and reteplase. They are seen to work well within 3 hours and may be of benefits up to 12 hours after the person is seen to be arriving in the hospitals. People who have a non-ST-segment elevation MI or unstable angina  are seen to be not benefitted from the immediate PCI as well as thrombolytic drugs. In some people, coronary artery grafting can be also done during acute coronary syndrome instead of PCI or the thrombolytic drugs. They are mainly done for people who have bleeding disorders or these who have suffered stroke or major surgery (Greeenslade et al., 2016). Following them, they should be transferred to the rehabilitation unit for further care and treatment to be done by the nursing professionals.
From the above discussion, it becomes clear that acute coronary syndromes are harmful threatening condition to the life of the patients when their blood vessels like the coronary arteries get blocked due to fatty deposits. Blood cannot carry oxygen to the cells of the heart and accordingly causes death to the cells of the heart. This is threatening situation and requires immediate emergency interventions by the healthcare professionals. More the time passes without care, lesser will be the chances of the survival of the patient. Within the first three hours, interventions need to be applied without which the heart muscles might be damaged to a considerable extent. This is called the golden hour and the professionals need to be quick in their actions. They need to diagnose the situation with ECG, blood test and then cardiac scan, after identification of the disorder, aspirins, beta-blockers, nitroglycerin, anti-platelet drugs, ACE inhibitors and others need to be provided because of their specific actions. Several surgeries need to be undertaken according to the requirement of the situation. This would help the professionals to save the life of patients in cases of this kind of emergency and saving the lives from further damage of heart.
Anderson, J. L., & Morrow, D. A. (2017). Acute myocardial infarction. New England Journal of Medicine, 376(21), 2053-2064. DOI: 10.1056/NEJMra1606915
Chew, D. P., Scott, I. A., Cullen, L., French, J. K., Briffa, T. G., Tideman, P. A., … & Aylward, P. E. (2016). National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Heart, Lung and Circulation, 25(9), 895-951. DOI:
Dumas, F., Bougouin, W., Geri, G., Lamhaut, L., Rosencher, J., Pène, F., … & Mira, J. P. (2016). Emergency percutaneous coronary intervention in post–cardiac arrest patients without ST-segment elevation pattern: insights from the PROCAT II registry. JACC: Cardiovascular Interventions, 9(10), 1011-1018. Retrieved from:
Foy, A. J., Liu, G., Davidson, W. R., Sciamanna, C., & Leslie, D. L. (2015). Comparative effectiveness of diagnostic testing strategies in emergency department patients with chest pain: an analysis of downstream testing, interventions, and outcomes. JAMA internal medicine, 175(3), 428-436. doi:10.1001/jamainternmed.2014.7657
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Han, Y., Guo, J., Zheng, Y., Zang, H., Su, X., Wang, Y., … & Jiang, D. (2015). Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: the BRIGHT randomized clinical trial. Jama, 313(13), 1336-1346. doi:10.1001/jama.2015.2323
Hao, K., Takahashi, J., Ito, K., Miyata, S., Nihei, T., Nishimiya, K., … & Shimokawa, H. (2015). Clinical Characteristics of Patients With Acute Myocardial Infarction Who Did Not Undergo Primary Percutaneous Coronary Intervention–Report From the MIYAGI-AMI Registry Study–. Circulation Journal, 79(9), 2009-2016.
Ho, P. M., Lambert-Kerzner, A., Carey, E. P., Fahdi, I. E., Bryson, C. L., Melnyk, S. D., … & Weaver, J. (2014). Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial. JAMA internal medicine, 174(2), 186-193. doi:10.1001/jamainternmed.2013.12944
Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., … & Hindricks, G. (2017). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal, 39(2), 119-177.
Khonsari, S., Subramanian, P., Chinna, K., Latif, L. A., Ling, L. W., & Gholami, O. (2015). Effect of a reminder system using an automated short message service on medication adherence following acute coronary syndrome. European Journal of Cardiovascular Nursing, 14(2), 170-179.
Nikolaou, N. I., Welsford, M., Beygui, F., Bossaert, L., Ghaemmaghami, C., Nonogi, H., … & Woolfrey, K. G. (2015). Part 5: acute coronary syndromes: 2015 International Consensus on Cardiopulmonary Resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation, 95, e121-e146. DOI:
Quinn, T., Johnsen, S., Gale, C. P., Snooks, H., McLean, S., Woollard, M., … & Myocardial Ischaemia National Audit Project (MINAP) Steering Group. (2014). Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: a linked cohort study from the Myocardial Ischaemia National Audit Project. Heart, 100(12), 944-950.
Reuter, P. G., Rouchy, C., Cattan, S., Benamer, H., Jullien, T., Beruben, A., … & Boccara, A. (2015). Early invasive strategy in high-risk acute coronary syndrome without ST-segment elevation. The Sisca randomized trial. International journal of cardiology, 182, 414-418.
Shah, A. S., Anand, A., Sandoval, Y., Lee, K. K., Smith, S. W., Adamson, P. D., … & Strachan, F. E. (2015). High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. The Lancet, 386(10012), 2481-2488.
Simeone, J. C., Molife, C., Marrett, E., Frech-Tamas, F., Effron, M. B., Nordstrom, B. L., … & Vetrovec, G. W. (2015). One-year post-discharge resource utilization and treatment patterns of patients with acute coronary syndrome managed with percutaneous coronary intervention and treated with ticagrelor or prasugrel. American Journal of Cardiovascular Drugs, 15(5), 337-350.
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