The nurse is teaching a patient about acute coronary syndrome. What will the nurse teach that describes the progression of events in this disorder?

Question

1. A thin fibrin layer stabilizes the ruptured plaque and prevents the occlusion of coronary vessels when stable angina is present in ACS.
2. When complete platelet occlusion occurs in a vessel, the ECG changes include nonspecific ST elevation without necrosis occurring in ACS.
3. The growth of platelet-rich thrombi in the smaller vessels creates a blockage and is the cause for unstable angina symptoms in ACS.
4. Sudden plaque buildup in a narrow vessel immediately leads to an acute myocardial infarction when stable angina is present in ACS.

Answer 1

3
Rationale 1: The formation of fibrin along the area of ruptured plaque will stabilize the thrombi and fully occlude the coronary vessel.
Rationale 2: When occlusion occurs, ST elevation occurs; necrosis and ischemia are a result of the decreased blood flow. Ischemic and necrotic tissue has decreased contractility, causing decreased cardiac output.
Rationale 3: Unstable angina occurs when a blockage from platelet-rich thrombi in smaller vessels occurs, causing myocardial ischemia. Because ischemic pattern of pain varies, it is unpredictable and can occur with exertion and rest.
Rationale 4: The buildup of plaque takes a longer period and will not give immediate symptoms of an MI. Stable angina occurs in a predictable manner, because there is gradual reduction of the vessel lumen size and other vessels may compensate for this minor hypoxia until the vessel is completely occluded.