Semi-Fowler Positioning Combined with Supplemental Oxygen for Dyspnea Management in Acute Coronary Syndrome: A Case Series

Introduction: Dyspnea is a common symptom in patients with acute coronary syndrome (ACS) and may result from myocardial ischemia, left ventricular dysfunction, and pulmonary congestion. Supportive respiratory management, including patient positioning and oxygen therapy, is frequently used in clinical practice to improve oxygenation and relieve respiratory distress. However, reports describing the combined use of semi-Fowler positioning and supplemental oxygen in ACS patients with dyspnea remain limited, particularly in Indonesian clinical settings. Case Presentation: This case series describes two patients with ACS presenting with dyspnea who were admitted to the intensive care unit of a type B hospital in Malang, Indonesia. Case 1 was a 54-year-old woman with suspected unstable angina, hypertension, ischemic electrocardiographic changes, elevated CK-MB levels, and oxygen saturation of 90% at admission. Case 2 was a 47-year-old man with suspected unstable angina following percutaneous coronary intervention who presented with dyspnea and oxygen saturation of 92%. Both patients received standard ACS medical treatment in addition to supportive respiratory management consisting of semi-Fowler positioning (45° head elevation) and supplemental oxygen via nasal cannula at 3 L/min. Clinical parameters were monitored during one nursing shift. Results: Improvements in respiratory status were observed in both patients. In Case 1, oxygen saturation increased from 90% to 98–99%, while respiratory rate decreased from 30 to 20–28 breaths/minute. In Case 2, oxygen saturation increased from 92% to 98–100%, accompanied by a reduction in respiratory rate from 30 to 20–26 breaths/minute. Both patients also reported subjective improvement in dyspnea. Conclusion: In these two cases, semi-Fowler positioning and supplemental oxygen were associated with short-term improvement in oxygen saturation and respiratory rate in ACS patients presenting with dyspnea. Although causality cannot be established due to the descriptive nature of this case series and concurrent ACS treatment, these findings highlight the potential role of supportive respiratory management in optimizing patient comfort and oxygenation during acute care.