Acute MI Flashcards
Acute myocardial infarction also called as
Heart attack
Occurs when there is a diminished blood supply to the heart which leads to myocardial cell damage and ischemia.
MI
stops in the necrotic areas of
the heart.
Contractile fx
usually occurs due to blockage of the
coronary vessels.
Ischemia
is often the result of thrombus that is superimposed on an ulcerated or unstable atherosclerotic plaque formation in the coronary artery.
Ischemia
- MI’s are described by the area of occurrence.
Anterior, inferior, lateral, posterior
MI classification
Anatomic
Diagnostic
Anatomic
Transmural
Subendocardial
Diagnostic
ST Elevation (STEMI)
Non ST Elevation (Non STEMI)
Non modifiable risk factors
Age
Gender
Fam hx
Modifiable
Smoking
Htn
Dm
Obesity
S/sx
Chest pain
Nausea and vomiting
Cardiovascular changes
The most common initial manifestation
Chest pain
PQRST assessment
Precipitating events
Quality of pain
Radiation of pain
Severity of pain
Timing
results as a reflex from severe pain.
Vomitng
reflexes initiated from area of ischemia.
Vasovagal reflexes
Cardiovascular changes
Initial, increase BP and pulse
Later, decrease bp
Decrease Urine output
Crackles
Distended jugular vein
Obvious pulse
First 10 minutes
Check vs and o2
Establish Iv access
Obtain and review 12 lead ECG
Take brief hx and perform PE
Obtain bld samples: initial cardiac markers, electrolytes, coagulation
Dx
ECG confirm MI
12 lead ECG distinguish STEMI and NONSTEMI
produce certain proteins and enzymes associated with cellular functions.
Myocardial cells
- When cell death occurs, these cellular enzymes are released into the blood stream.
CPK and TROPONIN
CPK
Creatine Phosphokinase
Cpk begins
rise 3 to 12 hours after acute MI.
CPK peak
In 24 hrs
CPK return to normal
2-3 days
Myocardial muscle protein
Troponin
When troponin released
After injury
High specific indicator of MI
Troponin
Elevation of troponin
2 wks
Treatment
Immediate goal:
Restore bld flow to vessels
Salvage myocardium
General tx
MONA
Indicated for patients with STEMI MI’s.
Fibrinolytic therapy
Fibrinolytic therapy when given
12 hrs of sx onset
will break down clots found
within the vessels
Fibrinolytic
Contraindications of fibrinolytic therapy
Post op surgery
Pregnancy
Ulcer disease
Hx of hemorrhagic stroke
A diagnostic angiography which includes
angioplasty and possible stenting.
Cardiac catheterization
Surgical treatment where saphenous vein is harvested from the lower leg and used to bypass the occluded vessels.
Coronary artery bypass graft
Long term care
Smoking cessation
Aspirin, beta blockers, clopidogrel indefinite
Lipid lowering meds c diet mod
Nsg interventions
O2 adm
Nitroglycerin adm
Assess signs if ischemic pain
Avoid valsalva maneuver
Stop smoking
Control HTN and DM
Reduce wt
Nursing interventions for a patient with acute MI focus on:
*Balance myocardial oxygen supply and demand through oxygen administration and vasodilators (e.g., nitroglycerin).
*Monitor for early ventricular dysrhythmias.
*Assess for signs of ischemic pain to prevent complications.
Understand acute MI and symptoms like
chest pain or pressure.
Inform nurses of any chest pain changes.
Avoid the Valsalva maneuver.
Modify risk factors:
*Fat intake < 30% of calories.
*Cholesterol < 200 mg/dL, LDL < 70 mg/dL.
*Stop smoking, reduce salt.
*Control hypertension, diabetes.
*Increase activity, reduce weight.
