ACUTE MI BOOK Flashcards
is an emergent situation characterized by an acute onset of myocardial ischemia that results in myocardial death (i.e., MI) if definitive interventions do not occur promptly.
Acute coronary syndrome
The spectrum of ACS includes
Unstable angina
NSTEMI
STEMI
there is reduced blood flow in a coronary artery, often due to rupture of an atherosclerotic plaque
Unstable angina
A clot begins to form on top of the coronary lesion, but the artery is not completely occluded
Unstable angina
In unstable angina This is an acute situation that can result in chest pain and other symptoms that may be referred to as
Preinfarction angina
plaque rupture and subsequent thrombus formation result in complete
occlusion of the artery, leading to ischemia and necrosis of the myocardium supplied by that artery
MI
(sudden constriction or narrowing) of a coronary artery, decreased oxygen supply, increased demand for O2
Vasopasm
reflects the urgency of appropriate treatment to improve patient outcomes.
Time is muscle
Various descriptions are used to further identify an MI
NSTEMI
STEMI
location of the injury to the ventricular wall
anterior, inferior, posterior, or lateral wall
point in time within the process of infarction
Acute
Evolving
Old
identifies the type and location of the MI, and other ECG indicators, such as a Q wave, and patient history, identify the timing
12 lead ECG
Clinical manifestations
Chest pain
SOB
indigestion
Nausea
Anxiety
Cool pale moist skim
Tachycardia
Assessment and dx
12 lead ECG
Physical exam
Pt history
Electrocardiogram
Echocardiogram
Laboratory tests
The expected ECG changes are
Twave inversion
St segment elevatiom
Abnormal Q wave
The patient has clinical manifestations of coronary ischemia, but ECG and cardiac biomarkers show no evidence of acute MI.
Unstable angina
The patient has ECG evidence of acute MI with characteristic changes in two contiguous leads on a 12-lead ECG. In this type of MI, there is a significant damage to the myocardium
STEMI
The patient has elevated cardiac biomarkers (e.g., troponin) but no definite ECG evidence of acute MI. In this type of MI, there may be less damage to the myocardium.
NSTEMI
is used to evaluate ventricular function. It may be used to assist in diagnosing an MI, especially when the ECG is nondiagnostic
Echocardiogram
a protein found in myocardial cells, regulates the myocardial contractile process
Troponin
Cardiac enzymes and biomarkers, which include…are used to diagnose an acute MI
Troponin
Creatine kinase
Myoglobin
can detect hypokinetic and akinetic wall motion and can determine the ejection fraction
Echocardiogram
There are three CK isoenzymes
CK-MM (skeletal muscle), CK-MB (heart muscle), and CK-BB (brain tissue
is the cardiac-specific isoenzyme; it is found mainly in cardiac cells and therefore increases when there has been damage to these cells
CK-MB
is a heme protein that helps transport oxygen. Like the CK-MB enzyme, it is found in cardiac and skeletal muscle
Myoglobin
Medical mgt
MONA
PCI
Thrombolytics
The procedure is used to open the occluded coronary artery and promote reperfusion to the area that has been deprived of oxygen.
PCI
is initiated when primary PCI is not available or the transport time to a PCI-capable hospital is too long
Thrombolytic therapy
Inpatient mgt
Aspirin, Ace inhibitor
is an important continuing care program for patients with CAD that targets risk reduction by providing patient and family education, offering individual and group support, and encouraging physical activity and physical conditioning
Cardiac rehabilitation
Nsg interventions
Relieve pain
Improve respiratory function
Promote adequate tissue perfusion
Reducing anxiety
