Emergency Myocardial Infarction Flashcards by Brina Quintanilla Reyes

What is the patho behind myocardial infarction ?

Like all heart muscles, we need oxygen and blood to be able to perfuse the heart. However, in myocardial infarction, there was some blockage in one or more of these oxygen tubes called the coronary arteries. So in essence the heart suffocates to death.

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How many heart cells die per minute?

500 heart cells

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what are some causes or risk factors that can cause a myocardial infarction?
remember the anagram that was given in the simple nursing video

S - stress, stimulates (caffeine, amphetamines), smoking
O - obesity (BMI over 25)
D - diabetes & HTN
D - diet ( high cholesterol ) atherosclerosis
A - African American male, age over 50

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If the heart does not receive enough oxygen or blood within 45 minutes, what happens to the cells?
- this is according to the simple nursing video however I vividly remember that you only have 20mins to reperfuse everything before it becomes necrosis (dead completely)

necrosis and will not regenerate

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The narrowing is characterized by ischemic heart disease, which means what?

low oxygen due to the coronary arteries being narrowed down from either of the previous risk factors

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narrowing comes in 3 forms, small, medium, and large! what are the first, second,d and third of these narrowings actually called or are considered as by medical terms
- this is from the simple nursing video

small
- coronary artery disease
- stable angina

medium
- unstable angina ( UNSAFE )

large
- myocardial infarction

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what are some signs and symptoms for myocardial infarction?

sudden, crushing, radiating, heavy pressure

substernal chest pain
jaw pain
left arm pain
mid back/shoulder pain
heartburn ( epigastric )

shortness of breath
dyspnea
labored breathing
nausea and vomiting - abdominal pain
diaphoresis
cool and pale skin
anxiety - impending doom

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diabetic patients and women typically are the ones who go undiagnosed for a myocardial infarction due to what reasons?

Diabetic patients will not feel a myocardial infarction due to their neuropathy - meaning they will not feel the key signs and symptoms

Women typically have a higher pain tolerance and will tough it out before realizing the situation they are in

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what are diagnostic studies for a myocardial infarction?
- what is the first thing you are going to order for these patients if they come in with chest pain
- what’s the gold standard diagnostic studies?

EKG
- ST elevation ( means no O2) (STEMI)
- ST depression ( means low O2) T-wave inversion (NSTEMI)

Troponin levels & Trauma
CK, CKMB, CRP, Myoglobin

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What is the ABC’s for a patient who has a myocardial infarction, simple nursing considers it the ABC’s of MI surgery.

angioplasty - visual or place a stent for the blockage (PCI)

Bypass cabbage - go around server blockage using a piece of vein or another artery

Cut out the fatty blockage ( endarterectomy ) - literally cut out the blockage

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Some other forms of treating a myocardial infarction are using what type of heavy medications?

why do you think this is not the first line of treatment?

what are some common examples of thrombolytic?

thrombolytics

do the risk of massive bleeding and we really need an in-depth history of what the patient is currently taking and has for diseases

TPA (aminolase) & Streptokinase

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if the patient comes in with all the signs and symptoms of myocardial infarction, however when we collect a diagnostic test of troponin levels and it comes back negative, meaning no increase in troponin, what would be the next step for us to do to see what is going on ?

stress test - exercise (treadmill) or chemical (dye)

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what are the 3 S’s when it comes to stress test regarding the exercise version ?

Stress test
Stop the test if change pain occurs
St changes - looking for the st elevation that would indicate some form of blockage

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the chemical stress test is a test where we inject a dye that goes into the heart to detect for any blockage or narrowing. What are we going to tell a patient before doing this chemical stress test ? (6)
( think of like medications too, there are 4 )

how long are they going to be NPO for when it comes to the test? remember its before and after the test too

Stop 24-48 hours before
- cigarettes, caffeine ( tea,soda, coffee)
- no decaf
Medications - nitro,beta blockers
Theophylline ( stimulant )
NPO 4 before and after the test
Metformin avoiding

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What is the anagram to help remember of what we are going to do now (STAT) when it comes to a patient with myocardial infarction?

MONA
morphine (4)
oxygen (1)
nitroglycerin (3)
aspirin (2)

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what are big things to remember when it comes to nitroglycerin?
What do we not take with it ?
How much can we take it before going to the hospital?
How do we take it? ( method of administration ) - why do we take it like this ?
What are 2 side effects that we need to watch out for?

No viagra - medications ending with -afil or sildenafil

3 doses max - 5minutes apart

No swallowing, its Sublingiul, under the tongue- cause of we swallow it the first bypass in the liver will not absorb it

Hypotension and headache, so we want to sit down and avoid the risk of falling over

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what are the big things to remember when it comes to morphine administration to patients with myocardial infarction?

Any PAIN after morphine = bad!

More pain = More tissue death

remember morphine is supposed to alleviate the pain that is occurring from the myocardial infarction however if that does not help then something is going on more - typically an MI

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After MONA, the immediate action regarding myocardial infarction what is the next step to do when we confirm the myocardial infarction?

Send them over to the Cath lab or give Clot buster medications

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What is the exact Cath Lab procedure?

PCI - percutaneous coronary intervention

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what is the difference between an angioplasty vs angiogram?

angioplasty is the actual procedure where they go in and place either a stent or balloon in the arties to open up

angiogram is where they inject a dye and see with images where the clot is at

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before a patient get an angioplasty or an angiogram, they are going to be NPO for at least how long ?

after the procedure is done, what do we recommend patients to do?

6-12 hours before the procedure

they will lie flat drink plenty of fluids to aid with removing the dye out of the system

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what are some post-operative instructions we give to patients after surgery?

no heavy lifting
no baths or soaking wounds
prevent infection - monitor redness,warmth, drainage, odor

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remember contrast kills the kidneys!!!
what are the ABCC’s to remember when it comes to taking care of a patient who is going under a procedure with the dye for MI?

a- allergy to iodine ( flushing is normal )
b - bleeding
c - creatinine kidney ( normal is 0.9-1.2 )
c - cant palpate a pulse

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what do we do for a patient if we find bleeding at the cath site?

direct or manual pressure ( on or above the site )

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what are some things we are going to avoid doing for a patient who had bleeding at the cath site? remember the medications (4) after how long from the procedure we cant give these

we are going to be having them supine, so no semi-fowers or anything, or crossing the legs ( if any other position or crossing the legs, can increase the workload of the heart to pump blood and push blood out of the cath site ) no heparin, aspirin, warfarin, or clopidogrel for 6 hours after the procedure

Remember the contrast kills the kidney, what is the normal range for a kidney for creatinine? what is a medication we can give to help protect the kidneys from the heavy dye?

0.9-1.2 anything over 1.3 is kidney damage or urine 30ml/hr or less! mucomyst ( acetylcysteine )

the last or 4th C when it comes to the contrast in these procedures is the inability to palpate a pulse, what is the first thing we are going to do? it is normal to have diminished pulses fro how long after the procedure ? what are some things we can see for a lack of a pulse?

call the doctor if you can not feel a pedal pulse! 4-12hours MAX, nothing longer than that cold and clammy feet

the simple nursing video provides a great coverage of what to worry about when giving thrombolytic. what is the biggest risk that we have? how long is the risk for? what 2 things we will not do? how do we administer this medication? how often do we administer this medication?

bleeding risk 8 hour window that this medication is working for no injections or give through a central line we administer through an IV ( the reason why we give through IV is because we can hold pressure at the site to avoid further bleeding ) we only administer it once

some additional information regarding thrombolytics is it safe to give a thrombolytic to a menstruating female? is it safe to give to someone who has a history of arteriovenous malformation?

yes it is safe no, never give

after the immediate interventions, after the procedure, what is the recovery period going to look like? we are going to do 2 big things

prevent/stabilize clots with heparin IV give the heart some rest - nitro IV drip, beta-blockers, Calcium channel blockers

what does heparin do? what is the risk ? what is the PTT therapeutic range? antidote for heparin?

they help prevent clots risk for bleeding PTT 46-70 protamine sulfate

what are the major complications after a myocardial infarction? (3)

cardiogenic shock dysrhythmias - v fib or v-tach heart failure

what is cardiogenic shock? what are some signs and symptoms to look out for? what is the treatment?

severe low blood pressure - low cardiac output - agitation, confusion - cold and clammy - low urine output treatment - pump fluids into the 2 large bore IV's - epi or dopamine

dysrhythmias are a fetal complication that can occur with a patient who has had a myocardial infarction. - Vfib or Vtac what are some things we can do to aid a patient who is having dysrhythmias? (2)

Defibrillate before CPR Don't have a pulse do not synchronize Cardioversion Count a pulse and synchronize

typically we are going to need to do a defibrillate and cpr for a patient who is going into what form of dysrhythmia?

VFIB

what is a cardioversion?

its a small shock that given to the body when there is a pulse and we can synchronize with it to go back to normal - typically we see this for patients who have Vtach

heart failure is a common complication that can happen and be chronic unlikely the acute cardiogenic shock or dysrhythmias. - what are some common signs and symptoms we should tell patients to report when they are going home on recovery after a myocardial infarction? (4) what is the number one treatment for heart failure? think of medication-wise

rapid weight gain worsening crackles sudden edema or JVD new S3 heart sound diuretics - furosemide

additional two complications that can occur as well, not as common but very deadly are what?

pericarditis, pericardial effusion and then cardiac tamponade mitral valve prolapse

pericarditis, pericardial effusion and then cardiac tamponade - this is the order on how it leads to cardiac tamponade explain the patho to me behind this

so after a heart attack, the heart is more than likely going to be very inflamed and irriatited, which can lead to that inflammation of the pericardium around the heart. after some time, the blood and fluid can push onto the heart and fill up it leading to that effusion- somethings we can even heart a muffle heart sound, but once we start hearing muffled heart sounds we are in cardiac tamponde, in essnese, the heart is drowning in fluid and blood and we have to do a pericenteisis

what is the anagram to help remember when it comes to cardiac tamponade?

B - big JVD E - extremely low blood pressure C - can't hear the heart sounds

what is the anagram to aid with the recovery and rest period we are going to educate our patient on when going home?

D - diet, low in sodium and fluids (2g/2l per day) R - reduce stress, alcohol, caffeine, cholesterol E - exercise (30min x 5 day ) S - smoking cessation S - Sex ( only after 2 flights of stairs with no SOB )

how often do we do weights for patients to help prevent heart failure after a MI?

daily weights

what is the limit of fluids and salt that a patient after having an MI can have in a day?

2 grams or 2 liters or LESS!

what are some cholesterol heavy foods that we want our patients after an MI to avoid?

land animals, milk, cheese, extra

this is the cholesterol panel that we want to educate our patients on - total cholesterol = ___ bad - triglycerides = ____ bad - LDL = ____bad - HDL =____good

200 or more bad 150 or more bad 100 or more bad 40 or more good

how often should these individuals exercise?

30mins a day, for 5 times a week

when can a patient return having sex after an MI?

after climbing a flight of stairs, with no shortness of breath

What medications do we tell patients to avoid after an MI?

NSAIDS - ibuprofen - risk for clots

what 2 medications do we tell patients they should start taking or continue taking after an MI to prevent future myocardial infarctions?

Anti-platelet drugs - aspirin or clopiodgrel - BLEEDING RISK cholesterol lowering medications - Lovastatin " stay clean " - LIVER TOXIC! - avoid grapefruit juice!

Now the following flashcards are going to be on the study guide that freshi wrote back in 410 talking about myocardial infarction - I'm simply going to add questions that have not be discussed over from the simple nursing video

What does an EKG mean?

the electrical conduct that is currently being sent to the heart

What is a STEMI on a EKG? What is a NSTEMI on a EKG?

ST elevations T wave inversions

how long do you have to take someone who is having a STEMI over to the PCI lab? how long do you have to take someone who is having a NSTEMI over to the PCI lab?

90mins 12 hours - 72 hours

According to brooks notes from last year, myocardial infarctions takes a while, like hours to a few days to evolve. Ischemia starts off from the inner to the outer layers of the heart an overtime slowly start to go into necrosis.

when does the pain often occur for patients who are having a myocardial infarction? like at what point in the day and for how long?

early morning last for like 20minutes

how long does it usually take for the heart to somewhat fully heal?

6 weeks

if pericarditis occurs, what is the treatment of choice?

high dose aspirin

if a PCI lab is not in the hospital and the patient is having a STEMI. remember they only have 90mins to get into the lab, that 90mins turn into ___minutes for transportation to a lab

120mins

what is our major concern when it comes to MI what is our major complication when it comes to thrombolytics?

reocclusive - so prevent that with IV heparin bleeding

the following flashcards are going to be from the NCLEX book mainly on the medication part

what is an anti-platelet?

they inhibit the aggregation of platelets in the clotting process, thereby prolonging the bleeding time

can you give an anti-platelet with anti-coagulants together?

yes

what are side effects of antiplatelets?

bruising hematuria gi bleeding tarry stools

should anti-platelet be taken with food?

yes to avoid that GI bleeding

what are two common anti-platelet medications?

aspirin clopidogrel

what is ACE inhibitors ?

ace inhibitors prevent peripheral vasoconstriction by blocking conversion of angitension 1 to angiotenstion 2

what do ACE inhibitors end with?

pril

what should we tell patients who are taking ACE inhibitors to avoid?

potassium supplements and potassium-retaining diuretics

what are common side effects of ACE inhibitors? (5)

persistent dry cough hyperkalemia hypoglycemic effect diminished taste bruising

if the patient is to discontinue the medication, we should educate them on what?

rebound hypertension can occur

what are anti-anginal medications function?

produce vasodilation, decrease preload and afterload and reduce myocaridal oxygen consumption - these are known as nitrates

Nitrates or anti-anginal medications are contraindicated in those who are taking what form of medications?

erectile dysfunction medications - additional information ICP, Severe hypotension, severe anemia

what are some side effects of nitrates?

hypotensiopn headache flushing or pallor reflex tachycardia

when taking a nitrate what should the patient do to avoid a fall risk? how often can they take it, with a max dose of? when do they call 911 for unrelieved pain?

sit down before taking it 3 doses for 5 mins each 2nd dose

what is the function of calcium channel blockers?

decrease cardiac contractility and the workload of the heart thus increasing the need for oxygen

what are some major side effects of calcium channel blockers? (5)

bradycardia hypotension peripheral edema flushing of the skin liver and kidney damage

what do calcium channel blockers end in?

-pine

what is the function of anti-dysrhythmics?

medications suppress dysrhythmias by inhibiting abnormal pathways of electrical conduction through the heart

anti-ilipemic medications functions are for what?

reduce serum levels of cholesterol

what is the major complication of statins? ^

rhabdomyolsis - muscle pain and cramping

I include, warfarin, heparin, Lovenox and beta blockers in another flashcard group to make it easier to focus on

the following flashcards are going to be on the actual textbook definition

What side of the heart do most myocardial infarctions affect?

left ventricle

the degree of collateral circulation influences what? why do you think that is?

severity of the myocardial infarction - not everyone develops this collateral circulation, a patient who has a long history of coronary artery disease might have plenty of collateral circulation to provide the tissue with adequate blood supply - this is why someone who is young and doesn't have that collateral circulation might have a worse outcome of MI

patients with an myocaridal infarction might have a fever that can last for 4-5 days even after an MI due to what reason?

systemic inflammatory process caused by the death of myocardial cells

typically when the patient is healing after an MI, they go through a phase called ventricular remodeling, this is where what? typically we want to avoid this only because of the risk of heart failure occurring, so we usually give what medications?

this is where the LV typically will hypertrophy and dilate In order to compensate for the damaged muscle ACE inhibitors

what do serum cardiac biomarkers stand for?

they are proteins that are released into the blood from necrotic heart muscle after an MI

we may need to give stool softeners to these patients, like colace, so we can prevent the valsalva maneuver. why do want to prevent this?

causes bradycardia and puts you at high risk of developing a dysrhythmia