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Critical Care > Myocardial Infarction > Flashcards

Myocardial Infarction Flashcards

1
Q

Description of a MI

A
  • Myocardium abruptly & severely deprived of O2
  • Blood flow decreased by 80-90% (no sx before this) causes ischemia which causes necrosis if blood flow not restored
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2
Q

Which part(s) of the heart does the left anterior descending artery supply?

A

Anterior left ventricle
Septum

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3
Q

Which part(s) of the heart does the right coronary artery supply?

A

Inferior left ventricle
Right ventricle

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4
Q

Which part(s) of the left circumflex artery supply?

A

Lateral left ventricle
Posterior left ventricle

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5
Q

Where is the left main artery?

A

At the top of the heart = very bad
Aka widow maker

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6
Q

What is collateral blood flow?

A

Vessels that are developed around a blockage if it builds up over time

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7
Q

Nonmodifiable risk factors for atherosclerosis

A

Age
Gender
Family history
Ethnicity

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8
Q

Modifiable risk factors for atherosclerosis

A

Smoking (2x risk)
Sedentary
Stress
Obesity
Elevated cholesterol
HTN
Homocysteine
C-reactive protein

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9
Q

What are homocysteine and C-reactive protein?

A

Predictive inflammatory markers (esp C-reactive protein)
Tell if there’s an inflammatory process going on in the body

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10
Q

Initial assessment of pt with chest pain (w/in 1st 10 min of arrival)

A

VS (& pain scale)
ECG
Cardiac enzymes (troponin)
Electrolytes (BUN, creatinine, etc)
Coag studies
CBC
H&P (history & physical: very focused on cardiac)
CXR (w/in 1st 30 min)

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11
Q

*Cardiac presentation of pain or discomfort

A

Precipitating factors: occurs without cause, early morning, or middle of night
Quality: pain, tightness, pressure, discomfort (may feel like heartburn)
Region/radiation: chest, shoulders, arms, neck, back, jaw, upper abdomen, sub sternal
Severity: scale; not necessarily severe
Timing/treatment: lasts >20 min; relieved by opioids
(If lasts <20 min, usually angina)

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12
Q

Most commonly associated S/S of cardiac pain

A

N/V
SOB
Diaphoresis
Dizziness
Weakness
Fatigue
Feeling of doom
Syncope
Elevated temp
Elevated BP
Denial

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13
Q

Most common associated S/S of cardiac pain in women

A

N/V
SOB
Fatigue

Also could have sleep disturbance

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14
Q

Other ways cardiac pain could present:

A

Pain that is:
Vague ache
Poorly localized
Absent

Sleep disturbance
Back pain
Unexplained fall
Acute delirium

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15
Q

Similarities between Angina and MI cues

A

Both have sub sternal pain radiating to jaw, neck, ear, and left arm

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16
Q

Differences between angina and MI cues

A

Angina lasts < 15 min - MI lasts > 20 min
Angina precipitated by activity - MI occurs w/o cause
Angina relieved by rest/NTG - MI relieved by opioids
Angina has few associated S/S - MI has frequent associated symptoms

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17
Q

What is the gold standard for diagnosing an MI?

A

*Troponin I

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18
Q

Normal value of troponin I

A

<1.5 ng/ml

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19
Q

Requirements to use fibrinolysis on a pt with MI

A
  • EKG with *Significant ST segment elevation
  • *Ongoing chest discomfort: >20 min & < 12 hrs (not helpful if out of this time frame)
  • *BP <180/110
  • *No use of anticoagulants
  • no hx of stroke or TIA, bleeding issues, surgery/trauma in past 3 wks, terminal illness, liver or kidney issues
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20
Q

3 things we look for to classify patients with acute ischemic chest pain

A

Significant ST elevation
ST depression or dynamic T wave inversion
Non diagnostic ECG, or absent of changes

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21
Q

If pt having significant ST elevation:

A

Strongly suspicious for injury
= *ST elevation AMI

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22
Q

If pt having ST depression or dynamic T wave inversion:

A

Strongly suspicious for ischemia
= *High-risk unstable angina / non-ST elevation ACS

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23
Q

If pt has nondiagnostic ECG or absences of changes in ST segment or T waves:

A

Intermediate / low risk unstable angina

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24
Q

Where is the J point located on an ECK?

A

Where the QRS meets the ST segment

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25
How to recognize an AMI on an ECG
- *Know what to look for: *ST elevation > 1 mm - *Know where to look: Buddy leads (*must be in more than one lead)
26
On a 12-lead ECG, What does a tall or inverted T wave indicate?
Ischemia
27
*On a 12-lead ECG, What does an elevated ST segment indicate?
* Injury of myocardial cells
28
On a 12-lead ECG, What does an abnormal Q wave, elevated ST segment, and inverted T wave indicate?
*Infarction = An involving MI (Has ischemia - tall/inverted T wave, injury - elevated ST, and infarction - abnormal Q, elevated ST, & inverted T)
29
What indicates an abnormal Q wave?
More than 1 block wide and more than 1 block deep
30
Goals of treatment for a MI
*Limit infarct size *Reprofuse ischemic / injured area *Prevent/treat complications Provide emotional support and education
31
What is the first priority for a pt with a MI?
*Eliminate pain b/c don’t want to stimulate SNS
32
Go-to opiate for MI
Morphine sulfate
33
Actions of morphine sulfate
Decreases pain of ischemia Decreases extension of ischemia (by decreasing O2 demands) Decreases anxiety
34
Indications for morphine sulfate
*STEMI *Consider in NSTE-ACS - Evidence of *acute pulmonary edema - Systolic BP >90mm Hg
35
Precautions of morphine sulfate
- Drop in BP * Depression of ventilation * N/V (common) (Zofran often prescribed with) * Bradycardia
36
Actions of nitroglycerin
- increase venous dilation - dilate coronary arteries - decrease pain of ischemia - decrease venous blood return to heart - decrease preload & cardiac O2 consumption - increase cardiac collateral flow
37
Indications for nitroglycerin
(Not routinely administered) - Suspected ischemic chest pain - Unstable angina (change in angina pattern) - Acute pulmonary edema (if BP >90 systolic)
38
Nitroglycerin precautions Nitroglycerin side effects
*Extreme caution if systolic BP <90 mm Hg - Extreme caution in RV infarction *Patient in sitting/lying during administration Side effects: - Watch for HA, decreased BP, syncope, tachycardia
39
Type of med that pts who have had a STEMI should discontinue forever
All NSAIDs except aspirin are to be discontinued forever
40
When should O2 be used to tx MI?
Only if sat is <94% or if indications of hypoxia Give 3-5 mL/min
41
When should aspirin be given during an MI?
Everyone gets aspirin except pts with an ASA allergy, right away
42
Actions of aspirin Functions of aspirin
Blocks formation of thromboxane A2 Reduces: - overall mortality from AMI - nonfatal reinfarction - nonfatal stroke
43
Dose of aspirin for MI
160 - 325 mg 2-4 baby aspirin tablets chewed
44
Precautions for aspirin
PUD or asthma Bleeding disorders Severe hepatic disease
45
When is fibrinolytic therapy indicated?
*Only for STEMI when balloon and stent (PCI) not available Time must be *> 20 min and < 12 hr Patients <75 b/c risk of *death from brain hemorrhage increases
46
Action of fibrinolytic therapy
Breaks up fibrin network that binds clots
47
Door to drug time if using a fibrinolytic
30 mins
48
Suffix of fibrinolytic therapy drugs
-plase or -ase
49
Indications for heparin
- *PTCA or CABG - with fibrin-specific *lytics X 48hrs (if longer than 48 hrs, use Lovenox) - *STEMI with/without reperfusion up to 8 days
50
Mechanism of action of heparin
Indirect thrombin inhibitor (with AT III)
51
Gold standard for treatment of STEMI
percutaneous transluminal coronary angioplasty (PCI or PTCA) - balloon followed by stent placement
52
Door to PCI time
*90 min *(If transfer required - 120 min)
53
PTCA indications
*STEMI * NSTEMI * UA
54
*Nursing actions for PTCA preprocedure
- informed consent - shave prep - IV - Teaching - *Allergies (shellfish/iodine)
55
*Nursing actions for PTCA post procedure
- Check site for *bleeding - VS - Cardiac rhythm - **Check for reocclusion (by looking for ST seg elevation) - *Circ checks to check for clots/occlusion - Dye reaction - Encourage *fluids to flush dye
56
Indications for Antiplatelet agents (GPIIBIIIA Inhibitors)
ACS Unstable angina managed medically UA undergoing PCI
57
Class for Clopidogrel (Plavix)
Antiplatelet
58
Actions of *Clopidogrel (Plavix)
*Keeps clots from forming or getting bigger - inhibits platelet aggregation - prolongs bleeding time
59
Nursing considerations for Plavix
*Watch for bleeding, esp when giving with NSAIDs, ASA, Heparin, or Coumadin
60
Indications for Plavix
*Pt will remain on plavix post-procedure - With or without lytics for 14 days - With or without reperfusion - STEMI - give for 1 year
61
Indications for beta blockers
STEMI or NSTEMI once stable, but not in early management (Beta blocker will be added w/in 12-24 hrs after MI and pt will be on it forever to reduce workload of heart)
62
*Absolute contraindications of beta blockers
Severe CHF/PE SBP <100 mm Hg Acute asthma (bronchospasm) 2nd or 3rd degree AV block (b/c SE of beta blockers is heart block)
63
Indications for ACE inhibitors
*Given indefinitely post MI (b/c prevent abnormal myocyte remodeling)
64
*Secondary prevention strategies & other post MI meds
Smoking cessation BP control LDL less than 100 Exercise 30 min x 7 day BMI 18-25% DM management (HA1C less than 7) ASA Plavix (long term) Coumadin (A fib) ACE inhibitors Beta blockers Aldosterone blockers
65
When is a Coronary Artery Bypass Graft (CABG) performed?
>50% occlusion of LCA Triple vessel disease Chronic angina refractory to other treatment Unstable angina LVF Lesions not amenable to PCI PCI failure
66
Most common post surgical complication
Dysrhythmias (usually resolve with no or very little tx as heart heals)

Critical Care (35 decks)

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