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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
Q

How to recognize an AMI on an ECG

A
  • *Know what to look for: *ST elevation > 1 mm
  • Know where to look: Buddy leads (must be in more than one lead)
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26
Q

On a 12-lead ECG, What does a tall or inverted T wave indicate?

A

Ischemia

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27
Q

*On a 12-lead ECG, What does an elevated ST segment indicate?

A
  • Injury of myocardial cells
28
Q

On a 12-lead ECG, What does an abnormal Q wave, elevated ST segment, and inverted T wave indicate?

A

*Infarction = An involving MI
(Has ischemia - tall/inverted T wave, injury - elevated ST, and infarction - abnormal Q, elevated ST, & inverted T)

29
Q

What indicates an abnormal Q wave?

A

More than 1 block wide and more than 1 block deep

30
Q

Goals of treatment for a MI

A

*Limit infarct size
*Reprofuse ischemic / injured area
*Prevent/treat complications
Provide emotional support and education

31
Q

What is the first priority for a pt with a MI?

A

*Eliminate pain b/c don’t want to stimulate SNS

32
Q

Go-to opiate for MI

A

Morphine sulfate

33
Q

Actions of morphine sulfate

A

Decreases pain of ischemia
Decreases extension of ischemia (by decreasing O2 demands)
Decreases anxiety

34
Q

Indications for morphine sulfate

A

*STEMI
*Consider in NSTE-ACS
- Evidence of *acute pulmonary edema
- Systolic BP >90mm Hg

35
Q

Precautions of morphine sulfate

A
  • Drop in BP
  • Depression of ventilation
  • N/V (common) (Zofran often prescribed with)
  • Bradycardia
36
Q

Actions of nitroglycerin

A
  • 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
Q

Indications for nitroglycerin

A

(Not routinely administered)
- Suspected ischemic chest pain
- Unstable angina (change in angina pattern)
- Acute pulmonary edema (if BP >90 systolic)

38
Q

Nitroglycerin precautions
Nitroglycerin side effects

A

*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
Q

Type of med that pts who have had a STEMI should discontinue forever

A

All NSAIDs except aspirin are to be discontinued forever

40
Q

When should O2 be used to tx MI?

A

Only if sat is <94% or if indications of hypoxia
Give 3-5 mL/min

41
Q

When should aspirin be given during an MI?

A

Everyone gets aspirin except pts with an ASA allergy, right away

42
Q

Actions of aspirin

Functions of aspirin

A

Blocks formation of thromboxane A2

Reduces:
- overall mortality from AMI
- nonfatal reinfarction
- nonfatal stroke

43
Q

Dose of aspirin for MI

A

160 - 325 mg
2-4 baby aspirin tablets chewed

44
Q

Precautions for aspirin

A

PUD or asthma
Bleeding disorders
Severe hepatic disease

45
Q

When is fibrinolytic therapy indicated?

A

*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
Q

Action of fibrinolytic therapy

A

Breaks up fibrin network that binds clots

47
Q

Door to drug time if using a fibrinolytic

A

30 mins

48
Q

Suffix of fibrinolytic therapy drugs

A

-plase or -ase

49
Q

Indications for heparin

A
  • *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
Q

Mechanism of action of heparin

A

Indirect thrombin inhibitor (with AT III)

51
Q

Gold standard for treatment of STEMI

A

percutaneous transluminal coronary angioplasty (PCI or PTCA) - balloon followed by stent placement

52
Q

Door to PCI time

A

*90 min
*(If transfer required - 120 min)

53
Q

PTCA indications

A

*STEMI
* NSTEMI
* UA

54
Q

*Nursing actions for PTCA preprocedure

A
  • informed consent
  • shave prep
  • IV
  • Teaching
  • *Allergies (shellfish/iodine)
55
Q

*Nursing actions for PTCA post procedure

A
  • 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
Q

Indications for Antiplatelet agents (GPIIBIIIA Inhibitors)

A

ACS
Unstable angina managed medically
UA undergoing PCI

57
Q

Class for Clopidogrel (Plavix)

A

Antiplatelet

58
Q

Actions of *Clopidogrel (Plavix)

A

*Keeps clots from forming or getting bigger
- inhibits platelet aggregation
- prolongs bleeding time

59
Q

Nursing considerations for Plavix

A

*Watch for bleeding, esp when giving with NSAIDs, ASA, Heparin, or Coumadin

60
Q

Indications for Plavix

A

*Pt will remain on plavix post-procedure
- With or without lytics for 14 days
- With or without reperfusion
- STEMI - give for 1 year

61
Q

Indications for beta blockers

A

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
Q

*Absolute contraindications of beta blockers

A

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
Q

Indications for ACE inhibitors

A

*Given indefinitely post MI (b/c prevent abnormal myocyte remodeling)

64
Q

*Secondary prevention strategies

& other post MI meds

A

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
Q

When is a Coronary Artery Bypass Graft (CABG) performed?

A

> 50% occlusion of LCA
Triple vessel disease
Chronic angina refractory to other treatment
Unstable angina
LVF
Lesions not amenable to PCI
PCI failure

66
Q

Most common post surgical complication

A

Dysrhythmias (usually resolve with no or very little tx as heart heals)

Critical Care (35 decks)

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