Myocardial Infarction

Question 1

When does acute coronary syndrome occur

Answer 1

when the heart tissue endures prolonged ischemia without recovery

Question 2

How is acute coronary syndrome classified

Answer 2

STEMI or nonSTEMI

Question 3

STEMI heart attack

Answer 3

elevated ST, damage goes through the entire cardiac wall

Question 4

nonSTEMI heart attack

Answer 4

depressed ST, damage does not go through the entire cardiac wall (subendocardial)

Question 5

When does myocardial infarction begin

Answer 5

with coronary artery atherosclerosis with causes obstruction then ischemia

Question 6

What are the ways an obstruction can occur

Answer 6

ruptured plaque attracts platelets, which then forms a thrombus

Question 7

What can result if coronary artery blood supply remains constant but myocardial demands increase

Answer 7

severe hypertension, left ventricular hypertrophy

Question 8

Risk factors

Answer 8

atherosclerosis, hyperlipidemia, diabetes, hypertension, smoking, family history

Question 9

What is the extent of damage influenced by

Answer 9

location/level of occlusion in coronary artery, length of time the coronary artery is occluded, and heart’s availability of collateral circulation

Question 10

Womens s/s

Answer 10

SOB, sweating, nausea, vomiting, ingestion, panic/anxiety

Question 11

Diagnostic tests

Answer 11

ECG, blood tests, echocardiogram, coronary angiography

Question 12

Blood tests

Answer 12

CPK-MB fraction, troponin 1

Question 13

Why are blood tests used

Answer 13

when heart cells die, intracellular contents spill into the bloodstream

Question 14

Troponin 1

Answer 14

a cardiac protein highly specific for cardiac muscle necrosis released only when myocardial cell death has occured

Question 15

When does troponin increase

Answer 15

cell death

Question 16

Echocardiogram

Answer 16

identifies what portion of the heart has been affected by the MI, identify abnormal wall motion/contractile dysfunction

Question 17

Primary goal of treatment

Answer 17

re-establish blood flow to the heart muscle and minimize damage

Question 18

What can be taken at the start of chest pain

Answer 18

antiplatelet agent (aspirin)

Question 19

What does morphine do

Answer 19

pain relief, anxiety relief, improve gas exchange

Question 20

Treatment options

Answer 20

antiplatelet agent, nitrates, morphine, thrombolytic medicine, beta-blockers, heparin, PTCA/CABG

Question 21

Drug eluting stent

Answer 21

a polymer coating over the mesh, that emits a drug over time to help keep the blockage from coming back, stay slippery to prevent cells from getting stuck

Question 22

Complications

Answer 22

dysrhythmias, papillary muscle rupture, thromboembolism, ventricular rupture, pericarditis, heart failure, cardiogenic shock

Question 23

What happens if the cardiac muscle loses blood supply and electrical pathways are disrupted

Answer 23

the precise electrical pathways become interrupted because infarcted tissues no longer conduct

Question 24

What complications can arise from disruption in electrical pathways

Answer 24

fatal dysrhythmias, ventricular tachycardia, ventricular fibrillation

Question 25

What does slowing/blocking of impulses cause

Answer 25

some impulses to change direction, disrupt conduction, and the cardiac tissue to fire inappropriately

Question 26

Follow-up

Answer 26

cardiac stress testing, cardiac rehabilitation, nutrition consultation, routine cardiologist visits