myocardial infarction

Question 1

myocardial infarction
- risk factors
- diagnostics
- clinical manifestations
- complications
- educations
- medications

Question 2

what is a myocardial infarction?

Answer 2

a sudden stoppage of blood flow through a coronary artery with a thrombus caused by platelet aggregation causing irreversible myocardial cell death ( necrosis )

Question 3

cardiac ischemia often leads to myocardial infarction how and why ?

Answer 3

ischemia is the beginning phase in which blood flow suddenly and slowly stops reaching an area in the body

the reason why this leads to myocardial infarction is because it takes time for that ischemia to become necrosis, dead and lack of oxygen tissue.

Question 4

infarction does not occur instantly but however ?

Answer 4

evolves over several hours

Question 5

there are two forms of myocardial infarction, what are the names?

Answer 5

stemi
nstemi

Question 6

which one do you think is worse
stemi or nstemi and why?

Answer 6

stemi
- occlusive thrombus (clot)
- ST elevations

Question 7

nstemi is still just as bad however we have what?

Answer 7

12-72 hours to reverse it and it isn’t a blood clot

Question 8

how long do we have for a stemi for treatment with a PCI or thrombolytic medication?

Answer 8

90minutes

Question 9

what is super dangerous about myocardial infarction is the fact the heart cells in only have ___Minutes of life until damage is irreversible

if we fix it within the ___minutes, by repercussion, everything basically comes back on, like aerobic metabolism and contractility are restored and cells begin to repair themselves.

Answer 9

20minutes

Question 10

myocardial infarction Is often described by its ?

Answer 10

location

Question 11

typically myocardial infarction severity is determined and influenced by ___and why do you think that?

Answer 11

collateral circulation

( the body has so many side roads to try to get blood flow in, all these roads are getting blocked and you can only take so many )

Question 12

what are risk factors for patient with myocardial infarction?

Answer 12

artheosclerosis
coronary artery disease
obesity
hypertension
physical inactivity
impaired glucose tolerance

Question 13

what is the diagnostic study for a patient with myocardial infarction ? (3)

Answer 13

troponin level
electrocardiogram
myoglobin

Question 14

what does the electrocardiogram show for stemi ?

what about an nstemi?

Answer 14

St elevation

t wave inversion

Question 15

what is the clinical manifestation for a patient with a myocardial infarction?

Answer 15

crushing pain that radiates left arm/substernal up to jaw causing dizziness, shortness of breath, nausea, sweating

Question 16

its important to note that if a patient is diabetic and could be having an myocardial infarction but they dont feel it, why do you think this patient may not feel it ?

Answer 16

cardiac neuropathy from the diabetes

Question 17

troponin levels rises within __hours and remains elevated for _-_days

Answer 17

3 hours
7-10 days

Question 18

why do you think we use myoglobin to diagnose myocardial infarction?

Answer 18

because myoglobin will increase within 2 hours after cell death = rapid decline in the level after 7 hours

Question 19

what is the cardiovascular response when a patient is having a myocardial infarction?

Answer 19

increase heart rate and blood pressure
then decrease blood pressure, urinary output

crackles

jugular venous distention, liver enlargement, peripheral edema

murmurs

Question 20

why do you think a patient with a myocardial infarction will have a fever of 100.4 ?

Answer 20

its a systemic inflammatory process that occurs when the heart cells die

Question 21

another big clinical manifestion I forgot to mention is that patients will feel this what?

Answer 21

impending doom!

Question 22

most of the time patients pain will be in the morning and will take a nitoglycerin to help, however It will last longer than 30minutes, so patients need to be send over to the ED and be evaluated !

Question 23

what are some major complications of myocardial infarction?

Answer 23

• dysrhythmias
• heart failure
• pulmonary edema
• pericarditis
• cardiogenic shock

Question 24

what would be interventions to help for a patient in myocardial infarction?

Answer 24

oxygen
nitroglycerin
morphine
upright position
2 large bore ivs
12 lead ECG

Question 25

so we understand that we are going to need to give the patient an emergency PCI - pretty much an access site in the heart to open it up and stop that heart blocking however the secondary form of treatment if pci is not done, for a patient with a stemi is what?

Answer 25

thrombolitc therapy

Question 26

what would be contraindications for patients with thrombolitc therapy?

Answer 26

anticoagulant hemorrhagic stroke perforated ulcer bleeding

Question 27

our main concern after treating a patient with myocardial infarction is the reocclusion of the heart so our goal is to give them what?

Answer 27

IV heparin and give anticogulant like warfarin to take him - remember take both at the same time cause warfarin takes time to work

Question 28

cardiac rehab - process of actively assisting the client with cardiac disease to achieve and maintain a vital and productive life within the limitations of the heart disease

Question 29

if a patient wants to return with sexual activity - erectile dysfunction drugs are contraindicated when takings nitrates if that is an issue also if you can handle a flight of stairs and dont feel out of breath, you may have intercourse