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Case studies > Myocardial infarction Mike > Flashcards

Myocardial infarction Mike Flashcards

1
Q

MI Risk factors general

A
  • Older age
  • genetics
  • male sex
  • hypertension
  • obesity
  • lack of exercise
  • diabetes
  • smoking
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2
Q

Mike risk factors MI

A
  • Smoking
  • genetics
  • male sex
  • atherosclerosis
  • hyperlipidemia
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3
Q

General s+s for MI

A
  • chest pain
  • sweating
  • nausea and vomiting
  • shortness of breath
  • anxiety
  • pale
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4
Q

S+S mike during MI

A
  • hot and sweaty
  • chest pain
  • ECG changes
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5
Q

S+S before MI

A
  • chest pain
  • pale face
  • sore arm
  • ringling sensation
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6
Q

MI patho

A
  • Blockage of coronary artery, likely associated with atherosclerosis
    = myocardial ischemia and hypoxia
    = myocardial necrosis = either subendocardial or transmural
    = breakdown of cell membrane = cardiac enzyme leakage into blood
    = contractile disfunction
    = heart failure
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7
Q

Potential effects on injured muscle cells

A
  • # surrounding affected cells
    1. stunning: temp loss of contractility
    2. hibernation: prolonged loss of contractility
    3. remodeling: perm loss of contractility with hypertrophy
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8
Q

evaluation/tests done

A
  • ECG
  • blood tests
  • aspirin
  • GTN
  • fentanyl/morphine
  • oxygen
  • thrombolysis
  • PCI
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9
Q

complications with thrombolytic drug

A
  • mike collapsed because heart went into ventricular fibrillation cardiac arrest
  • was defibrillated
  • later developed atrial fibrillation
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10
Q

MI management

A
  • decrease heart workload
  • increase oxygen delivery to body tissue
  • re-perfuse heart wall (PCI)
    M - morphine = relieve chest pain
    O - oxygen if below 92%
    N - nitroglycerin = reduce chest pain
    A - Aspirin = reduce risk of occlusion or re-occlusion of coronary artery
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11
Q

What is PCI

A
  • use of coronary angiograms to visualise and assess damage of coronary ischemia
  • once problem located angioplasty preformed to open affected vessels
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12
Q

how angiogram work

A
  • inject contrast agent into blood stream
    = make blood vessels around heart visible on x-ray
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13
Q

what did mike angiogram show

A
  • stenosis and thrombosis in right coronary artery
    = went right coronary artery angioplasty
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14
Q

what is angioplasty with stent

A
  • widens narrowed or obstructed artery
  • collapsed metal stent surround collapsed balloon is passed into vascular system using catheter
  • balloon positioned in narrowed area and inflated
    = squashes deposits causing narrowing and expands stent
    = opens blood vessels
  • balloon is deflated and removed
  • stent remains to keep artery open = allowing normal blood flow
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15
Q

main medications after MI

A
  • aspirin
  • anti-coagulants
  • beta blockers
  • nitroglycerine
  • cholesterol lowering meds
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16
Q

mikes main medications MI

A
  • aspirin = NSAID that prevents platelet aggregation
    = helps prevent blood clotting
  • clopidogrel = inhibits platelet activation and aggregation, prevents thrombosis after angioplasty
  • GTN spray = relaxes smooth muscle and decreases cardiac workload
  • Metoprolol = Beta blockers reduces heart rate, cardiac output and blood pressure though inhibition of catecholamines
  • Simvastatin = inhibits cholesterol synthesis to lower cholesterol
17
Q

what is a stemi

A
  • Full thickness necrosis
  • S-T segment elevation on ECG
18
Q

what is Nstemi

A

Partial thickness necrosis
No S-T elevation on ECG

19
Q

What MI classification did Mike experience

A
  • stemi
20
Q

What is ECG, how to use it

A
  • Measures electrical activity of heart
  • Ten electrodes placed on skin to measure 12 leads = record cardiac depolarization and repolarization throughout cardiac cycle from different directions
21
Q

Mikes ECG MI

A

S-T elevation
Areas of S-T depression
= reflect damaged to ventricular walls of heart

22
Q

What blood tests should be done

A

Cardiac enzyme
Blood count
Blood lipids
Troponin

23
Q

What were Mikes blood test results

A

-Elevated troponin T levels = myocardial necrosis
-Elevated triglyceride levels
-Decreased HDL
-Higher cholesterol/HDL ration

24
Q

Stable vs unstable angina

A

stable
- pattern predictable
unstable
- no pattern
- dangerous

25
Q

what is angina

A

type of chest pain caused by reduced blood flow to heart

Case studies (4 decks)

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