Myocardial infarction Mike Flashcards
MI Risk factors general
- Older age
- genetics
- male sex
- hypertension
- obesity
- lack of exercise
- diabetes
- smoking
Mike risk factors MI
- Smoking
- genetics
- male sex
- atherosclerosis
- hyperlipidemia
General s+s for MI
- chest pain
- sweating
- nausea and vomiting
- shortness of breath
- anxiety
- pale
S+S mike during MI
- hot and sweaty
- chest pain
- ECG changes
S+S before MI
- chest pain
- pale face
- sore arm
- ringling sensation
MI patho
- 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
Potential effects on injured muscle cells
- # surrounding affected cells
- stunning: temp loss of contractility
- hibernation: prolonged loss of contractility
- remodeling: perm loss of contractility with hypertrophy
evaluation/tests done
- ECG
- blood tests
- aspirin
- GTN
- fentanyl/morphine
- oxygen
- thrombolysis
- PCI
complications with thrombolytic drug
- mike collapsed because heart went into ventricular fibrillation cardiac arrest
- was defibrillated
- later developed atrial fibrillation
MI management
- 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
What is PCI
- use of coronary angiograms to visualise and assess damage of coronary ischemia
- once problem located angioplasty preformed to open affected vessels
how angiogram work
- inject contrast agent into blood stream
= make blood vessels around heart visible on x-ray
what did mike angiogram show
- stenosis and thrombosis in right coronary artery
= went right coronary artery angioplasty
what is angioplasty with stent
- 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
main medications after MI
- aspirin
- anti-coagulants
- beta blockers
- nitroglycerine
- cholesterol lowering meds
mikes main medications MI
- 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
what is a stemi
- Full thickness necrosis
- S-T segment elevation on ECG
what is Nstemi
Partial thickness necrosis
No S-T elevation on ECG
What MI classification did Mike experience
- stemi
What is ECG, how to use it
- 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
Mikes ECG MI
S-T elevation
Areas of S-T depression
= reflect damaged to ventricular walls of heart
What blood tests should be done
Cardiac enzyme
Blood count
Blood lipids
Troponin
What were Mikes blood test results
-Elevated troponin T levels = myocardial necrosis
-Elevated triglyceride levels
-Decreased HDL
-Higher cholesterol/HDL ration
Stable vs unstable angina
stable
- pattern predictable
unstable
- no pattern
- dangerous
what is angina
type of chest pain caused by reduced blood flow to heart
