Acute Myocardial Infarction
Terms
undefined, object
copy deck
- If not a thrombolytic candidate, person may have:
-
*angioplasty (ask if allergic to iodine; check BUN/Cr because dye is nephrotoxic)
*stents
*Directional coronary atherectomy
*laser ablation
*bypass surgery - Successful reperfusion is evidenced by:
-
*EKG ST segment and T wave "back to normal"
*relief of chest pain
*presence of reperfusion dysrhythmias (PVC's)
*cardiac enzymes decrease - Once in ER (AMI)
-
*4 D's - door, data, decision, drug
*O2, ECG monitor, IV, draw labs, obtain 12 lead EKG
*tx pain with IV morphine (helps < afterload, cuts pain) - Emergency treatment of person experiencing AMI
-
*call 911
*chew an ASA (mortality <23%)
*most people experiencing AMI don't think this is what AMI should feel like - Not all persons are candidates for thrombolytic therapy
-
*pregnant
*hx of CVA
*recent surgery
*person already on anticoagulants
*complications include: bleeding, allergic reaction and stroke - EKG findings
-
*bradycardia or tachycardia
*ventricular ectopy (PVC's)
*ST segment changes(depression - subendocardial MI; elevation - acute MI)
*T wave inversion
*presence of Q wave - Laboratory Findings of AMI
-
*creatinine kinase-MB (^3-4 hrs, >6%)
*myoglobin (^ 2hrs, >90ng/ml)
*cardiac troponin T (^3-5 hrs, >1/5 ng/ml)
*cardiac troponin I (^ 3 hrs, >0.1 - 0.2 ng/ml) - Pharmalogical Treatment of AMI
-
*anti-ischemic therapy
*nitroglycerin IV
*Beta blockade - Assessment of persons experiencing AMI
-
*chest pain not releived by NTG SL
*pain may be present in neck, jaw, back, epigastium or arms
*diaphoresis, restlessness, pallor, nausea, vomiting, SOB
*s/s low CO - Caring for person undergoing angiography
-
*before angiography: check allergies; distal pulses, and prep groin site
*after angiography: check for bleeding, pulses, reperfusion dysrhythmias, kidneys, neuro changes and flat for at least 4 hours - Angioplasty
-
*a balloon tipped catheter is introduced into femoral artery to thrombosed vessel. The balloon is filled, compressing plaque and restoring flow
*an arterial sheath is left in place after procedure in case they have to emergently re-open vessel
*consent for open heart surgery is signed in case vessel can't be opened or if accidentally torn
*risk: bleeding, MI, tearing vessel - Anti-thrombotic Therapy (AMI)
-
*ASA, Heparin (help clot be not as strong)
*thrombolytic (streptokinase, urokinase, t-PA, anisoylated plasminogen streptikinase activator complex (APSAC), urokinase plasminogen activator and reteplase
*after thrombolytic given, person maintained with Heparin or a glycoproetin II/II inhibitor (abciximab) - Stents
-
*small self expandable or balloon expandable tubing is set in narrowed region to physically maintain vessel open
*person must be on anti-platelet meds
*thrombus vessel dissection and bleeding are complication - Directional Coronary Atherectomy
-
*rotating blade that shaves off plaque and deposits in the nose cone of the housing
*complications include embolus, vessel occlusion, perforation or spasm - Laser Ablation
-
*vaporize plaque, usually used right after a PCTA to fully remove plaque
*complications include vessel dissection, occlusion, perforation and embolism - Coronary Artery Bypass Grafting
-
*traditional, minimally invasive or "octopus" approach
*internal mammary artery or radial artery best choice for graft
*can also use saphnous, xenograft (pic), cadaver or synthetic grafting - If person has diffuse CHD and severe angina they might try
-
*trans-myocardial revascularization (TMR) or percutaneous myocardial revascularization (PMR)
*using short bursts of laser beams them "burn" holes in the myocardium to allow blood to enter the channels to feed the heart oxygenated blood - After initial treatment, the person may have
-
*anti-arrhythmics
*stool softeners
*ace inhibitors
*should start cardiac rehab - Mortality from AMI increases with
-
*old age (>80 yrs have 60% mortality)
*evidence of other diseases (COPD, DM)
*anterior MI (30% mortality)
*hypotension (systolic BP <55mmHG on admission has a 60% mortality) - Risk factors for CHD
-
*age *gender *cigarette smoke *HTN
*^cholesterol (^240mg/dl)
*low HDL (^35mg/dl desired)
*^LDL (< 130mg/dl desired)
*diabetes *stress *homocysteine *menopause
*obesity *physical inactivity - Problems
-
*pain *impaired tissue perfusion *dysrhythmias
*decreased CO *impaired gas exchange
*risk for bleeding *powerlessness *anxiety/fear
*activity intolerance *heart failure
*fluid volume excess *skin breakdown
*potential for infection *knowledge deficit