AMS1

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Author:
alyn217
ID:
162981
Filename:
AMS1
Updated:
2012-07-18 13:39:21
Tags:
AMS1T1 Acute MI
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Description:
Acute MI and sudden cardiac death
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  1. Pathophys of acute MI
    • Necrosis of myocardial tissue
    • --85% due to thrombus formation
    • --Coronary artery spasm
    • --Embolism
    • Locations
    • --Anterior wall, lateral wall, inferior wall, posterior
    • --Look at presentor notes in ppt for more information on implications of locations.
  2. SnSs of acute MI
    • Cardinal symptoms:
    • immobilizing chest pain
    • not relieved with rest
    • not relieved with position
    • not relieved with NTG (nitroglycerine)
  3. Other clinical affects of acute MI
    • Feeling of impending doom
    • Fatigue
    • Nausea, vomiting
    • Shortness of breath
    • Some may have no symptoms
    • Catecholamine responses, ie BP goes up, comes back down. Going to try to maintain core conditions.
    • Fever
  4. Complications of MI
    • Most common: can minimize if problem vessel is opened quickly.
    • --dysrhythmias
    • --heart failure
    • --cardiogenic shock
    • Pericarditis
    • Dressler’s Syndrome
  5. Diagnosis of acute MI
    • ST-segment changes on EKG
    • Cardiac markers—CK, Troponin, CK-MB. Drawn in series q6-8h. Normals are typically 0.
    • Coronary angiography, ie the artery picture dealie-bob.
    • Assume acute MI until ruled out!!
    • Time of onset of chest pain. "Time is muscle." May also be able to give thrombolytic if within 4 hours of start of MI.
  6. Treatment of MI
    • ABC’s
    • Relieve chest pain
    • Assess & stabilize heart rhythm
    • Reduce cardiac workload
    • Revascularize the coronary artery
    • Preserve myocardial tissue
  7. Other treatments for acute MI
    • Aspirin
    • Atropine
    • Nitrates
    • Calcium channel blockers
    • Heparin
    • Morphine
    • ACE inhibitors
    • Antidysrhythmics
    • Stool softeners--to avoid death by valsalva. Also treats ae's of morphine (constipation)
    • Beta-blockers
  8. What is a pumonary artery catheter?
    • Inserted via subclavian.
    • down through superior vena cava, into rt atrium, rt ventricle, pulmonary vein, into lung.
    • Stops with inflated balloon.
    • Measures cardiac output.
    • Deflate upon obtaining diagnostic values.
  9. What is sudden cardiac death
    • Death usually within one hour of symptom onset
    • Usually caused by acute ventricular arrhythmias
    • Can be caused by interuption of T interval.
  10. Risk Factors of sudden cardiac death
    • Male
    • Family hx
    • Elevated cholesterol
    • HTN
    • Tobacco use
    • DM
    • EF <30% (ejection fraction)
    • Cardiomyopathy
  11. Nursing considerations for sudden cardiac death
    • Diagnostic workup
    • Continuous Hemodynamic monitoring
    • Drug therapy
    • EPS: electrophysiology study. Done in the cath lab.
    • ICD: Implantable cardiac defibrillator.
    • Psychosocial adaptation: need to adjust to realities of treatment.

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