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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.
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SnSs of acute MI
- Cardinal symptoms:
- immobilizing chest pain
- not relieved with rest
- not relieved with position
- not relieved with NTG (nitroglycerine)
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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
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Complications of MI
- Most common: can minimize if problem vessel is opened quickly.
- --dysrhythmias
- --heart failure
- --cardiogenic shock
- Pericarditis
- Dressler’s Syndrome
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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.
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Treatment of MI
- ABC’s
- Relieve chest pain
- Assess & stabilize heart rhythm
- Reduce cardiac workload
- Revascularize the coronary artery
- Preserve myocardial tissue
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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
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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.
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What is sudden cardiac death
- Death usually within one hour of symptom onset
- Usually caused by acute ventricular arrhythmiasCan be caused by interuption of T interval.
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Risk Factors of sudden cardiac death
- Male
- Family hx
- Elevated cholesterol
- HTN
- Tobacco use
- DM
- EF <30% (ejection fraction)
- Cardiomyopathy
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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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