MYOCARDIAL INFARCTION.docx - MYOCARDIAL INFARCTION Care of...

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MYOCARDIAL INFARCTION Care of the Client with MI Acute Coronary Syndrome o ACS-emergent situation of myocardial ischemia resulting in myocardial death o Results in unstable angina with ST elevation STEMI o Coronary artery not completely occluded yet o Immediate interventions before cell death! Myocardial Infarction o MI refers to the process by which myocardial tissue is destroyed in regions of the heart deprived of an adequate blood supply because of coronary artery blood flow. o An infarction is an area of localized necrosis due to ischemia. A myocardial infarction is caused when one of the coronary arteries suddenly becomes blocked cutting off the blood supply to the heart muscle. The necrotic area heals by scar formation and fibrosis. Causes of MI o Critical narrowing of a coronary artery due to atherosclerosis o Complete occlusion of a coronary artery due to embolus or thrombus o Decreased coronary blood flow as a result of vasospasm of a coronary artery o Decreased oxygen supply: shock/hemorrhage o Increased demand for oxygen: tachycardia o Embolism of a coronary artery Clinical Manifestations o Chest pain that occurs suddenly and continues despite rest and medication o Describes pain as crushing, squeezing, pressure in center of chest o EKG changes o Pain may radiate to other areas o Other symptoms: cool skin pallor clammy diaphoresis tachycardia, tachypnea, SOB nausea/vomiting Diagnostic Evaluation o Complete client and family history o Physical assessment o Electrocardiogram ( EKG or ECG) ST segment elevation; abnormal Q wave o Serial serum enzymes, isoenzymes, myoglobin, troponin o Echocardiogram for ventricular function Patient History o History of chest pain, palpitations, or dyspnea o Family history of heart disease or stroke o Hyperlipidemia or atherosclerosis o Stressful life style Physical Assessment o Assess level of consciousness o Evaluate chest pain o Assess heart sounds: S3 impending left ventricular failure o Evaluate skin color and temperature
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o Measure blood pressure, heart rate,RR o Auscultate lung fields for crackles o Observe edema and urinary output EKG Changes o Q wave MI o Non Q wave MI Cardiac enzymes o Creatine Kinase (CK) or o Creatine Phosphokinase (CPK) Normally in cells Levels increase with tissue injury Peaks in 12-24 hours o Isoenzymes: CK-MB Specific to cardiac muscle Levels increase with muscle damage Shows an increase in about 6 hours after start of an MI Peaks in about 18 hours Returns o normal 24-36 hours o Troponin A protein which assists in contraction and squeeze of the heart muscle. Levels increase with heart muscle injury and released into the blood stream within hours.
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  • Spring '14
  • Brinkley
  •  ST segment elevation,  Myocardial Infarction

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