o Done during rest or during supine exercise o Valve problems Physiologic

O done during rest or during supine exercise o valve

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Identifies structural abnormalities and blood flow through the heart using ultrasound. o Done during rest or during supine exercise. o Valve problems Physiologic Response What happens to the heart after infarction? o 6 hours: Ischemia o 48 hours: Grey tissue, necrosis around infarction o 8-10 days: Extended grey tissue, collateral circulation begins to develop o 2-3 months: Scar tissue begins to form (remodeling)
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Treatment Goals Relieve chest pain Reduce extent of myocardial damage Maintain cardiovascular stability Decrease cardiac workload Prevent complications Treatment/Medications Aspirin/ASA – ESSENTIAL!!! Analgesics – morphine Antidysrhythmics – class I or class III Fibrinolytic drugs NTG Other drugs: beta blockers, ACE inhibitors o Beta Blockers decrease work load of heart by reducing pulse and BP. o ACE inhibitors prevent angiotensin I from turning into angiotensin II Nitroglycerin o Increases collateral blood flow, redistributes blood flow to subendocardium and dilates coronary arteries and veins . o Usually given in IV form in AMI o Monitor rating and location of pain: What relieves it? o Nitroglycerin: Give IV fluid prior to decrease risk of hypotension Fibrinolytic Therapy o Used to establish reperfusion in patients with no contraindications. o Lyse coronary thrombi by converting plasminogen to plasmin, converting degradation of fibrin and fibrinogen resulting in clot lysis o Fibrinolytics use? Dissolve thrombi in the coronary arteries and restore blood flow. o Streptokinase o t-PA o TNK o Usually only used when cardiac cath lab not available o Monitor contraindications before use. o Maximal benefit given within first three hours after onset of S/S’s. o Contraindications include: Know these… History or bleeding disorders History of stroke (bleeding) HTN Pregnancy Recent trauma/surgery to head/spine o Post Fibrinolytic Therapy/Nursing Care Resolution of chest pain EKG for normalization of elevated ST segment Allergic reactions: Bleeding, Hypotension Indicators of re-occlusion: CP, ST elevation Bleeding: Internally, urine, stool, SQ, mucous, increased ICP
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Reperfusion Therapy o After clot is lysed to maintain patency of coronary arteries, aspirin and IV heparin are prescribed. Treatment/Diagnostic Cardiac Catheterization: PCR (percutaneous coronary revascularization) o Assesses pathophysiology of cardiovascular disorder o Provides left ventricular function information o Measures heart pressures and cardiac output o o Stent Placement During PCR PCR o Used to compress the plaque against the vessel wall, dilating and restoring blood flow. o May be used alone or with GP IIb/IIIa. o Stents may also be used. o Myocardial Infarction o Has great outcomes in terms of risk, success rate, the pt’s physical capacity after the procedure, length of hospital stay, and cost. o 48-72 hour stay o Reduced mortality and morbidity.
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