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Identifies structural abnormalities and blood flow through the heart using ultrasound. oDone during rest or during supine exercise. oValve problemsPhysiologic ResponseWhat happens to the heart after infarction?o6 hours: Ischemiao48 hours: Grey tissue, necrosis around infarctiono8-10 days: Extended grey tissue, collateral circulation begins to developo2-3 months: Scar tissue begins to form (remodeling)
Treatment GoalsRelieve chest painReduce extent of myocardial damageMaintain cardiovascular stabilityDecrease cardiac workloadPrevent complicationsTreatment/MedicationsAspirin/ASA – ESSENTIAL!!!Analgesics – morphineAntidysrhythmics – class I or class III Fibrinolytic drugsNTGOther drugs: beta blockers, ACE inhibitorsoBeta Blockers decrease work load of heart by reducing pulse and BP.oACE inhibitors prevent angiotensin I from turning into angiotensin IINitroglycerinoIncreases collateral blood flow, redistributes blood flow to subendocardium and dilatescoronary arteries and veins.oUsually given in IV form in AMIoMonitor rating and location of pain: What relieves it?oNitroglycerin: Give IV fluid prior to decrease risk of hypotensionFibrinolytic TherapyoUsed to establish reperfusion in patients with no contraindications. oLyse coronary thrombi by converting plasminogen to plasmin, converting degradation of fibrin and fibrinogen resulting in clot lysisoFibrinolytics use? Dissolve thrombi in the coronary arteries and restore blood flow. oStreptokinase ot-PAoTNKoUsually only used when cardiac cath lab not availableoMonitor contraindications before use.oMaximal benefit given within first three hours after onset of S/S’s.oContraindications include: Know these…−History or bleeding disorders−History of stroke (bleeding)−HTN−Pregnancy−Recent trauma/surgery to head/spineoPost 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
Reperfusion TherapyoAfter clot is lysed to maintain patency of coronary arteries, aspirin and IV heparin are prescribed. Treatment/DiagnosticCardiac Catheterization: PCR (percutaneous coronary revascularization)oAssesses pathophysiology of cardiovascular disorderoProvides left ventricular function informationoMeasures heart pressures and cardiac outputooStent Placement During PCRPCRoUsed to compress the plaque against the vessel wall, dilating and restoring blood flow. oMay be used alone or with GP IIb/IIIa.oStents may also be used.oMyocardial InfarctionoHas great outcomes in terms of risk, success rate, the pt’s physical capacity after the procedure, length of hospital stay, and cost.o48-72 hour stayoReduced mortality and morbidity.