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Emergency PCI is being used frequently in the management of acute MI, with improved outcomes for patients. Cardiac cath a catheter with a balloon tip is inserted , once the blocked coronary artery is entered the balloon on the catheter is inflated and the plaque is compressed.- this allows more blood to the myocardium. Coronary Artery Stent Placed during angioplasty- used to prevent closure of the coronary artery from the lesion. A stent is a expandable metal mesh tube that is implanted at the site of blockage-allows for blood flow.Complications include thrombus formation in the vessel, bleeding from anticoagulation, stent occlusion, or coronary artery occlusion. MITherapeutic Interventions‒Bedrest/Bedside Commode ‒Intra-aortic Balloon Pump‒Glucose Control ‒Daily Weight ‒Low-sodium Clear Liquids‒Low-fat, Low-cholesterol, Low-sodium Diet‒No Caffeine ‒Fluid RestrictionBedrest to decrease oxygen needsIntra- aortic balloon pump- supports an ischemic heart. While the heart is relaxed (diastole), theballoon is inflated, sending more blood into the coronary arteries. Just before the heart contracts (systole), the balloon deflates creating a suction effect that allows blood to flow past itwith less resistance into the aorta.9
Blood sugar should be maintained at 140-180mg/dl AVOID HYPOGLYCEMIA- Strict glycemic control has been shown to increase the risk of death at 90 days.Diet- heart healthy, restrict fluids if HFTherapeutic Interventions‒Weight Loss‒Smoking Cessation‒Antiplatelets‒Statins‒ACEIs‒Beta Blockers Myocardial RevascularizationCoronary Artery Bypass Graft‒Coronary Artery Occlusions Bypassed with Vein/Artery Grafts‒Increases Blood Flow/Oxygen to Myocardium The saphenous vein or internal mammary artery from the chest wall is used to reroute blood around a segment of the artery that is narrowed. One or more vessels can be bypassed.Types of Bypass Surgery Arrested Heart SurgeryBeating Heart SurgeryMinimally Invasive Surgery‒Minimally invasive direct coronary artery bypass grafting (MIDCAB) ‒Totally endoscopic coronary artery bypass surgery (TECAB) MidcabThoracoscope No Cardiopulmonary Bypass Small IncisionsMulti-vesselsMinimally invasive surgery- endoscopic MIDCAB- done off pump- done through small fifth intercostal incision.Three or four chest holesInsertion of robotic arms and a cameraSurgeon controls robotic armsTECAB done on or of the pump- three or four chest holes for insertion of robotic arms and a camera that the surgeon views the armsRehab begins when the patient’s acute symptoms are relieved.Phase one begins in the hospital, phase 2 begins 4-6 weeks after discharge Phase 3 patient are encouraged to maintain optimal physical fitness and a healthy lifestyle.