Acute Myocardial Infarction AMI Ischemia with myocardial cell death Imbalance

Acute myocardial infarction ami ischemia with

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Acute Myocardial Infarction (AMI) Ischemia with myocardial cell death Imbalance of oxygen supply and demand Causes Atherosclerosis *** Emboli Blunt trauma Vasospasm
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Acute Myocardial Infarction (AMI) Types ST elevation MI (STEMI) Non-ST elevation MI (NSTEMI) Amount of collateral circulation (determines severity of MI)
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Is it a STEMI or a Non-STEMI?
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ST Elevation Myocardial Infarction
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ST Elevation Myocardial Infarction STEMI Tombstone T’s
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ST Elevation Myocardial Infarction STEMI
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Q waves Q wave present on ECG indicate previous MI Pathological Q-Wave
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Acute Coronary Syndrome ACS – Unstable Angina or Myocardial Infarction
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Assessment of AMI Midsternal chest pain Severe, crushing, and squeezing pressure May radiate Unrelieved with nitrates Pale and diaphoretic Dyspnea and tachypneic Syncope Nausea and vomiting Dysrhythmias
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Diagnosis of AMI The Clot is the Culprit!! Take-Home Message ->
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Diagnosis of AMI Signs and symptoms Often atypical symptoms in women and people with diabetes 12-lead: Is there ST elevation or ST depression ? Elevated cardiac enzymes CPK-MB Elevated myoglobin  Elevated serum troponin I/T Diagnostic criteria. Positive = MI
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Complications of AMI Dysrhythmias Cardiogenic shock Ventricular aneurysm or rupture Papillary muscle dysfunction Pericarditis Congestive heart failure Sudden death
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Medical Management: AMI Pain relief: morphine, nitroglycerin Oxygen Drugs affecting platelets ASA (Acetylsalicylic Acid -> aspirin) Glycoprotein IIb/IIIa inhibitors Beta blockers Nitrates (nitroglycerin) ACE inhibitors (enalapril, captopril) Antidysrhythmic medications
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Thrombolytic Therapy Time is muscle!! 6-hour window Several thrombolytic agents available, such as (t-PA, Streptokinase, Reteplase Heparin and glycoprotein IIb/IIIa inhibitors
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Primary Angioplasty Get patient to catheterization lab STAT for emergent percutaneous intervention or stenting, if facilities available Better outcomes than thrombolytics ? v=gvRtP3wl_AY
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Cardiac Catheterization and Arteriography May only be diagnostic Potential Intervention Catheter (right or left) Heart pressures (similar to PA catheter) Cardiac output Arteriography Visualize blood vessels- arteries punctured, use a sealing device (AngioSeal, a stitch or pressure at the end)
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Intracoronary Stents Tubes placed in conjunction with angioplasty to keep vessel patent Help prevent the restenosis associated with angioplasty Similar procedure as PCA Anticoagulation therapy
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Post-catheterization Nursing Care
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  • Spring '17
  • Patricia Harris
  • acute myocardial infarction, infarction, Acute coronary syndrome

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