Acute Myocardial Infarction (AMI) • Ischemia with myocardial cell death • Imbalance of oxygen supply and demand • Causes – Atherosclerosis *** – Emboli – Blunt trauma – Vasospasm
Acute Myocardial Infarction (AMI) • Types – ST elevation MI (STEMI) – Non-ST elevation MI (NSTEMI) • Amount of collateral circulation (determines severity of MI)
Is it a STEMI or a Non-STEMI?
ST Elevation Myocardial Infarction
ST Elevation Myocardial Infarction STEMI Tombstone T’s
ST Elevation Myocardial Infarction STEMI
Q waves • Q wave present on ECG indicate previous MI Pathological Q-Wave
Acute Coronary Syndrome ACS – Unstable Angina or Myocardial Infarction
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
Diagnosis of AMI The Clot is the Culprit!! Take-Home Message ->
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
Complications of AMI • Dysrhythmias • Cardiogenic shock • Ventricular aneurysm or rupture • Papillary muscle dysfunction • Pericarditis • Congestive heart failure • Sudden death
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
Thrombolytic Therapy • Time is muscle!! • 6-hour window • Several thrombolytic agents available, such as (t-PA, Streptokinase, Reteplase • Heparin and glycoprotein IIb/IIIa inhibitors
Primary Angioplasty • Get patient to catheterization lab STAT for emergent percutaneous intervention or stenting, if facilities available • Better outcomes than thrombolytics • ? v=gvRtP3wl_AY
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)
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
Post-catheterization Nursing Care
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- Spring '17
- Patricia Harris
- acute myocardial infarction, infarction, Acute coronary syndrome