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21 Cards in this Set
- Front
- Back
If not a thrombolytic candidate, person may have:
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*angioplasty (ask if allergic to iodine; check BUN/Cr because dye is nephrotoxic)
*stents *Directional coronary atherectomy *laser ablation *bypass surgery |
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Successful reperfusion is evidenced by:
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*EKG ST segment and T wave "back to normal"
*relief of chest pain *presence of reperfusion dysrhythmias (PVC's) *cardiac enzymes decrease |
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Once in ER (AMI)
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*4 D's - door, data, decision, drug
*O2, ECG monitor, IV, draw labs, obtain 12 lead EKG *tx pain with IV morphine (helps < afterload, cuts pain) |
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Emergency treatment of person experiencing AMI
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*call 911
*chew an ASA (mortality <23%) *most people experiencing AMI don't think this is what AMI should feel like |
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Not all persons are candidates for thrombolytic therapy
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*pregnant
*hx of CVA *recent surgery *person already on anticoagulants *complications include: bleeding, allergic reaction and stroke |
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EKG findings
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*bradycardia or tachycardia
*ventricular ectopy (PVC's) *ST segment changes(depression - subendocardial MI; elevation - acute MI) *T wave inversion *presence of Q wave |
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Laboratory Findings of AMI
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*creatinine kinase-MB (^3-4 hrs, >6%)
*myoglobin (^ 2hrs, >90ng/ml) *cardiac troponin T (^3-5 hrs, >1/5 ng/ml) *cardiac troponin I (^ 3 hrs, >0.1 - 0.2 ng/ml) |
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Pharmalogical Treatment of AMI
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*anti-ischemic therapy
*nitroglycerin IV *Beta blockade |
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Assessment of persons experiencing AMI
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*chest pain not releived by NTG SL
*pain may be present in neck, jaw, back, epigastium or arms *diaphoresis, restlessness, pallor, nausea, vomiting, SOB *s/s low CO |
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Caring for person undergoing angiography
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*before angiography: check allergies; distal pulses, and prep groin site
*after angiography: check for bleeding, pulses, reperfusion dysrhythmias, kidneys, neuro changes and flat for at least 4 hours |
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Angioplasty
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*a balloon tipped catheter is introduced into femoral artery to thrombosed vessel. The balloon is filled, compressing plaque and restoring flow
*an arterial sheath is left in place after procedure in case they have to emergently re-open vessel *consent for open heart surgery is signed in case vessel can't be opened or if accidentally torn *risk: bleeding, MI, tearing vessel |
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Anti-thrombotic Therapy (AMI)
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*ASA, Heparin (help clot be not as strong)
*thrombolytic (streptokinase, urokinase, t-PA, anisoylated plasminogen streptikinase activator complex (APSAC), urokinase plasminogen activator and reteplase *after thrombolytic given, person maintained with Heparin or a glycoproetin II/II inhibitor (abciximab) |
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Stents
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*small self expandable or balloon expandable tubing is set in narrowed region to physically maintain vessel open
*person must be on anti-platelet meds *thrombus vessel dissection and bleeding are complication |
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Directional Coronary Atherectomy
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*rotating blade that shaves off plaque and deposits in the nose cone of the housing
*complications include embolus, vessel occlusion, perforation or spasm |
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Laser Ablation
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*vaporize plaque, usually used right after a PCTA to fully remove plaque
*complications include vessel dissection, occlusion, perforation and embolism |
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Coronary Artery Bypass Grafting
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*traditional, minimally invasive or "octopus" approach
*internal mammary artery or radial artery best choice for graft *can also use saphnous, xenograft (pic), cadaver or synthetic grafting |
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If person has diffuse CHD and severe angina they might try
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*trans-myocardial revascularization (TMR) or percutaneous myocardial revascularization (PMR)
*using short bursts of laser beams them "burn" holes in the myocardium to allow blood to enter the channels to feed the heart oxygenated blood |
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After initial treatment, the person may have
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*anti-arrhythmics
*stool softeners *ace inhibitors *should start cardiac rehab |
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Mortality from AMI increases with
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*old age (>80 yrs have 60% mortality)
*evidence of other diseases (COPD, DM) *anterior MI (30% mortality) *hypotension (systolic BP <55mmHG on admission has a 60% mortality) |
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Risk factors for CHD
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*age *gender *cigarette smoke *HTN
*^cholesterol (^240mg/dl) *low HDL (^35mg/dl desired) *^LDL (< 130mg/dl desired) *diabetes *stress *homocysteine *menopause *obesity *physical inactivity |
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Problems
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*pain *impaired tissue perfusion *dysrhythmias
*decreased CO *impaired gas exchange *risk for bleeding *powerlessness *anxiety/fear *activity intolerance *heart failure *fluid volume excess *skin breakdown *potential for infection *knowledge deficit |