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51 Cards in this Set

  • Front
  • Back
Dressler syndrome
Post MI syndrome
characterized by pericarditis with effusion and fever that develops one to four weeks after MI
Myocardial infarction
Myocardial tissue destroyed due to diminished blood supply. Caused by sustained ischemia causing your reversible cellular death.
Area of bull's-eye
Area of damage works out like a bull's-eye -- area away from the injury is less irritated
Necrosis to heart
Cells can withstand ischemic conditions for up to 20 minutes before cell death begins
Transmural MI
Full thickness of myocardium in the region is involved
Subendocardial MI
Damage has not penetrated through the entire thickness of the myocardial wall
Inferior wall infarctions
Result from right coronary artery lesions
Anterior wall infarctions
Result from lesions in the left anterior descending artery
Lateral/posterior/inferior wall infarctions
Result from lesions in the left circumflex artery
Healing process after MI
-- inflammatory process
-- 24 hours leukocytes infiltrate the area
-- enzymes are released by the dead cardiac sails
-- enzymes of neutrophils and macrophages remove all necrotic tissue by the second or third day
Healing Process of MI
-Lipolysis & Glycogenolysis
-Collagn Matrix forms scar tissue after necrotic tisue is cleared
-By 6 weeks area is usually healed
release of glucose
(will see rise in serum glucose levels)
release of fatty acids
Clinical Manifistations of MI
-Pain, Severe, immobilizing not relieved by repositioning, rest, nitrates
-Anxious, restless
-^ HR & RR
-Fever may ^ 1st 24hr & last for 1 week
Site of MI pain
MI presentation in Women
-c/o discomfort
**MI in women is usually mis-diagnosed
MI presentation in Elderly
MI presentation in Diabetic
May not experience pain
**Silent MI**
Cardiovascular manifistations of MI
-^BP initially -- then drop due to decreased CO
-HR may ^ initially
-Urine output may decrease (r/t decrease perfusion of kidneys
-Crackles to lungs may last hours - days
-hepatic enlargement, peripheral edema (may indiciate cardiac failure)
-Jugular vein distention (early ventricular dysfunction & pulmonary congestion)
Assessment & Diagnostics of MI
Details of current episode of pain: where, intesity/description, duration, percipitating factors
Risk Factors: (family, stress, activity)
Previous Illness (similar symptoms)
Diagnostics of MI
*ST segment ^
*Q wave or Non-Q wave (1-3 days)
*Serial measurement of cardiac markers
Diagnostic examination to establish or r/o MI
-Cardiac Markers
*CK (creatine kinase)
*LDH (lactic dehydrogenase)
Cardiac Markers
Proteins released into the blood as a result of the necrotic hear muscle after an MI
Main enzyme released after MI
Begin to rise in 3-12 hrs
Peak in 24hrs
Return to normal 2-3 days
Myocardial Specific Enzyme
>3% ^ indicative of MI
Myocardial muscle protein released into the blood stream after MI tissue injury
Troponin T
Troponin I
-rises as quickly as CK
-remains ^ for 2 weeks
-^ 3-12 hrs
-Peak 24-48 hrs
-Returns to baseline 5-14 days
-Released within few hrs of MI
-Lacks cardia specificity
-Rapidly excreted in urine resulting in blood levels returning to normal within 24hrs
Management of patient with MI
-minimize myocardial damage
-preserve myocardial function
-prevent complications
Medication tx for MI
-Nitroglycerine IV
Nitroglycerine IV
-promotes peripheral vasodilation, decreasing preload and afterload
-Coronary artery vasodilation
-Acts as an analgesic and sedative
-Reduces preload and myocardial O2 consumption
Inhibits platelet aggregation
Angiotensin-converting enzyme
(ACE) inhibitors
-Decreases mortality and prevents onset of CHF
-MOnitor B/P, urine output, serum sodium and potassium
Thrombolytics TNKase
-Dissolve & lyse thrombus in coronary artery
*must be given within very short period of time of onset of MI
Other collaborative Care/Tx of patient with MI
-IV therapy
-Continuous monitoring
-Hemodynamic monitoring
*EKG, labs, v/s, Swans (pressures)
Complications of MI
*#1 complication of MI - most common cause of death
-Cardiogenic Shock
-Papillary muscle dysfunction
-Ventricle aneurysm
-Dressler Syndrome
-inflammation of visceral and/or parietal pericardium.
-may occur 2-3 days after acute MI
-Chest pain is aggravated by inspiration, coughing and movement of upper body
*Pain may be relieved by sitting in forward position
-Friction rub over pericardium
-Glass bottle
-Very sesnitive to light
*bottle and tubing must be covered and protected from light
Papillary muscle dysfunction
-Systolic murmur over apex of heart
-causes mitral valve regirgitation (^ volume of blood in left atrium)
Nursing Process for patient with MI
-Cardiac & Resp. Asessment
-Nursing Dx
Nursing Dx in patient with MI
-decrease myocardial perfusion r/t reduced coronary blood flow
-Potential impaired gas exchange r/t fluid overload from left ventricular dysfunction
-Potential altered peripheral tissue perfusion r/t decreased cardiac output
-Anxiety r/t fear of death
-Knowledge deficit about post MI self care
Myocardial Revascularization:
*primary surgical tx for CAD
--usually patient had failed medical management
Reasons for Cardiac Surgery
-Improve blood flow to the heart
-Repair/replace cardiac valves
-Congenital Anatomic Heart defects
-Cardiac Transplant
-minimally invasice direct coronary artery bypass grafting
-used for patients with LAD or single vessel dz (medical management not effective)
-several small incisions between ribs
-heart slowed with IV Beta adrenergic or calcium channel blockers
-Lt internal mammary artery is used for anasomosis to LAD
Care of patient with MIDCABG
-postop - like other cardiac surgery's
-IV nitro to minimize ischemia/coronary spasm
-Recovery time shorter
-Performed without cardiopulmonary bypass
Transmyocardial Laser
-indirect revascularization procedure using laser to make channels between lt ventricular activity & the cornary microcirculation
*channels allow blood to flow into ischemic areas
-may be performed during cath/surgery using lt anterior thoscotomy incision
_current tx for patients with CAD who are not candidates for bypass/failed medical therapy
Risk of "on pump" vs "off pump"
has been found that "on pump" can result in deminished memory, decreased mental function in later years
Graft sites for bypass
-Saphenous vein
-Internal Mammary Artery
(Internal Thoracic Artery)
-Radial Artery
-Gastroepiploic Artery
-Inferior Epigastric Artery
Most common artery for used for bypass
Internal Mammary Artery
-patency rate is ^
Cardiac Surgery Complications
-Collapse of graft
*patient will c/o heart pain