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37 Cards in this Set
- Front
- Back
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What is an MI? |
-Death of myocardial tissue due to cutoff of O2 supply -dynamic process |
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Types of MIs |
-STEMI, non-Stemi -Q wave, non-Q wave -Identified by wall affected -Inferior/Anterior |
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STEMI stands for? What is it? |
ST elevation MI (stemi) -acute muscle injury- sign that process is happening RIGHT now- Must intervene (send pt to cath lab)
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What is a non stemi? |
labs saying something is off, but ECG is "normal" still can be just as severe or ECG didn't catch in that time period |
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What does a deep Q wave mean? |
shows up after MI occurred, will always be there if there Pathological Q wave |
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_____% of MIs are due to ______ _______. |
80-90% coronary thrombosis |
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What is the critical amount of time to treat MI? |
First 4-6 hours critical for tx |
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What is our goal r/t MI patient? |
Want to save ischemic and injured tissue. Nothing we can do about the infarcted tissue. |
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What do most MI pt's have as a previous diagnosis? Describe what this can cause? |
-CAD (atherlosclerosis) -Fatty streaks form (1st stage) -Fibrous plaque (streaks harden) -Complicated lesion---> ruptures which leads to unstable angina |
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How does angina and MI pain differ? |
-crushing, unrelenting, worse pain *doesn't go away with rest |
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What does the "classic pt" present as? |
-Pain: severe, unrelenting, not relieved -N/V -Diaphoretic, cold, clammy -BP elevation (anxiety/pain) -BP depression (conduction affected, Muscle loss, can't pump efficiently, stunned) -Crackles, SOB, JVD, elevated WBC, Fever |
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Why would the pt have elevated WBC count or a fever? |
Inflammatory response to injury |
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What are the 4 layers of cardiac tissue? (outer to inner) |
sac epicardial myocardial endocardial |
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Often times, infarction starts from _____ to ____. |
Inside to out |
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__________ MI is a slight MI. (not a lot of damage) |
submyocardial |
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What supplies the SA node? |
R coronary artery |
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Why is posterior wall MI less likely to occur? |
it is supplied by 2 arteries (1 from L CA, 1 from R CA) |
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Diagnostics of an MI |
-hx, physical, pain assessment -ECG Q 6 hours, x 2-3 -Cardiac enzyme markers Q6hr X 2-3 |
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What are the cardiac enzyme markers? |
-CK/CPK (creatinine phosphokinase) -CK-MB (isoenzyme) -Troponin |
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What is troponin? |
-newer lab for dx MI -released from damaged muscle -will start to increase after couple hrs -can last for weeks -want to see at peak - |
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What is CPK? |
-Not cardiac specific -can be elevated with exercise such as marathon |
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What is CK-MB? |
Cardiac specific |
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What to do to manage MI? |
-Oxygen (2-3L NC) -IV (need access x2) -Cardiac monitor -ECG -VS, Heart/lung assessment -Labs: enzymes, electrolytes -Pain: treat w/ nitro, morphine -Rest (BEDREST) |
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What 3 electrolytes play a significant role r/t heart? |
-potassium -sodium -magnesium |
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What can happen if magnesium is low? |
Ventricular fibrillation |
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What meds to treat MI? |
-Antiplatelet (ASA) -BB (metoprolol) -Nitrates/Morphines -Anticoagulants (Heparin) -Antidysrhythmic drugs (amiodarone, Lidocaine) -CCB (Slow Hr, vasodilate, lower PL+AL) |
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Interventions for a coronary occlusion |
-Cath lab: angioplasty, stents -Thrombolytic agents: Alteplase (tPa) |
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How much time does it take for infarction to take place? |
-20 minutes "Time is muscle" Goal: door to dilation/drugs 90 minutes or less |
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Care for the cardiac cath patient: L vs R? |
-2 separate procedures because 2 separate sides of heart -L side (go through femoral, bed rest, what we use to determine heart disease, can measure CO, EF, SV, and where blockage is) -R side (go through vena cava)
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Care for cardiac cath patient: assessments? |
-vital signs -presence of pain -insertion site check -circulation check -Ejecting dye (reaction) -Retrobleed (bleed backwards) |
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What is a stent? |
Keeps plaque up against wall of vessel never remove Can place stent over stent
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What is the worst complication of MI |
Dysrhythmias: irritability of ischemic heart muscle -most times if someone dies from an MI it is from a dysrhythmia
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What are dysrhythmias often caused by? |
-injured tissue Cannot be the infarcted tissue (it is dead tissue, so will not give off electricity) |
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Other Complications of MI |
-Heart failure: loss of muscle or valve function -Cardiogenic shock: poor CO leads to ischemia at cellular level--> multi system failure (really bad HF). High mortality levels -Potential for recurrence: PCI or surgery |
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What is PCI? |
Percutaneous coronary intervention |
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What are the phases of cardiac rehab? |
Phase I: period of hospitalization II: closely monitored exercise/activity outpatient III: less direct monitoring outpatient IV: recovery and maintenance |
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Home care management for MI |
cardiovascular risk reduction continuity of care drug therapy rehab exercise plan: walking AHA resources |
