Myocardial Ischaemia Case Study

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Myocardial Ischemia
Introduction
A 55-year old, male truck driver, presents with crushing central chest pain which has radiated to his neck and occurred on rest. On arrival, the patient was pale and clammy, demonstrated shortness of breath. his pulse rate was 120 beats per minute, blood pressure 150/70 and his oxygen saturation level was 96%. The patient presented with chest pain due to myocardial ischaemia. Myocardial ischaemia is a disease caused by a coronary artery obstruction which reduces or cuts off the blood supply to the heart muscle tissue or myocardium and causes tissue ischaemia. 1 When myocardial ischaemia is prolonged it can cause acute coronary syndromes such as unstable angina, ST-elevation myocardial infarction and non-ST elevation
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A 12 lead electrocardiography (ECG) should be attached to the patient within the first 10 minutes of arrival to measure the electrical activity of the heart and to identify suspected acute coronary syndromes such as myocardial ischaemia, unstable angina and acute myocardial infarction. 11,12 Low flow oxygen is also necessary to reduce shortness of breath (dyspnoea) and to improve the patient’s oxygen saturation levels and hypoxemia. 11,13 Providing supplemental oxygen via nasal prongs or a face mask ensures that any tissue damage caused by myocardial ischemia is minimalised 1. Assess patient for reduced shortness of breath and monitor vital signs, particularly respiratory rate and oxygen saturation levels, to identify effect of supplemental oxygen. Sublingual glyceryl trinitrate (GTN) should be administered because it is considered first line treatment for acute coronary syndromes such as myocardial ischaemia because it acts a vasodilator which dilates blood vessels, increases blood flow to the myocardium and reduces workload of the heart. 14 It is very effective in restoring blood flow and oxygen to an ischemic heart. 1 Continue to observe and monitor patient’s vital signs for adverse side effects. One spray should be administered 400microg which should be repeated at 5 minute intervals. Blood pressure should be monitored in between doses to ensure systolic blood pressure does not fall below 100mmHg. If patient become dizzy, nauseous or feels like vomiting, an antiemetic should be administered.11 Administer aspirin to the patient because aspirin is known to decrease mortality associated with acute myocardial ischemia or infarction. 300mg of aspirin should be administered to a maximum of 450mg. 11-13 Aspirin is an

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