Introduction/Etiology and Pathophysiology of STEMI
Myocardial infarction is a serious and potentially life threatening emergency. Rapid assessment and diagnosis is imperative to correctly treat a patient. It is essential for the nurse and healthcare team to understand the diagnostic procedures, lab tests, and treatments that can provide life -saving treatment for a patient presenting with chest pain. Myocardial infarctions can occur in different parts of the heart and can be given different classifications depending on the presenting symptoms. The most serious type of myocardial infarction is classified as an ST-elevation myocardial infarction or STEMI.
A STEMI is one type of heart attack that involves an ST-elevation myocardial infarction (CDC, 2010). A STEMI is the traditional manifestation and was historically used to diagnose a myocardial infarction (Ignatavicius & Workman, 2013, p. 829). It is now known that not all patients experiencing a myocardial infarction will present this way (Ignatavicius & Workman, 2013, p. 829). According to Ignatavicius and Workman (2013), patients presenting with STEMI typically have ST elevation in two contiguous leads on a 12-lead ECG. A STEMI indicates myocardial infarction or necrosis and requires immediate treatment (Ignatavicius & Workman, 2013, p. 829). According to the American Heart Association (AHA) (2010), STEMI comprises 25% to 40% of the 683,000 United States patients diagnosed with acute coronary syndrome each year.
A myocardial infarction occurs when the myocardial tissue is abruptly and severely deprived of oxygen (Ignatavicius & Workman, 2013, p. 829). Due to this quick decrease in blood flow, ischemia develops which can then lead to injury and necrosis of the myocardia...
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...hey may need to have surgical management, which could require another PTCA or CABG. In the case of surgery, the nurse would need to monitor her patient for post-operative complications.
Conclusion
In conclusion, coronary health is of utmost importance. The prevalence of coronary heart disease and acute coronary syndromes is alarming. Education and changing modifiable risk factors are essential to promote cardiac health, and decreasing the chance of an MI. An acute myocardial event such as a STEMI can be an acutely life threatening. Rapid diagnosis and treatment is imperative to provide the best chance of reperfusion to the myocardial muscle to restore oxygen and blood flow to decrease injury and complications. It is essential that the nurse be educated on the signs, symptoms, diagnosis, and treatment of a STEMI to help achieve the best outcome for the patient.
Patients that come in in cardiogenic shock during there echocardiogram need to be evaluated in a whole looking for any abnormalities. Diastole dysfunction, systolic dysfunction, any possible shunting issues, aortic stenosis, coarctation of the aorta or
Which of the following is used to distinguish the diagnosis of MI (Myocardial Infarction) from that of Unstable angina?
After review of the clinical information provided by North Central Bronx Hospital, the Medical Director has denied your admission to North Central Bronx Hospital. It was determined that the clinical information did not justify an inpatient stay. Acute inpatient hospitalization was not medically necessary. You are a 56 year old female with complaints of worsening pressure-like chest pain on the left sided that radiated to your left arm and neck. The symptoms began when you were at rest and woke you from your sleep. Based on the Interqual guideline (a decision based program to determine medical need) criteria to for acute coronary syndrome the clinical guidelines were not met because troponins were negative, there was no diagnostic testing such as a stress test, or documentation of ischemia in the clinical information that was submitted.
Myocardial infarction and acute coronary syndrome require the same medications such as: “aspirin, nitroglycerin, morphine, beta blockers, and thrombolytics” (Smeltzer, pp. 744, 2010) Oxygen administration and a 12-lead electrocardiogram is also required upon arrival to the hospital. A PCIS is a procedure for “opening the occluded artery and providing perfusion to the area of the heart that has been deprived of oxygen” and should be done in less than one hour of patient arrival (Smeltzer, pp. 745, 2010). When a PCI is contraindicated or unavailable at a certain facility, thrombolytics are admistered to “dissolve the thrombus in a coronary artery” in order for reperfusion to the deoxygenated area of the heart to occur (Smeltzer, pp. 745, 2010). After the initial medical treatment for acute coronary syndrome and a myocardial infarction, “continuous cardiac monitoring” is required to ensure that another episode is not going to occur (Smeltzer, 745, 2010). Monitoring is preferably done on an intensive care unit because of the severity of the complications that could occur. Medications such as “aspirin, beta-blockers, and an ACE inhibitor” is included in the ongoing treatment (Smeltzer, pp. 745, 2010). Cardiac rehabilitation is initiated after the patient with acute coronary
The term acute myocardial infarction is used when talking about myocardial necrosis in a setting consistent with myocardial ischemia (Steg, et al., 2012). Acute myocardial infarctions are the major cause of disability and death worldwide. Myocardial infarctions can be one of the first signs of acute coronary syndrome and they can also occur repeatedly in patients that have an ongoing coronary artery disease (Thygesen, et al., 2012).
Second diagnoses is Acute Myocardial Infarct (AMI) is the results from plaque rupture which then followed by the formation of large thrombus that mostly or fully stops the lumen of a coronary artery, which then results in myocardial ischemia, injury and necrosis of myocytes (Wesley, 2011).
Smeltzer, S., Bare, B., Farrell, M., & Dempsey, J. (2011). Smeltzer & Bare's Textbook of Medical-Surgical Nursing (2nd Australian and New Zealand edition ed. Vol. 1): Lippincott Williams & Wilkins Pty Ltd.
Lewis, Sharon Mantik, Shannon Ruff Dirksen, Margaret M. Heitkemper, and Linda Bucher. 2014. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 9th ed. St. Louis, MI: Elsevier Mosby.
Oxygen is vital to a beating, healthy heart because it is needed to perform cellular respiration in order to pump the blood. When there is no oxygen being transported to the heart, the heart cannot pump blood, and eventually after being inactive, the heart tissue dies . This results in a heart attack. Heart attacks can be diagnosed before it is too late. One method of diagnosis is through a blood test. Blood tests are capable of sorting through the material found in blood, and if heart cell contents are found in the specimen, a heart attack can be diagnosed. If the levels of the cell contents are higher, this signifies that the heart attack is more severe. Another method of diagnosis is an electrocardiogram (ECG). An ECG measures the rhythm of the heart in order to detect defects. There are many other strategies that are used by doctors in order to diagnose a heart attack, such as chest x-rays, stress tests, tilt table tests, and echocardiograms, to name a few. A myocardial biopsy involves looking at the heart cells, and is accomplished by collecting a sample of heart cells from the patient. If the results are positive, a heart attack is diagnosed. A heart MRI involves looking at images of the heart in order to detect heart failure. The doctor uses the images to look for disorders in the structure of the
Myocardial infarctions are caused by vascular endothelial disruption most often associated with plaque build-up or atherosclerosis that develops over several years and causes thrombus formation which in turn
Succinctly speaking, a myocardial infarction is not a disease but rather an event occurring due to the progression of coronary heart disease. 1(p.125) With coronary heart disease, the flow of blood which supplies the heart with oxygen is blocked, reducing the amount of oxygen received by the cardiac muscles and resulting in damage or death of cardiac muscle....
One of the leading causes of death in the United States is heart disease. “Approximately every 29 seconds one American will have a heart attack, and once a minute one American will die from a heart attack” (Ford-Martin and Odle, 915). According to the Gale Encyclopedia of Alternative Medicine men over the age of 45 and women over the age of 55 are considered at risk for heart disease. Heart disease is a major cause of death. It is beneficial to individuals who seek to prevent heart disease to recognize the risks leading to heart attacks as they are one of the primary indications of developing heart disease; especially those that fall into the at risk age groups. These risks consist of some that cannot be changed such as heredity risks, or those that can change such as smoking habits. It is very important to know these specific risks for prevention and to understand the symptoms of heart attacks, such as sweating or the feeling of weakness so if these or other symptoms occur people are aware. Finally heart disease treatment is of vital importance if you experience a heart attack so you can learn how to prevent another one from occurring.
The term, ischemia, denotes inadequate blood supply to tissues due to blockage of the arterial inflow, while, reperfusion injury is defined as the injury caused by the restitution of blood flow after an ischemic peroid, leading to death of cells that were only reversibly injured at the time of blood flow restitution. [63]. The final infarct size after an MI event is therefore the result of the ischemic and reperfusion damage. For this reason, the term that best describes this process of myocyte death in reperfused MI is myocardial ischemia/reperfusion (I/R) injury [64]. In the early hours post myocardial ischemia, injured cardiac cells can release several molecules, including adenosine, opioids, and bradykinin, which activate the G protein signaling pathways therefore promoting myocardial survival. While in the late phase, myocardial ischemia induces upregulation of growth factors and cytokines, including VEGF, ILGF and SDF-1, in the injured myocardium, hence promoting a cardio-protective state. The liver also participates in cardioprotection through the up regulation and release of secretory proteins, including FGF21 and TFF3, which also promote cardiomyocyte survival. [65]. Foundational studies performed about three decades ago with animal models demonstrated that an early reperfusion was able to limit infarct size [66]. Then fibrinolysis was indisputably associated with a decrease in mortality in patients with STEMI [67].A decade later; primary angioplasty was shown to be more superior than fibrinolysis [68]. Currently primary coronary angioplasty (PCI) has been established as the backbone treatment for STEMI patients. The period from the onset of symptoms of MI (representative of the time of coronary occlusion) and reperfusio...
Oxygen was first admitted to the client with chest pain over 100 years ago (Metcalfe, 2011). Chest pain is a large bracket that can contain many different conditions, but for the purpose of this analysis it is focused manly upon a myocardial infarction. A myocardial infarction is mainly referred to as a heart attack, and occurs when one or more coronary arteries leading to the heart reduce or completely stop blood flow (Tuipulotu, 2013 ). Administering high concentrations of oxygen to patients with chest pain is now embedded in guidelines, protocols and care pathways, even with a lack of clear supporting evidence (Nicholson, 2004 ). High concentration of oxygen means that up to 60% is administered (Knott, 2012). More recent research has suggested that the use of oxygen in this scenario is unnecessary and can lead to unwanted side effects, especially in normoxic cardiac patients (Moradkham & Sinoway, 2010 ). The aim of this comparative analysis is to dismantle and understand both the benefits and risks of the commonly known practice of administration of oxygen to the client with chest pain. Through completing this analysis using recent and appropriate evidence a more improved practice can be given and understood.
Myocardial infarction occurs when the coronary arteries are blocked by a blood clot. It is commonly known as “heart attack”. The heart needs its own constant supply of oxygen and nutrients to work properly. Two coronary arteries delivery oxygenated blood to the heart, and if one of these two arteries fail or become blocked, then a portion of the heart will not acquire the necessary oxygen. This clot could be because of CAD (coronary artery disease), which happens when the inner walls of the coronary arteries thicken because of build up of cholesterol, fatty deposit, calcium among other elements that are carried in the blood (Boston Scientific, 2009).