M06: Cardiac

MI lab test: troponin I

highly sensitive to cardiac tissue

MI lab test: LDH

• Creatine Kinase, CK-MB, LDH

• BMP, CBC, BNP, Lipid Profile

MI diagnostic test

• 12 lead ECG → to determine stable/unstable/nSTEMI/STEMI

• Cardiac Angiography** (Left Heart Catheterization)

if STEMI, what test do we do for diagnosis/treatment

Cardiac Angiography** (Left Heart Catheterization)

ECG Evolution of MI: stage 1

Ischemic changes

ECG Evolution of MI: stage 2

Infarction ST Elevation (mins to hrs.)

ECG Evolution of MI: stage 3

Q waves (up to 12 hrs.)

ECG Evolution of MI: stage 4

ST elevation with t-wave inversion (persist for 2-5 days)

Treatment goals of medical management MI

• Maximize oxygenation

• Control pain (get them to PCI lab)

• Dilate coronary arteries

• Prevent clots

• Decrease myocardial workload

Reperfusion Therapy for MI

• Percutaneous coronary intervention

• Fibrinolytics (within 30 min of arriving, determine if eligible)

Medication Treatment DURING MI

• Morphine (Pain medication)

• Oxygen

• Nitroglycerin (vasodilate coronary artery, reduce workload on heart)

• Aspirin

“MONA”

Medication Treatment AFTER MI

• Daily ASA

• Betablockers (decrease HR)

• Lipid lowering medications (i.e., Statins)

• Antiplatelet (i.e., Clopidogrel)

• ACE inhibitors or ARB

Surgical management for MI, pre & post op management

Coronary artery bypass graft (CABG)

Pre-op

• Education, grooming, labs (Type & Screen), diagnostic tests

Post-op

• Monitoring, pain management, medications, sternal precautions (PT/OT)

• Complications: Arrhythmias, bleeding, infection, organ failure, cardiac tamponade

CABG Complication: Cardiac Tamponade symptoms

Beck’s Triad

1. hypotension

2. diminished heart sounds

3. distended neck veins

Nursing management: Priority problems for MI

• Decreased cardiac output

• Decreased tissue perfusion

• Pain

Nursing management: Assessment + reassessment! MI

• Vital signs and pulse oximetry

• Characteristics of pain

• ECG

• Restlessness

• Skin color and temperature, peripheral pulses, diaphoresis

• Urine output

• Labs

Nursing management: Interventions MI

• Administer oxygen

• Insert two large-bore IVs

• Administer medications as ordered

• Continuous ECG monitoring

• Bed rest

Nursing management: Teaching MI

• Report s/s of MI

• Medication education

  • Quadruple Therapy

    • Betablocker, Statin, ASA, ACE or ARB

• American Heart Association “Life’s simple 7”

Nursing management: Evaluation MI

• Nursing Management – Evaluating care outcomes

  • Resume normal activity

  • Pain free

  • Anxiety free