potential complications and nursing considerations

Acute myocardial infarction

Highest priority- irreversible myocardial death. It looks like: crushing, pressure-like chest pain (>20min), pain radiating to jaw, arm, shoulder, diaphoresis, nausea/ vomiting, SOB, anxiety, sense of doom, women/older adults: fatigue, indigestion, SOB.

Dangerous: coronary artery occludes leading to myocardial necrosis, then leading to lethal arrhythmias, cardiogenic shock or HF.

Nursing priorities: oxygen if SpO2<90%, 12-lead ECG within 10 minutes, cardiac enzymes (troponin ⬆), administer MONA per orders (morphine, oxygen, nitroglycerin, aspirin) , continuous cardiac monitoring, keep patient NPO (possible cath), prepare for PCI/ cardiac catheterization.

Lethal dysrhythmias (VT, VF, complete heart block)

Second highest- sudden cardiac death risk. Looks like: palpitations, dizziness or syncope, hypotension, no pulse (VF/VT), sudden LOC.

Ineffective cardiac output & no cerebral perfusion ➡ death in minutes.

Nursing priorities: immediate rhythm recognition, assess pulse & LOC, call rapid/code, defibrillation if indicated, IV access, administer antiarrhythmics per ACLS, continuous ECG monitoring.

Cardiogenic shock (pump failure)

Looks like: hypotension, cold, clammy skin, decreased urine output, altered LOC, pulmonary edema (crackles) , tachycardia. Dangerous: heart cannot pump ➡ systemic hypoperfusion and multi organ failure.

Nursing priorities: continuous BP & ECG monitoring, oxygen/ possible ventilators support, strict I&O, administer inorropes/ vasopressors, prepare for mechanical support (IABP, LVAD).

Acute decompensated heart failure (pulmonary edema)

Airway + circulation risk. Looks like: severe dyspnea, orthopnea, pink frothy sputum, crackles throughout lungs, S3 hear sound, weight gain, edema.

Dangerous: fluid overload ➡impaired gas exchange and can progress to respiratory failure.

Nursing priorities: high Fowler position, oxygen or BiPAP, IV diuretics daily weights, strict I&O, monitor BNP, electrolytes.

Pulmonary embolism (cardiac- respiratory overlap)

Looks like: sudden SOB, sharp chest pain, tachycardia, hypoxia, hemoptysis, anxiety. Dangerous: acute right ventricular strain leading to sudden death risk.

Nursing priorities: oxygen immediately, continuous pulse oximetry, CT angiography/ VQ scan prep, administer anticoagulants, bed rest initially, monitor for bleeding.

Uncontrolled hypertension

⬆silent organ damage. Looks like BP> 180/120, headache, blurred vision, chest pain, SOB. risk for stroke, MI, HF, kidney failure.

Nursing priorities: frequent BP monitoring, IV antihypertensives, monitor neuro status, gradual BP reduction

Pericardial Tamponade (restricted cardiac filling)

Looks like: becks triad( hypotension, JVD, muffled heart sounds), tachycardia, pulsus paradoxus. dangerous: decreased cardiac output leading to shock.

Nursing priorities: rapid recognition, notify provider STAT, prepare for pericardiocentesis, monitor BP and heart sounds closely.

Chronic heart failure progression

Looks like: fatigue, edema, SOB on exertion, weight gain, poor activity tolerance.

Nursing priorities: medication adherence, sodium& fluid restriction education, daily weights, symptom recognition teaching.