Cardiology Terms MI
Terms
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- Dressler syndrome
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Post MI syndrome
characterized by pericarditis with effusion and fever that develops one to four weeks after MI - Myocardial infarction
- Myocardial tissue destroyed due to diminished blood supply. Caused by sustained ischemia causing your reversible cellular death.
- Area of bull's-eye
- Area of damage works out like a bull's-eye -- area away from the injury is less irritated
- Necrosis to heart
- Cells can withstand ischemic conditions for up to 20 minutes before cell death begins
- Transmural MI
- Full thickness of myocardium in the region is involved
- Subendocardial MI
- Damage has not penetrated through the entire thickness of the myocardial wall
- Inferior wall infarctions
- Result from right coronary artery lesions
- Anterior wall infarctions
- Result from lesions in the left anterior descending artery
- Lateral/posterior/inferior wall infarctions
- Result from lesions in the left circumflex artery
- Healing process after MI
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-- inflammatory process
-- 24 hours leukocytes infiltrate the area
-- enzymes are released by the dead cardiac sails
-- enzymes of neutrophils and macrophages remove all necrotic tissue by the second or third day - Healing Process of MI
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-Lipolysis & Glycogenolysis
-Collagn Matrix forms scar tissue after necrotic tisue is cleared
-By 6 weeks area is usually healed - Lipolysis
-
release of glucose
(will see rise in serum glucose levels) - Glycogenolysis
- release of fatty acids
- Clinical Manifistations of MI
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-Pain, Severe, immobilizing not relieved by repositioning, rest, nitrates
-Anxious, restless
-^ HR & RR
-N/V
-Fever may ^ 1st 24hr & last for 1 week - Site of MI pain
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Substernal
Epigastric
Retrosternal - MI presentation in Women
-
-c/o discomfort
-SOB
-Fatigue
**MI in women is usually mis-diagnosed - MI presentation in Elderly
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-SOB
-Edema
-AMS
-Dysrrhythmias - MI presentation in Diabetic
-
May not experience pain
**Silent MI** - Cardiovascular manifistations of MI
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-^BP initially -- then drop due to decreased CO
-HR may ^ initially
-Urine output may decrease (r/t decrease perfusion of kidneys
-Crackles to lungs may last hours - days
-hepatic enlargement, peripheral edema (may indiciate cardiac failure)
-Jugular vein distention (early ventricular dysfunction & pulmonary congestion) - Assessment & Diagnostics of MI
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-HX:
Details of current episode of pain: where, intesity/description, duration, percipitating factors
Risk Factors: (family, stress, activity)
Previous Illness (similar symptoms) - Diagnostics of MI
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-ECG
*ST segment ^
*Q wave or Non-Q wave (1-3 days)
*Serial measurement of cardiac markers - Diagnostic examination to establish or r/o MI
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-Cardiac Markers
*CK (creatine kinase)
*CK-MB
*LDH (lactic dehydrogenase)
*Myoglobin
*Troponin - Cardiac Markers
- Proteins released into the blood as a result of the necrotic hear muscle after an MI
- Main enzyme released after MI
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CK
Begin to rise in 3-12 hrs
Peak in 24hrs
Return to normal 2-3 days - Myocardial Specific Enzyme
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CK-MB
>3% ^ indicative of MI - Troponin
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Troponin T
Troponin I
-rises as quickly as CK
-remains ^ for 2 weeks
-^ 3-12 hrs
-Peak 24-48 hrs
-Returns to baseline 5-14 days - Myoglobin
-
-Released within few hrs of MI
-Lacks cardia specificity
-Rapidly excreted in urine resulting in blood levels returning to normal within 24hrs - Management of patient with MI
-
-minimize myocardial damage
-preserve myocardial function
-prevent complications - Medication tx for MI
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-Nitroglycerine IV
-Morphine
-ASA - Nitroglycerine IV
-
-promotes peripheral vasodilation, decreasing preload and afterload
-Coronary artery vasodilation - Morphine
-
-Acts as an analgesic and sedative
-Reduces preload and myocardial O2 consumption - Aspirin
- Inhibits platelet aggregation
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Angiotensin-converting enzyme
(ACE) inhibitors -
-Decreases mortality and prevents onset of CHF
-MOnitor B/P, urine output, serum sodium and potassium - Thrombolytics TNKase
-
-Dissolve & lyse thrombus in coronary artery
*must be given within very short period of time of onset of MI - Other collaborative Care/Tx of patient with MI
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-O2
-IV therapy
-Continuous monitoring
-Hemodynamic monitoring
*EKG, labs, v/s, Swans (pressures) - Complications of MI
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-Dysrrhythmias
*#1 complication of MI - most common cause of death
-Cardiogenic Shock
-CHF
-Papillary muscle dysfunction
-Ventricle aneurysm
-Pericarditis
-Dressler Syndrome
-PE - Pericarditis
-
-inflammation of visceral and/or parietal pericardium.
-may occur 2-3 days after acute MI
-Chest pain is aggravated by inspiration, coughing and movement of upper body
*Pain may be relieved by sitting in forward position
-Friction rub over pericardium - Nitropusside
-
-Glass bottle
-Very sesnitive to light
*bottle and tubing must be covered and protected from light - Papillary muscle dysfunction
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-Systolic murmur over apex of heart
-causes mitral valve regirgitation (^ volume of blood in left atrium) - Nursing Process for patient with MI
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-Cardiac & Resp. Asessment
-Nursing Dx - Nursing Dx in patient with MI
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-decrease myocardial perfusion r/t reduced coronary blood flow
-Potential impaired gas exchange r/t fluid overload from left ventricular dysfunction
-Potential altered peripheral tissue perfusion r/t decreased cardiac output
-Anxiety r/t fear of death
-Knowledge deficit about post MI self care - CABG
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Myocardial Revascularization:
*primary surgical tx for CAD
--usually patient had failed medical management - Reasons for Cardiac Surgery
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-Improve blood flow to the heart
-Repair/replace cardiac valves
-Congenital Anatomic Heart defects
-Cardiac Transplant - MIDCABG
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-minimally invasice direct coronary artery bypass grafting
-used for patients with LAD or single vessel dz (medical management not effective)
-several small incisions between ribs
-heart slowed with IV Beta adrenergic or calcium channel blockers
-Lt internal mammary artery is used for anasomosis to LAD - Care of patient with MIDCABG
-
-postop - like other cardiac surgery's
-IV nitro to minimize ischemia/coronary spasm
-Recovery time shorter
-Performed without cardiopulmonary bypass - Transmyocardial Laser
-
-indirect revascularization procedure using laser to make channels between lt ventricular activity & the cornary microcirculation
*channels allow blood to flow into ischemic areas
-may be performed during cath/surgery using lt anterior thoscotomy incision
_current tx for patients with CAD who are not candidates for bypass/failed medical therapy - Risk of "on pump" vs "off pump"
- has been found that "on pump" can result in deminished memory, decreased mental function in later years
- Graft sites for bypass
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-Saphenous vein
-Internal Mammary Artery
(Internal Thoracic Artery)
-Radial Artery
-Gastroepiploic Artery
-Inferior Epigastric Artery - Most common artery for used for bypass
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Internal Mammary Artery
-patency rate is ^ - Cardiac Surgery Complications
-
-Infection
-Collapse of graft
*patient will c/o heart pain
-Dysrrhytmias