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TREATMENT OF ACUTE MYOCARDIAL INFARCTION NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN - PowerPoint PPT Presentation


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TREATMENT OF ACUTE MYOCARDIAL INFARCTION NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN. Acute Myocardial Infarction (AMI) is ischemia with death to the myocardium caused by lack of blood supply Can be classified as Q-wave or non-Q wave

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TREATMENT OF

ACUTE MYOCARDIAL INFARCTION

NUR 351/352

PROFESSOR DIANE E. WHITE RN MS CCRN


  • Acute Myocardial Infarction (AMI) is ischemia with death to the myocardium caused by lack of blood supply

  • Can be classified as Q-wave or non-Q wave

  • Q-wave results from total occlusion of coronary artery represented by in elevated ST segment and cardiac enzymes

  • Non-Q wave results from partially occluded & associated with ST depression and increased cardiac enzymes

  • Dx: 12-lead ECG, Cardiac Enzymes

  • 12-lead vs 5-lead placement

  • CK, CK-MB, Troponin levels


  • INTERVENTIONS the myocardium caused by lack of blood supply

  • Pain Relief

  • Morphine – increases collateral circulation

    • NTG – vasodilates 5-200 mcg.min titrated

    • Oxygen

    • 4-6 L/min nasal cannula

    • Decrease Platelet Aggregation

    • Aspirin po

    • Repro ( gtt for 12 hours after bolus IV per kg)

    • Aggrestat (weight based continuous gtt)


  • Thrombolytic Therapy the myocardium caused by lack of blood supply

  • Criteria of Usage: patient symptomatic for less than 6 hour, 20 minutes of CP not relieved by NTG, & Q-wave AMI

  • Agents –

  • -- Streptokinase: increase risk of reactions in patient’s with recent strep infections, less expensive but less reperfusion

  • -- TPA: tissue plasminogen activator; caution with bleeding; bolus and gtt changes every hour for 3 then gtt runs at same rate for 3 hours

  • -- TNK: tenecteplase a newer agent; single dose, 30-50mg over 5 seconds based on patient’s weight


  • ** Heparin is still used in conjunction with other medications and sometimes with thrombolytics. Usually seen in Non- Q wave AMI

  • Cardiology Interventions

  • PTCA – percutaneous transluminal coronary angioplasty; compresses intracoronary plaque

  • Coronary Rotational Atherectomy – compresses & shaves the plaque off the vessel wall & removes it with a rotablator

  • Intracoronary Shunt – tubes placed at site of stenosis

  • Nursing Care After Procedures


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