coronary artery disease and acute myocardial infarction l.
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Coronary Artery Disease and Acute Myocardial Infarction. NPN 200 Fall 2006. Coronary Artery Disease. Atherosclerosis Define: thickness and hardening of the arteries caused by deposits of fat and fibrin which harden.

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coronary artery disease
Coronary Artery Disease
  • Atherosclerosis
    • Define: thickness and hardening of the arteries caused by deposits of fat and fibrin which harden.
    • Leads to decreased lumen and decreased blood flow and ischemia and death of the tissue
  • Arteriosclerosis
    • Define: loss of elasticity and abnormal thickening or hardening of the walls of the arteries which can be due to accumulation of lipids, cholesterol, calcium or thrombus.
    • May also lead to occlusion of the lumen of the vessel, usually at the bifurcation of the vessels
    • May develop collateral circulation if develops slowly
signs and symptoms
Signs and Symptoms
  • Usually none until > 60%
  • LAD most effected
  • Pain usual symptom but may experience dyspnea
  • May have irregular heart rate
  • N/V may also accompany the other symptoms
  • Called angina
    • Unstable – persistent, even at rest
    • Prinzmetal's – variant, and may occur without atherosclerosis
medical treatment
Medical Treatment
  • Decrease risk factors
    • Diet
    • Control cholesterol/triglycerides
    • Exercise
    • Smoking
    • Hypertension
  • Drugs
    • Calcium channel blockers
    • Nitroglycerin
    • Low dose ASA
  • Surgery
myocardial infarction
Myocardial Infarction
  • Myocardial infarction is the necrosis of an area of cardiac tissue as a result of obstruction of blood flow through a coronary artery or one of its branches
  • The myocardial tissue dies as a result of the occlusion
  • The size and location of the necrosed area affects the heart’s ability to squeeze
  • Death occurs from this cardiac damage or complications R/T to the MI
  • ½ of deaths occur within 1 hour after the onset of symptoms
complications of an mi
Complications of an MI
  • Cardiogenic shock
  • Arrhythmias
  • CHF
  • Ventricular rupture or aneurysm
  • Pericarditis
  • Pulmonary embolism
  • Post-myocardial infarction
risk factors
Risk Factors
  • Smoking
  • Family history
  • Hypertension
  • Elevated triglycerides and cholesterol levels
  • Obesity
  • Sedentary lifestyle
  • Aging
  • Stress
  • Men more than women (but women are increasing)
  • Diabetes mellitus
causes
Causes
  • Arthrosclerosis (90%)
  • Constriction or spasm of the coronary artery
  • Coronary artery embolus
  • Coronary artery thrombus
assessment for chest pain
Assessment for Chest Pain
  • Subjection
    • Tightness, heaviness, squeezing, or crushing pain in the substernal area, which can radiate to the jaw, neck, left arm, or shoulder
    • Determine if pain is precipitated by an event (exercise, stress or exertion)
    • Is the pain relieved by rest or drugs?
    • Is there any predisposing factors?
    • URI, PE, Hypoxemia, blood loss
    • Patient may experience anxiety and feeling of doom
assessment for chest pain cont
Assessment for Chest Pain, cont.
  • Objective
    • Dyspnea
    • N/V
    • Profuse diaphoresis
    • Adventurous breath sounds
    • Tachycardia, decreased B/P, ^ temp
    • Elevation of cardiac enzymes (CPK, CPK-MB, AST, LDH, Troponin)
    • EKG changes
    • Results of any procedures completed
medical treatment12
Medical Treatment
  • Early treatment is important
  • Goal is to preserve myocardial tissue
  • Nitroglycerin
    • Dilates coronary arteries
  • Morphine sulfate – 2-4 mg titrated for pain relief
    • decreases blood return to the heart
    • decreases anxiety
    • relaxes smooth muscle in the lungs
    • has analgesic effect
medical treatment cont
Medical Treatment, cont.
  • Oxygen at 2-4 L/min
  • Thrombolytic therapy – must meet criteria
    • Streptokinase
    • TPA
    • Heparin
    • ASA
  • Lidocaine, Calcium channel blockers, Digoxin, Beta blockers, Dopamine, Dobutamine
  • Angioplasty/Stent placement
  • Coronary Artery Bypass Grafting
  • Transmyocardial Lazer revascularization
nursing interventions for mi
Nursing Interventions For MI
  • Provide quiet, calm environment
  • Keep client on bedrest for 24-48 hours
  • Give medications as ordered –analgesics, O2, Nitroglycerin
  • Elevate head of bed
  • Watch for any more chest pain
  • Maintain IV line
  • Monitor for signs of CHF, cardiogenic shock, and pulmonary edema
  • Evaluate signs of MI
    • Skin color, and temperature
    • Monitor vitals
    • Observe EKG for dysrhythmias
    • Monitor fluid volume levels
    • Check labs
continued care of mi
Continued Care of MI
  • Cardiac Rehab
    • Begin as soon as patient is stable
    • Individualized for need
    • Involves stages
    • Includes nurse, physician, nutritionist, physical therapy and social workers
  • Home care
    • Teach about medications
    • Include follow-up with physician
    • May need to teach about CAD
    • Teach modification of risk factors –weight, diet, smoking, exercise, etc.
    • Notify of any chest pain
cardiopulmonary arrest
Cardiopulmonary Arrest
  • Sudden cessation of hearts pumping function, stopping ventilation and circulation
  • Rapidly fatal if untreated
  • Accounts for > 350,000 deaths/year
  • Prompt treatment and early hospitalization necessary to prevent death
  • Causes
    • MI
    • V-Fib
    • Heart failure
    • Electrolyte imbalances
    • Hemorrhage
    • Electrical shock
objective symptoms
Objective Symptoms
  • Unconscious
  • Absence of pulse and respirations
  • Absence of heart sounds
  • Pupillary dilation
  • Cyanosis
diagnostic tests
Diagnostic Tests
  • History
  • Physical
  • EKG
  • Enzymes after emergency treatment
implementation
Implementation
  • CPR
  • ABC’s
  • IV for administration of drugs
  • ABG’s frequently
  • Give Lidocaine, etc.
  • Watch for hypoxia, arrythmias, acidosis, and hypokalemia
  • Monitor labs
  • Assess LOC, skin color, temp, pulses, seizures, pupil changes
  • Observe for complications (rib fractures, tamponade, pneumothorax)
  • Give emotional support to the family