Acute Myocardial

Infarction
Anna Bianca Marie F. Watanabe | April Joy Cubil

back. neck. occurs when blood flow stops to a part of the heart causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder. arm. or jaw.What is AMI?  Commonly known as a heart attack. .

S4. clammy. restlessness. bradycardia or other dysrhythmias  SOB. Chest pain not relieved by rest or nitroglycerin  Heart sounds may include S3. or denial that anything is wrong . and onset of murmur  Increased jugular vein distention (if MI has caused heart failure)  Elevated blood pressure Assessing for Myocardial Infarction  Irregular pulse (may indicate atrial fibrillation)  Tachycardia. diaphoretic and pale appearance (due to sympathetic stimulation and may indicate cardiogenic shock)  Anxiety. lightheadedness (decreased cerebral oxygenation)  Fear with feeling of impending doom. crackles (if MI has caused pulmonary congestion)  Nausea and vomiting  Decreased urine output (may indicate cardiogenic shock)  Cool.

but ECG and cardiac biomarkers show no evidence of acute MI.Patients are diagnosed with one of the following forms of Acute Coronary Syndrome:  Unstable Angina: The patient has clinical manifestation of coronary ischemia.  NSTEMI: The patient has elevated cardiac biomarkers but no definite ECG evidence of acute MI. There is significant damage to the myocardium. .  STEMI: The patient has ECG evidence of acute MI with characteristic changes in two contiguous leads on a 12-lead ECG.

.  Myoglobin: found in cardiac and skeletal muscle. ST segment elevation. I and T. 12-lead ECG: T wave inversion. abnormal Q wave (develops within 1 to 3 days)  Echocardiogram: can detect hypokinetic and akinetic wall motion  Laboratory Tests: Diagnostics  There are three creatinine kinase isoenzymes: CK-MM (skeletal muscle). Levels begin to increase within a few hours. An increase in myoglobin is not very specific in indicating an acute cardiac event. I and T are specific for cardiac muscle. and CK-BB (brain tissue).  Troponin: three isomers C. CK-MB (heart muscle). CK-MB increases only with cardiac damage.

Normal ECG Tracing .

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 Use rapid transit to the hospital  Obtain 12-lead ECG to be read within 10 minutes  Obtain laboratory blood specimens of cardiac biomarkers  Obtain other diagnostics to clarify diagnosis Treatment Guidelines for AMI  Begin routine medical interventions:  Supplemental oxygen  Nitroglycerin  Morphine  Aspirin 162 to 325mg  Beta-blocker  ACE inhibitor within 24 hours  Anticoagulation with heparin and platelet inhibitors  Evaluate for indications for reperfusion therapy: PCI or thrombolytic  Continue therapy as indicated:  Intravenous heparin or LMWH  Clopidogrel  Glycoprotein IIb/IIIa inhibitor .

 Ineffective cardiac tissue perfusion related to reduced coronary blood flow  Risk for imbalanced fluid volume Nursing Diagnoses  Risk for ineffective peripheral tissue perfusion related to decreased cardiac output from left ventricular dysfunction  Death anxiety related to cardiac event  Deficient knowledge about post ACS self care .

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