Myocardial Infarction
A lab value specific for cardiac necrosis and MI.
What is troponin?
(Ignatavicius et al., 2021, p. 626)
The patient is as risk for this after a left heart catheterization (LHC) due to the medication administered to enhance visualization of the coronary arteries.
What is an acute kidney injury- intrarenal due to the IV contrast?
Get a good medical history before the procedure and monitor labs after the procedure.
(Ignatavicius et al., 2021, p. 629)
Frequency of monitoring the chest tubes for output/color/consistency.
What is hourly?
Report output greater than 150mL/hr to the surgeon.
(Ignatavicius et al., 2021, p. 770)
Oliguria is the first symptom of this MI complication.
What is pre-renal acute kidney injury (AKI)?
This results due to the lack of flow (decreased cardiac output) to the kidney. Watch for UOP less than 0.5mL/kg/hr or less than 30mL/hr.
(Ignatavicius et al., 2021, p. 763)
Screening tool used to rule out a medical emergency associated with chest pain.
What is a 12-lead EKG/ECG?
Remember we're looking for a STEMI or ST Elevation Myocardial Infarction, which is a medical emergency.
(Ignatavicius et al., 2021, p. 751)
If the Left Heart Catheterization (LHC) is unable to provide intervention and the patient has multi-vessel disease, the patient requires this surgery.
What is a coronary artery bypass graft (CABG)?
(Ignatavicius et al., 2021, p. 767)
Symptoms of a life threatening complication after CABG that must be reported IMMEDIATELY.
What are JVD with clear lung sounds, distant, muffled heart sounds, hypotension? Also sudden cessation of previously heavy chest tube drainage, pulsus parodoxus, cardiovascular collapse. All signs of cardiac tamponade.
(Ignatavicius et al., 2021p. 770)
This results in shortness of breath, crackles, increased respiratory effort and decreased oxygenation after a MI.
What is cardiogenic pulmonary edema?
(Ignatavicius et al., 2021, p. 763)
MI associated symptoms (because patients do not always present with CP)
What are N/V, diaphoresis, palpitations, SOB, dizziness, weakness, fatigue, neck/back/jaw/abdominal pain?
(Ignatavicius et al., 2021, p. 755)
The most commonly accessed site for a LHC.
What is the femoral artery?
The radial and brachial can also be used but are not used as frequently.
(Ignatavicius et al., 2021, p. 629)
Frequency to check neurologic status after a CABG.
What is q30-60 minutes until awakened from anesthesia, then q2-4 hours, depending on agency policy.
(Ignatavicius et al., 2021, p. 770)
The resultant ischemia and scar tissue with and after a MI does not transmit _______ well and can result in ___________.
What are electrical impulses and dysrhythmias?
(Ignatavicius et al., 2021, p. 763)
Pain management strategies recommended by the AHA to increase O2 supply and decrease myocardial oxygen demand.
What are morphine, oxygen, nitro, and nitro?
(Ignatavicius et al., 2021, p. 759)
These are things you should monitor AFTER the LHC.
What is monitor the access site for bleeding or hematoma, monitor the vitals (q15m for 1 hour, q 30 for 1 hour, q 1h for 4 hours, etc), monitor the peripheral pulse on the affected side along with color, cap refill, and temperature, monitor for flank/abdominal pain, abnormal rhythms, neurologic changes?
(Ignatavicius et al., 2021, p. 630)
Essential to control in order to prevent heart failure and leakage from suture lines.
What is blood pressure?
Hypertension after CABG is dangerous because it can cause bleeding and it increases the workload of the heart. Hypotension reduces cardiac output to the rest of the body and can cause the collapse of the coronary graft.
(Ignatavicius et al., 2021, p. 769)
After a myocardial infarction, the heart can remodel and this leads to.
What is cardiomyopathy?
Cardiomyopathy is treated very similarly to heart failure. Heart failure is also a complication of MI because scar tissue in the myocardium does not pump well.
(Ignatavicius et al., 2021, p. 752)
Invasive procedure that provides reperfusion of coronary arteries after STEMI and must be done within 90 minutes after identification. Also done with NSTEMI but not as urgently.
What is a left heart catheterization (LHC) with percutaneous coronary intervention (PCI)?
(Ignatavicius et al., 2021, p. 761)
If the patient has a stent after a left heart catheterization (LHC), they should be discharged on these medications.
What is dual antiplatelet therapy (DAPT)?
Aspirin with Plavix (clopidogrel) or Brillinta (ticagrelor) or Effient (prasugrel).
(Ignatavicius et al., 2021, p. 762)
A common problem after CABG that should be addressed before hypertension and vasoconstriction begin.
What is hypothermia?
Warming blankets and monitoring of the temperature are essential to prevent complications. However, rewarming should not be done too quickly because it can cause shivering which leads to metabolic acidosis and hypoxia. The temp should be raised no faster than 1 degree Celsius per hour.
(Ignatavicius et al., 2021, p. 769)
There might be a murmur after a heart attack indicating this complication.
What is valvular regurgitation?
The scar tissue after a heart attack can cause weak or failing papillary muscles, which open and close the valves.
Make sure to assess in all 4 points- All Physicians Take Money (aortic, pulmonic, tricuspid, mitral).
(Ignatavicius et al., 2021, p. 763)