Apr
27
Not All Heart Attacks Are The Same
Filed Under heart attacks
Jaaska Lyn Cather asked:
Not All Heart Attacks Are the Same
Jaaska Lyn Cather, RN, BSN, MSN
Proper assessment, diagnosis, and treatment of the patient presenting with acute myocardial infarction will not only decrease mortality, but decrease morbidity as well. Properly indentifying the origin of the myocardial infarction by 12 lead EKG will decrease complications such as: arrhythmias, pump failure, hypo or hypertension, cardiogenic shock, congestive heart failure, and pulmonary edema. With the proper immediate treatment and interventions, your patient can reduce the incidence of suffering from long-term complications such as decreased ejection fraction. The ultimate goal of the treatment of the patient presenting with acute myocardial infarction is to save the heart muscle, which ultimately preserves heart function.
Every personnel that cares from the patient with acute myocardial infarction should be strongly encouraged to take a 12-lead EKG class. This includes paramedics in the field, Emergency Department staff, Cardiac Cath lab teams, and Critical Care nurses.
PRESENTATION OF ACUTE MYOCARDIAL INFARCTION
So what signs and symptoms will a patient presenting with acute myocardial infarction have? Typically, the patient will have severe, prolonged chest pain, lasting more than 30 minutes, which may be described as squeezing, tightness, or vise-like. The location is usually sub-sternal or retro-sternal, with radiation to the neck or jaw. Shortness of breath, nausea and vomiting commonly occur as well in the typical presentation. This patient’s pain is NOT relieved by nitroglycerin.
The atypical presentation of symptoms include: pain or discomfort either localized or radiating to areas such as the back, arms, or simply the epigastric area. This patient may have nausea and vomiting only, or fatigue. These vague symptoms make it harder to diagnosis acute myocardial infarction, therefore, a 12-lead EKG should be performed on all patients presenting with atypical symptoms. This patient is often anxious, and may have a feeling of “impending doom”. This is an ominous sign and should be taken seriously.
Left Ventricular Infarct or anterior myocardial infarction involves the left anterior descending artery. This patient will have ST changes in leads V1-V6, aVL.
The goal is to optimize left ventricular filling pressures and cardiac output. This is achieved by: diuretics and vasodilators to decrease pre-load and after-load, and inotropes to improve contractility. This patient often benefits from an Intra-Aortic Balloon Pump (IABP) to decrease the workload of the heart, and augment diastolic filling of the coronary arteries. Invasive hemodynamic monitoring should also be initiated to evaluate increased left heart pressures, as this patient can very easily develop pulmonary edema or congestive heart failure.
Right ventricular infarct involves the RCA in 80% of the population and the left circumflex artery in 20% of the population. ST changes will be seen in leads II, III, avF if the RCA is the culprit lesion, or V4R if the left circumflex artery is the culprit lesion.
Brady-arrythmias are the most common complication, and temporary trans-venous pacing may be required. Fluid boluses and inotropes should be administered. Fluid boluses will augment RV filling pressures, and are beneficial for this patient, but can be detrimental to the patient with LV infarct. Nitrates should also be avoided because they can produce profound hypotension.
Reperfusion by means of percutaneous transluminal coronary angioplasty and stenting within 90 minutes of onset of symptoms is the gold standard set by the American College of Cardiology. Thrombolytic therapy is also utilized in areas in which a cardiac cath lab is not available within this time frame. As stated previously, the goal in the treatment of the patient presenting with acute myocardial infarction is reperfusion to the myocardium and prevention of co-morbidities. With proper diagnosis of the origin of the infarct and proper treatment, many co-morbidities and possibly mortality may be avoided.
High Efficiency Gas Furnace
Not All Heart Attacks Are the Same
Jaaska Lyn Cather, RN, BSN, MSN
Proper assessment, diagnosis, and treatment of the patient presenting with acute myocardial infarction will not only decrease mortality, but decrease morbidity as well. Properly indentifying the origin of the myocardial infarction by 12 lead EKG will decrease complications such as: arrhythmias, pump failure, hypo or hypertension, cardiogenic shock, congestive heart failure, and pulmonary edema. With the proper immediate treatment and interventions, your patient can reduce the incidence of suffering from long-term complications such as decreased ejection fraction. The ultimate goal of the treatment of the patient presenting with acute myocardial infarction is to save the heart muscle, which ultimately preserves heart function.
Every personnel that cares from the patient with acute myocardial infarction should be strongly encouraged to take a 12-lead EKG class. This includes paramedics in the field, Emergency Department staff, Cardiac Cath lab teams, and Critical Care nurses.
PRESENTATION OF ACUTE MYOCARDIAL INFARCTION
So what signs and symptoms will a patient presenting with acute myocardial infarction have? Typically, the patient will have severe, prolonged chest pain, lasting more than 30 minutes, which may be described as squeezing, tightness, or vise-like. The location is usually sub-sternal or retro-sternal, with radiation to the neck or jaw. Shortness of breath, nausea and vomiting commonly occur as well in the typical presentation. This patient’s pain is NOT relieved by nitroglycerin.
The atypical presentation of symptoms include: pain or discomfort either localized or radiating to areas such as the back, arms, or simply the epigastric area. This patient may have nausea and vomiting only, or fatigue. These vague symptoms make it harder to diagnosis acute myocardial infarction, therefore, a 12-lead EKG should be performed on all patients presenting with atypical symptoms. This patient is often anxious, and may have a feeling of “impending doom”. This is an ominous sign and should be taken seriously.
Left Ventricular Infarct or anterior myocardial infarction involves the left anterior descending artery. This patient will have ST changes in leads V1-V6, aVL.
The goal is to optimize left ventricular filling pressures and cardiac output. This is achieved by: diuretics and vasodilators to decrease pre-load and after-load, and inotropes to improve contractility. This patient often benefits from an Intra-Aortic Balloon Pump (IABP) to decrease the workload of the heart, and augment diastolic filling of the coronary arteries. Invasive hemodynamic monitoring should also be initiated to evaluate increased left heart pressures, as this patient can very easily develop pulmonary edema or congestive heart failure.
Right ventricular infarct involves the RCA in 80% of the population and the left circumflex artery in 20% of the population. ST changes will be seen in leads II, III, avF if the RCA is the culprit lesion, or V4R if the left circumflex artery is the culprit lesion.
Brady-arrythmias are the most common complication, and temporary trans-venous pacing may be required. Fluid boluses and inotropes should be administered. Fluid boluses will augment RV filling pressures, and are beneficial for this patient, but can be detrimental to the patient with LV infarct. Nitrates should also be avoided because they can produce profound hypotension.
Reperfusion by means of percutaneous transluminal coronary angioplasty and stenting within 90 minutes of onset of symptoms is the gold standard set by the American College of Cardiology. Thrombolytic therapy is also utilized in areas in which a cardiac cath lab is not available within this time frame. As stated previously, the goal in the treatment of the patient presenting with acute myocardial infarction is reperfusion to the myocardium and prevention of co-morbidities. With proper diagnosis of the origin of the infarct and proper treatment, many co-morbidities and possibly mortality may be avoided.
High Efficiency Gas Furnace
