Care of Patient with an Acute Myocardial Infarction (MI

1
Care of Patient with an Acute Myocardial
Infarction (MI)

• Tiffany Boyd BSN, RN, PCCN
• Staff Development Instructor
• Pinnacle Health

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Case Study

• Mrs. Rogers is a 63 year old Hispanic Female that
  was admitted to the ED with an Acute MI. She was
  experiencing vague heaviness for about 3 hours
  after a dinner party with co-workers. She really
  ate too much and the Mylanta helped a lot. She
  went to bed and was awakened feeling short of
  breath and noticed that her heart felt fluttery.
  The same chest heaviness returned. Mr. Rogers
  called 911.

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Case Study Cont.

• Past Medical History
• Anterior MI with stent in 2005
• EF 45
• Type 2 Diabetes
• High Cholesterol
• HTN
• Some wine on weekends
• BGMs 170s-190s

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Case Study Cont.

• Its 430pm and the charge nurse calls that you
  are receiving a 63 year old female patient from
  the Cath lab, Mrs. Rogers
• Next, you get report from the Cath lab

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Case Study Cont.

• Hi. I am calling report from the cath lab. You
  are receiving Mrs. Rogers. She is a 63 year old
  Hispanic female who came directly to us from the
  ED as a CODE STEMI. She was at a party felt
  indigestion like symptoms. She was diagnosed
  with an AWMI. We angioplastied stented the
  proximal LAD with 2 DES. She was angiosealed in
  the right groin. The site is soft and flat
  without hematoma or ecchymosis. Her pedal pulse
  is strong on the right. Her PMH includes
  previous MI with stent, DM, High Cholesterol,
  HTN. We gave her 25 of Fentanyl. Her sheath was
  removed at 1500 and she can get out of bed at
  2100. She has NSS infusing at 100ml/hr into a RFA
  peripheral IV. She had 600 mg of Plavix in the
  lab and still needs education on her MI. She
  will be arriving shortly. Any questions?

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Case Study Report

• S-
• B-
• A-
• R-

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Case Study Report

• S- Hi, I am calling report on Mrs. Rogers who is
  63 years old and came to us as a CODE STEMI,
  AWMI, from the ED. We angioplastied stented the
  proximal LAD x2 DES. Her previous stent was
  patent. Her right groin was angiosealed.
• B-
• A-
• R-

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Case Study Report

• S-
• B- She was at a party and felt indigestion-like
  symptoms. Her right groin is soft and flat
  without hematoma or ecchymosis. Her pedal pulse
  is strong on the right. Her PMH includes previous
  MI with stent, DM, High cholesterol, HTN. Her
  sheath was removed at 1500. She received 600mg of
  Plavix in the lab
• A-
• R-

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Case Study Report

• S-
• B-
• A- She can get out of bed at 2100. She has NSS
  infusing at 100ml/hr into a RFA IPID. She needs
  teaching about her MI.
• R-

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Case Study Report

• S-
• B-
• A-
• R- She will be arriving shortly. Any questions?

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Admission to Telemetry Unit

• Frequent Vitals
• Telemetry Monitoring
• Frequent Groin Checks
• Frequent Neurovascular Checks (pedal pulses)
• EKGs

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Lead Changes Wall Injury
septal
(LAD)
ANT
LAT
(CIRC)
(LAD)
ANT
septal
LAT
LAT
INF
(RCA)
(CIRC)
(CIRC)
(LAD)
ANT
INF
INF
(RCA)
(RCA)
LAT
(CIRC)
(LAD)
ANT
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EKG Changes

• ST elevation in V1-V4
• V1-V4 changes ?????
• ST elevation hyperacute T waves in V2-V4
  Acute MI (determining age of MI)

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EKG Changes

• ST elevation in V1-V4
• V1-V4 changes Anterior Wall MI
• ST elevation hyperacute T waves in V2-V4
  Acute MI (determining age of MI)

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PHS Algorithm for Code STEMI
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Symptom Differences

• Male vs. Female
• Diabetics

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Male vs Female
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Male vs Female

• 10 years older
• Less likely to have to typical angina
• Describes CP as sharp burning
• Pain in throat, neck, jaw, back area
• Other symptoms include nausea, GI symptoms, SOB,
  weakness, fatigue, sleep disturbance,
  palpitations
• Usually underestimates importance of CP

• Have CP at younger ages
• Typical angina symptoms
• Crushing pain, elephant sitting on chest
• Seeks help sooner
• More likely to have ST elevated MIs

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Diabetics

• Due to the automatic denervation of the heart
  with diabetes, most diabetics suffer from silent
  ischemia
• Some diabetics have blunted appreciation of
  ischemic pain, which may result in atypical
  anginal symptoms
• They wont have chest pain
• Symptoms more like SOB

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Diabetics

• During stress testing they wont have angina, but
  might have ischemia related to their prolongation
  of the anginal perceptual threshold

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Case Study

• Our patients symptoms
• vague heaviness
• Indigestion like symptoms
• SOB
• Fluttery heart (a-fib)
• Are these typical symptoms?
• Are these symptoms likely for a female?
• Are these symptoms likely for a diabetic?

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Case Study

• Would you have thought an Acute MI with this
  patient?
• What would you have treated her as?
• MI
• Indigestion
• A-fib