TREATMENT OF ACUTE MYOCARDIAL INFARCTION NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN

Acute Myocardial Infarction (AMI) is ischemia with death to the myocardium caused by lack of blood supply Can be classified as Q-wave or non-Q wave Q-wave results from total occlusion of coronary artery represented by in elevated ST segment and cardiac enzymes Non-Q wave results from partially occluded & associated with ST depression and increased cardiac enzymes Dx: 12-lead ECG, Cardiac Enzymes 12-lead vs 5-lead placement CK, CK-MB, Troponin levels

INTERVENTIONS 1.Pain Relief Morphine – increases collateral circulation NTG – vasodilates mcg.min titrated 2.Oxygen 4-6 L/min nasal cannula 3.Decrease Platelet Aggregation Aspirin po Repro ( gtt for 12 hours after bolus IV per kg) Aggrestat (weight based continuous gtt)

4.Thrombolytic Therapy Criteria of Usage: patient symptomatic for less than 6 hour, 20 minutes of CP not relieved by NTG, & Q-wave AMI Agents – -- Streptokinase: increase risk of reactions in patient’s with recent strep infections, less expensive but less reperfusion -- TPA: tissue plasminogen activator; caution with bleeding; bolus and gtt changes every hour for 3 then gtt runs at same rate for 3 hours -- TNK: tenecteplase a newer agent; single dose, 30-50mg over 5 seconds based on patient’s weight

** Heparin is still used in conjunction with other medications and sometimes with thrombolytics. Usually seen in Non- Q wave AMI Cardiology Interventions PTCA – percutaneous transluminal coronary angioplasty; compresses intracoronary plaque Coronary Rotational Atherectomy – compresses & shaves the plaque off the vessel wall & removes it with a rotablator Intracoronary Shunt – tubes placed at site of stenosis Nursing Care After Procedures