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 5-200 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