Cardiac-MI V Angina

  1. Myocardial Perfusion
    • Supply
    • - coronary arteries (wide open)
    • - adequate circulation- BP
    • - adequacy of blood
    •   - how well is blood carrying O2
    • Demand
    • - Inc work or O2 demand
    • - myocardial damage or hypertrophy- enlarged
    • supply have to meet demand
    • demands goes up and we cant supply need we have a problem
  2. Angina Pectoris
    • CP associated w/myocardial ischemia
    • insufficient blood supply
    • exertion, emotion, exposure to cold can percipitate
  3. Angina Pectoris- Patho
    • ischemia- reduced pumping action---anaerobic metabolism--- lactic acid production--- pain
    • ** with restoration of blood flow, no permanant damage
    • fix it by giving the cell what they are asking for
    • goal: to increase O2 to cell
  4. Angina- type
    • Stable- predictable, stable (you know when it starts and when it will go away)
    • unstable- unpredictable , worsening (the demand gets so hgih when you are just resting)
    • Variant (Prinzmetal's)- usually due to spasm
  5. Myocardial Infarction
    • Mortality rate 30-40%
    • most deaths before reaching the hospital
    • 80% of those who reach hospital survive
    • In hospital deaths usually occur within first 72 hrs
    • * in the first 72 hours most critical
    • starts with angina (ischemia) then cells dies
  6. Acute MI
    • Us after sudden CA (coronary artery) occlusion
    • & abrupt loss of O2 & blood supply to myocardium
    • life threatening
    • too many victims wait before seeking help
    • those cells can only be ischemic for 20 mins
    • total occulusion of cell
  7. Patho MI
    • Atherosclerotic plaques narrow vessel, thrombus occuldes it
    • prolonged, unrelieved ischemia causes irreversible damage- necrosis
    • cardiac cells can only withstand about 20 mins of ischemia before necrosis starts
    • starts w/CAD- thrombus occuldes
  8. Patho MI 2
    • anaerobic metabolism- latic acid- dec contractility
    • ANS tries to compenstate- inc imbalance
    • acidosis
    • leads to conduction disorders and dysrhythmias
    • prolonged ischemia-- irreversible cellular damage & necrosis
    • (chest pain- go to hospital)
    • contractile function lost permanently
    • intracellular exzymes released (once cells die they release enzymes- labs will tell you if you had MI)
  9. Patho MI 3
    • necrosis can be in 1 layer (NSTEMI) or all 3 layers (STEMI)
    • Infarction process can take up to 6 hrs to complete
    • Stemi- ST elevation myocardial infarction
    • NStemi- 1 layer of hear
    • - cant see on EKG
  10. Angina or MI?
    • Chief Compliant
    • - Chest pain **Pain= ischemia
    • P- precipating, agravating, allevating
    • Q- quality- subjective what does it feel like
    • R- Radiating, region, where is it, does it travel
    • S- severity (0-10)
    • T- time ** TIME= muscle
  11. Angina or MI
    • CEP- serial x 24H- keep doing this
    • CK, CKMB- elevates in 4 hours (both elevated in MI- CKMB (heart) norm if not MI)
    • Troponin- elevates in 3h, normalizes 5-7d (heart muscles)
    • Myoglobin- elevates in 3 hrs (tells muscle damage)
  12. Angina or MI- EKG
    • angina- ST depression
    • MI ST elevation
  13. Q wave formation
    if pt has a Q wave they had a MI in the past
  14. Exercise Tolerance test
    • stress test
    • exercise incr myocardial o2 demand
    • radioactive isotopes may be injected to study function, motion, perfusion- look at rest and exercise and how things are being perfused
    • false (+) often in women , false (-) less common
    • pain is ischemia
    • - if pain failed test
    • - didn't have supply to meet demands
  15. ETT nursing
    • NPO, no tobacco 4 hours before test
    • flat, comfortable shoes
    • loose clothing
  16. ETT- Persantine or Adenosine
    • alternate to exercise
    • IV to dilate coronary arteries, then radioactive isotopes
    • same pre care as above- NPO, no smoking
    • antagonist- aminophylline (stop ischemia, give med if pain comes)
    • pt who cant exercise
Card Set
Cardiac-MI V Angina
chest pain chest pain what to do