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