Podcast
Questions and Answers
What is a characteristic of angina?
What is a characteristic of angina?
What does a coronary angiogram primarily visualize?
What does a coronary angiogram primarily visualize?
How does chest pain characteristic of angina typically present?
How does chest pain characteristic of angina typically present?
What is the primary purpose of the electrocardiogram (ECG)?
What is the primary purpose of the electrocardiogram (ECG)?
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Which cardiac marker is specifically found only in cardiac muscle and indicates myocardial injury?
Which cardiac marker is specifically found only in cardiac muscle and indicates myocardial injury?
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After a myocardial infarction, when do cardiac troponin I concentrations typically begin to elevate?
After a myocardial infarction, when do cardiac troponin I concentrations typically begin to elevate?
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Which statement about stressful situations and heart response is true?
Which statement about stressful situations and heart response is true?
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What is the normal range for CK-MB levels in the blood?
What is the normal range for CK-MB levels in the blood?
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What is the normal range of myoglobin in nano gram/ml?
What is the normal range of myoglobin in nano gram/ml?
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Which complication is most common three to five days after a myocardial infarction?
Which complication is most common three to five days after a myocardial infarction?
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Which symptom is NOT commonly observed during a physical examination of a patient with myocardial infarction?
Which symptom is NOT commonly observed during a physical examination of a patient with myocardial infarction?
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Which pharmacological therapy is indicated for myocardial ischemia within 12 hours of symptom onset?
Which pharmacological therapy is indicated for myocardial ischemia within 12 hours of symptom onset?
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What is the primary purpose of administering nitroglycerine in patients with myocardial infarction?
What is the primary purpose of administering nitroglycerine in patients with myocardial infarction?
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What happens to blood pressure in some patients during a myocardial infarction?
What happens to blood pressure in some patients during a myocardial infarction?
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Which of the following is NOT a benefit of opiate analgesic therapy in myocardial infarction management?
Which of the following is NOT a benefit of opiate analgesic therapy in myocardial infarction management?
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What is a common laboratory finding associated with myocardial infarction due to inflammation?
What is a common laboratory finding associated with myocardial infarction due to inflammation?
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What is the primary cause of myocardial infarction?
What is the primary cause of myocardial infarction?
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At what age does men acquire an independent risk factor for myocardial infarction?
At what age does men acquire an independent risk factor for myocardial infarction?
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Which of the following symptoms is commonly associated with a myocardial infarction?
Which of the following symptoms is commonly associated with a myocardial infarction?
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What can happen if atherosclerotic plaque ruptures in a coronary artery?
What can happen if atherosclerotic plaque ruptures in a coronary artery?
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Which of the following factors is NOT a risk factor for myocardial infarction?
Which of the following factors is NOT a risk factor for myocardial infarction?
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What role do collateral vessels play during a myocardial infarction?
What role do collateral vessels play during a myocardial infarction?
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What happens to heart muscle cells when ischemia lasts longer than 20-45 minutes?
What happens to heart muscle cells when ischemia lasts longer than 20-45 minutes?
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How does chest pain in myocardial infarction differ from angina?
How does chest pain in myocardial infarction differ from angina?
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What is the primary objective of cardiac rehabilitation?
What is the primary objective of cardiac rehabilitation?
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Which phase of cardiac rehabilitation focuses on maintaining cardiovascular stability?
Which phase of cardiac rehabilitation focuses on maintaining cardiovascular stability?
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What is a common component of Phase II of cardiac rehabilitation?
What is a common component of Phase II of cardiac rehabilitation?
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Which of the following is NOT a priority for education during cardiac rehabilitation?
Which of the following is NOT a priority for education during cardiac rehabilitation?
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What effect do calcium channel blockers have on the heart?
What effect do calcium channel blockers have on the heart?
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What should be assessed first in a patient with suspected myocardial infarction?
What should be assessed first in a patient with suspected myocardial infarction?
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What is the role of anticoagulation therapy during prolonged bed rest?
What is the role of anticoagulation therapy during prolonged bed rest?
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What is a significant risk associated with intramuscular injections in myocardial infarction patients?
What is a significant risk associated with intramuscular injections in myocardial infarction patients?
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What is the primary goal of the nursing intervention for ineffective cardiopulmonary tissue perfusion?
What is the primary goal of the nursing intervention for ineffective cardiopulmonary tissue perfusion?
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Which of the following interventions is appropriate to achieve the goal of adequate tissue perfusion?
Which of the following interventions is appropriate to achieve the goal of adequate tissue perfusion?
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What is the correct flow rate for oxygen delivery to maintain oxygen saturation at 96-100%?
What is the correct flow rate for oxygen delivery to maintain oxygen saturation at 96-100%?
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What nursing action can help reduce a patient's anxiety related to fear of death and chest pain?
What nursing action can help reduce a patient's anxiety related to fear of death and chest pain?
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How often should urine output be monitored to assess renal blood flow in a patient with potential altered peripheral tissue perfusion?
How often should urine output be monitored to assess renal blood flow in a patient with potential altered peripheral tissue perfusion?
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Which measure helps in reducing the workload of the heart for a patient with ineffective cardiopulmonary tissue perfusion?
Which measure helps in reducing the workload of the heart for a patient with ineffective cardiopulmonary tissue perfusion?
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What vital sign should be monitored every 2 hours due to its potential impact on cardiac function?
What vital sign should be monitored every 2 hours due to its potential impact on cardiac function?
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Which nursing intervention can assist in alleviating anxiety for a patient in cardiac distress?
Which nursing intervention can assist in alleviating anxiety for a patient in cardiac distress?
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Study Notes
Myocardial Infarction (Heart Attack)
- Irreversible death of heart muscle caused by prolonged lack of oxygen supply (ischemia)
- Can be triggered by psychological stress, physical exertion, infection, or trauma
- Occurs when an atherosclerotic plaque ruptures in a coronary artery, blocking blood flow
Risk Factors
- Tobacco smoking
- High blood pressure
- Family history of ischemic heart disease
- Obesity
- Age: men over 45, women over 55
- Prolonged alcohol consumption
Pathophysiology
- Plaque rupture leads to occlusion of the coronary artery
- Ischemia lasting more than 20-45 minutes causes cell death and tissue necrosis
- Good collateral circulation can limit the size of the infarction
Signs and Symptoms
- Chest pain: can be mild or severe, may radiate to arms, neck, jaw, or back
- Shortness of breath or trouble breathing
- Fatigue
- Nausea or stomach discomfort
- Heart palpitations
- Anxiety
- Sweating
Myocardial Infarction vs. Angina
- Myocardial Infarction: chest pain with heart damage, lasts for more than 15 minutes, not relieved by rest or nitroglycerin
- Angina: chest pain without heart damage, lasts less than 15 minutes, relieved by rest or nitroglycerin
Diagnosis
- Electrocardiogram: primary tool to detect ischemia or coronary injury
- Angiography: visualizes narrowing or obstructions in heart vessels, allows immediate therapeutic intervention
- Echocardiogram: identifies areas of the heart not working properly
- Stress test: evaluates heart response to exercise
-
Laboratory tests:
-
Serum Cardiac Markers (Enzymes):
- Troponin I: rises within 3-4 hours after infarction, peaks at 4-24 hours, remains elevated for 1-3 weeks
- Creatine Kinase (CK): rises 4-6 hours after infarction, declines over 48-72 hours
- CK-MB: most specific enzyme for cardiac tissue, rises 3-5 hours after infarction, peaks at 10-20 hours, returns to normal within 3 days
- Myoglobin: rises 1-3 hours after infarction, peaks at 4-12 hours, returns to normal in 24 hours
- Complete Blood Count: elevated white blood cell count due to myocardial inflammation
- Erythrocyte Sedimentation Rate: elevated due to inflammation
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Serum Cardiac Markers (Enzymes):
-
Physical Examination:
- Patient may be comfortable or in distress
- Cool, pale skin
- Low-grade fever
- Blood pressure may be elevated or decreased
- Irregular pulse
Complications
- Congestive heart failure: heart's pumping ability is compromised
- Myocardial rupture: most common 3-5 days after infarction, can occur 1-3 weeks later
- Pericarditis: inflammation of the heart sac
Management
-
Pharmacological Management:
- Thrombolytic therapy: streptokinase, urokinase, alteplase, used within 12 hours of symptom onset
-
Analgesics:
- Morphine sulfate: decreases pain and anxiety, relaxes bronchioles
- Demerol: pain management for patients allergic to morphine
- Nitroglycerine: dilates veins and arteries, decreases myocardial workload
- Beta-adrenergic Blocking Agents: reduce myocardial oxygen consumption, decrease heart rate and blood pressure
- Anticoagulation Therapy: prevents deep venous thrombosis
- Calcium Channel Blocking Agents: slow heart rate, decrease muscle contraction, relax blood vessels
- Antidysrhythmics: lidocaine, decreases ventricular irritability
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Cardiac Rehabilitation:
- Objectives: limit atherosclerosis progression, return patients to work and daily life, enhance psychological status
-
Phases:
- Phase I: begins with diagnosis, initial education for patient and family
- Phase II: outpatient program, lasts 4-6 weeks, focuses on exercise, education, and support
- Phase III: focuses on long-term maintenance, patient self-directed
-
Nursing Process:
- Assessment: Gather information regarding chest pain, vital signs, observe for pallor, dyspnea, weakness, confusion, assess cognitive, behavior, and emotional status
-
Nursing Diagnosis, Planning, and Intervention:
-
Ineffective Cardiopulmonary Tissue Perfusion:
- Goal: Relief of chest pain and discomfort
-
Interventions:
- Administer oxygen
- Assess vital signs frequently
- Physical rest
- Elevate head of bed
- Administer nitroglycerine and morphine based on vital signs
-
Potential Altered Peripheral Tissue Perfusion:
- Goal: Promoting adequate tissue perfusion
-
Interventions:
- Monitor urine output hourly
- Monitor mental status
- Limit patient to bed rest
- Administer oxygen
- Monitor blood pressure, respiration, and lungs
-
Anxiety:
- Goal: Reducing anxiety
-
Interventions:
- Provide information and education
- Explore stress reduction methods (music therapy, relaxation techniques)
- Ensure a quiet environment, use appropriate touch
-
Ineffective Cardiopulmonary Tissue Perfusion:
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Description
This quiz covers key aspects of myocardial infarction, including causes, risk factors, pathophysiology, and symptoms. Learn to differentiate between myocardial infarction and angina as well. Test your knowledge and reinforce your understanding of heart health.
