Podcast
Questions and Answers
What duration of chest pain typically indicates an instance of angina?
What duration of chest pain typically indicates an instance of angina?
- Up to 10 minutes
- 15 to 30 minutes
- More than 15 minutes
- Less than 15 minutes (correct)
Which diagnostic tool is primarily used to detect ischemia or acute coronary injury?
Which diagnostic tool is primarily used to detect ischemia or acute coronary injury?
- Stress test
- Coronary angiogram
- Electrocardiogram (correct)
- Echocardiogram
What is a common symptom of angina?
What is a common symptom of angina?
- Pressure radiating to the left shoulder (correct)
- Pain in the right arm
- Nausea without chest discomfort
- Severe abdominal pain
After a myocardial infarction, when can elevated levels of cardiac troponin I first be detected in serum?
After a myocardial infarction, when can elevated levels of cardiac troponin I first be detected in serum?
What is the main purpose of a coronary angiogram?
What is the main purpose of a coronary angiogram?
Symptoms of angina are typically relieved by which method?
Symptoms of angina are typically relieved by which method?
Which of the following enzymes is specifically analyzed in acute myocardial infarction?
Which of the following enzymes is specifically analyzed in acute myocardial infarction?
What is the primary cause of irreversible death of heart muscle during a myocardial infarction?
What is the primary cause of irreversible death of heart muscle during a myocardial infarction?
Which symptom would most likely indicate a developing myocardial infarction rather than angina?
Which symptom would most likely indicate a developing myocardial infarction rather than angina?
At what age do men independently acquire a higher risk factor for myocardial infarction?
At what age do men independently acquire a higher risk factor for myocardial infarction?
Which symptom is least characteristic of a myocardial infarction?
Which symptom is least characteristic of a myocardial infarction?
Which risk factor is not mentioned as contributing to myocardial infarction?
Which risk factor is not mentioned as contributing to myocardial infarction?
What occurs at the cellular level during a myocardial infarction due to prolonged ischemia?
What occurs at the cellular level during a myocardial infarction due to prolonged ischemia?
What is the most likely immediate effect of a rupture in an atherosclerotic plaque?
What is the most likely immediate effect of a rupture in an atherosclerotic plaque?
What term describes the condition when smaller arteries dilate to maintain blood flow to the cardiac muscle?
What term describes the condition when smaller arteries dilate to maintain blood flow to the cardiac muscle?
Which statement differentiates myocardial infarction from angina?
Which statement differentiates myocardial infarction from angina?
What is the primary purpose of myoglobin in the context of myocardial infarction?
What is the primary purpose of myoglobin in the context of myocardial infarction?
What critical period is indicated for the effectiveness of thrombolytic therapy following the onset of myocardial ischemia?
What critical period is indicated for the effectiveness of thrombolytic therapy following the onset of myocardial ischemia?
Which finding may be observed during the physical examination of a patient experiencing acute myocardial infarction?
Which finding may be observed during the physical examination of a patient experiencing acute myocardial infarction?
What complication can arise within 3 to 5 days after a myocardial infarction due to increased pressure against the heart walls?
What complication can arise within 3 to 5 days after a myocardial infarction due to increased pressure against the heart walls?
Which medication is commonly used to decrease myocardial oxygen demand?
Which medication is commonly used to decrease myocardial oxygen demand?
What effect does morphine sulfate have on a patient with myocardial infarction?
What effect does morphine sulfate have on a patient with myocardial infarction?
Which of the following is an elevated laboratory finding in a complete blood count during myocardial injury?
Which of the following is an elevated laboratory finding in a complete blood count during myocardial injury?
What condition can result from inflammation affecting the heart muscle after a myocardial infarction?
What condition can result from inflammation affecting the heart muscle after a myocardial infarction?
What is one key objective of cardiac rehabilitation?
What is one key objective of cardiac rehabilitation?
Which phase of cardiac rehabilitation occurs immediately after the patient is discharged?
Which phase of cardiac rehabilitation occurs immediately after the patient is discharged?
Which of the following is NOT a priority for patient education in cardiac rehabilitation?
Which of the following is NOT a priority for patient education in cardiac rehabilitation?
Why are intravenous sites examined frequently in patients with myocardium infarction?
Why are intravenous sites examined frequently in patients with myocardium infarction?
What is a potential complication for patients on anticoagulation therapy during prolonged bed rest?
What is a potential complication for patients on anticoagulation therapy during prolonged bed rest?
What change does calcium channel blocking agents primarily induce?
What change does calcium channel blocking agents primarily induce?
What is one psychological goal of cardiac rehabilitation?
What is one psychological goal of cardiac rehabilitation?
Which assessment is critical for a nurse caring for a patient with myocardium infarction?
Which assessment is critical for a nurse caring for a patient with myocardium infarction?
What is the primary goal related to ineffective cardiopulmonary tissue perfusion?
What is the primary goal related to ineffective cardiopulmonary tissue perfusion?
Which intervention is NOT appropriate for managing ineffective cardiopulmonary tissue perfusion?
Which intervention is NOT appropriate for managing ineffective cardiopulmonary tissue perfusion?
What should be closely monitored to assess potential altered peripheral tissue perfusion?
What should be closely monitored to assess potential altered peripheral tissue perfusion?
What intervention can help reduce a patient's anxiety related to fear of death and chest pain?
What intervention can help reduce a patient's anxiety related to fear of death and chest pain?
Which of the following is a sign that may indicate decreased cardiac output?
Which of the following is a sign that may indicate decreased cardiac output?
Which method is recommended for helping to relieve chest pain and discomfort in patients with ineffective cardiopulmonary tissue perfusion?
Which method is recommended for helping to relieve chest pain and discomfort in patients with ineffective cardiopulmonary tissue perfusion?
When monitoring vital signs in patients with potential altered peripheral tissue perfusion, how often should blood pressure be assessed?
When monitoring vital signs in patients with potential altered peripheral tissue perfusion, how often should blood pressure be assessed?
What physical intervention can help decrease myocardial oxygen consumption in patients with confined activity?
What physical intervention can help decrease myocardial oxygen consumption in patients with confined activity?
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Study Notes
Myocardial Infarction (Heart Attack)
- Irreversible death of heart muscle caused by prolonged lack of oxygen (ischemia)
- Atherosclerosis, a buildup of plaque in coronary arteries, is a primary cause
- Plaque ruptures, blocking blood flow and causing damage
Risk Factors
- Tobacco smoking
- High blood pressure
- Family history of ischemic heart disease
- Obesity
- Age: Men over 45, Women over 55 have increased risk
- Excessive alcohol consumption
Pathophysiology
- Plaque rupture in coronary arteries leads to a blood clot blocking blood flow
- Ischemia lasting over 20-45 minutes causes irreversible cell death (necrosis)
- Good collateral circulation can limit the size of the infarction
Signs and Symptoms
- Chest pain: can be mild discomfort or severe crushing pain, radiating to arms, neck, jaw, back, or waist
- Shortness of breath
- Nausea or stomach discomfort
- Fatigue
- Trouble sleeping
- Heart palpitations
- Anxiety
- Sweating
Myocardial Infarction vs. Angina
- Myocardial Infarction:
- Chest pain with heart muscle damage
- Pain is sudden, severe, and lasts over 15 minutes
- Symptoms not relieved by rest or nitroglycerin
- Angina:
- Chest pain without heart muscle damage
- Pain is a pressure or tightness in the chest, lasting less than 15 minutes
- Symptoms relieved by rest or nitroglycerin
Diagnosis
- Electrocardiogram (ECG): detects ischemia or acute coronary injury
- Coronary Angiography: visualizes narrowing or blockages in heart vessels, allowing immediate intervention
- Echocardiogram: assesses heart function
- Stress Test: measures heart response to physical activity
- Laboratory Tests:
- Serum Cardiac Markers (Enzymes):
- Troponins I: elevated within 3-4 hours after MI, peaking at 4-24 hours
- Creatine Kinase (CK): rises rapidly after MI, peaking at 4-6 hours
- CK-MB: most specific enzyme for heart muscle, detectable within 3-5 hours after MI
- Myoglobin: early indicator, rises within 1-3 hours after MI
- Complete Blood Count: elevated white blood cells due to inflammation
- Erythrocyte Sedimentation Rate: elevated due to inflammation
- Serum Cardiac Markers (Enzymes):
- Physical Examination:
- Assess general appearance, vital signs, skin color, and fever
- Monitor blood pressure, pulse, and respiratory rate
Complications
- Congestive Heart Failure: compromised heart function
- Myocardial Rupture: weakening of heart walls, occurring 3-5 days after MI
- Pericarditis: inflammation of the heart sac
Management
- Pharmacological Management:
- Thrombolytic Therapy: used within 12 hours of symptom onset (most effective within 2 hours)
- Streptokinase, urokinase, alteplase
- Analgesics:
- Morphine Sulfate: intravenous for pain and anxiety
- Nitroglycerin: dilates veins and arteries, reducing myocardial workload
- Beta-Blockers: reduce heart rate, blood pressure, and myocardial contractility
- Anticoagulation Therapy: prevents deep vein thrombosis during bed rest
- Calcium Channel Blockers: slow heart rate and relax blood vessels
- Antidysrhythmics: manage irregular heartbeats (e.g., lidocaine)
- Thrombolytic Therapy: used within 12 hours of symptom onset (most effective within 2 hours)
- Cardiac Rehabilitation:
- Phases:
- Phase I: initial education and stabilization
- Phase II: outpatient program for 4-6 weeks, including exercise training
- Phase III: long-term maintenance of cardiovascular stability
- Education: signs and symptoms, medication regimen, rest and activity balance
- Phases:
Nursing Process
- Assessment: gather information about chest pain, vital signs, and patient appearance
- Nursing Diagnoses, Planning & Intervention:
- Ineffective Cardiopulmonary Tissue Perfusion:
- Goal: relieve chest pain and discomfort
- Intervention:
- Oxygen administration
- Physical rest
- Elevate head of bed
- Monitor vital signs
- Administer nitroglycerin and morphine
- Potential Altered Peripheral Tissue Perfusion:
- Goal: promote adequate tissue perfusion
- Intervention:
- Monitor urine output
- Monitor mental status
- Limiting patient to bed or chair rest
- Oxygen therapy
- Monitor body temperature
- Monitor blood pressure
- Monitor respiration and lung sounds
- Anxiety:
- Goal: reduce anxiety
- Intervention:
- Provide education and reassurance
- Explore stress reduction methods
- Ensure quiet environment
- Ineffective Cardiopulmonary Tissue Perfusion:
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