Cardiac muscle tissue death from lack of blood flow. The blood carries oxygen and nutrients to the cells. When this is decreased, cells die also called necrosis. Cardiac muscle cells dying is problematic as they do not regenerate (although there is some debate of this topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042154/ )
Narrowing or occlusion of the cardiac vessels that perfuse the heart. The plaque that causes this could be from poor diet, lack of exercise, or genetics. It can also be from a deep vein thrombosis (DVT) that has broken free (embolus) and landed in the heart.Re-perfusion to cardiac muscle and return of cardiac muscle functionality, or as much as possible.
Re-perfusion to cardiac muscle and return of cardiac muscle functionality, or as much as possible.
*note – this is only a mnemonic and not the correct order of administration – see rationale for details*
Initial treatment for acute coronary syndrome.
If initial 12-lead ECG indicates inferior MI, do a right-sided 12-lead ECG.
Assess a 12 lead ECG immediately on anyone complaining of chest pain to determine if an ST elevated MI is occurring. If it is-Take the patient to the cath lab STAT! If the ECG is a normal sinus or otherwise non-concerning rhythm, place them on a 3 or 5 lead cardiac monitor for frequent re-assessing.
Right sided 12 lead ECG shows the right side of the heart to assess for right ventricular ischemia. **Inferior MI’s need to be treated differently!**
3 or 5 Lead monitoring
No matter the outcome of the 12 lead ECG, placing a patient on a form of cardiac monitoring is key. You are worried about a worsening condition such as cardiac arrest.
Cardiac Catheterization with Percutaneous Coronary Intervention (PCI)
A patient who has an ST elevated MI (STEMI) will be rushed to the cath lab so they can locate the clot and place a stent to regain blood flow to the heart.
A patient may also go to the cath lab without having a STEMI, and they may still find a clot. Most NON-STEMI’s are treated without catheterization.
This is important because the higher the blood pressure, the more pressure is on a clot. It isn’t out of the question for someone to have more than one clot, and increased pressure could break free a clot lodge itself somewhere else either in the heart, lungs, brain, or extremity.
This is an anticoagulant that breaks up blood clots (as well as prevents them).
Insert Large Bore IV and draw initial Cardiac Enzymes
IV access is important for administration of medications, possible interventions if angina worsens, and any scans that may be needed to rule out thrombosis.
Cardiac enzymes further serve to rule out Myocardial Infarction and can give an indication to the extent of myocardial damage.
Monitor Cardiac Enzymes:
The values of these enzymes are based on your institutional laboratory technique. If they are elevated it indicates that the cardiac muscle is stressed out or injured.
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