Management of STEMIs-MJ

Question 1

How many minutes can a client experience cardiac ischemia before cell death occurs?

Answer 1

20 minutes, if longer than 20 minutes, myocyte injury is irreversible

Question 2

What does myocardial injury trigger?

Answer 2

Ventricular remodling

Question 3

What is ventricular remodeling?

Answer 3

A process when ventricular mass increases and the chambers change in volume and shape

Question 4

What is ventricular remodeling driven by?

Answer 4

Local production of angiotensin II

Question 5

What does ventricular remodeling increase the risk of?

Answer 5

HF and death

Question 6

There are 4 main signs and symptoms for an acute STEMI. What are they?

Answer 6

1. Presence of chest pain
2. Characteristic ECG changes
3. Elevated serum levels of myocardial cellular components
4. “Other”

Question 7

S&S for acute STEMI: Presence of chest pain

• Severe substernal pressure results in unbearable ____ or ______.
• Where does the pain radiate?
• How is this different from angina pectoris?

Answer 7

• unbearable crushing or constriction
• radiates down the arm and up to the jaw
• Pain by STEMI lasts longer! & not relieved by nitroglycerine

Question 8

S&S for acute STEMI: Characteristic ECG changes

-What do we see almost immediately in response to ischemia: ST elevation or depression? Then what develops?

Answer 8

ST elevation..then a prominent Q wave develops in the majority of patients

*Q waves are small or absent in a normal ECG

Question 9

S&S for acute STEMI: Elevated serum levels of myocardial cellular components
-What levels are looked at?

Answer 9

Troponin and creatinine kinase

Question 10

S&S for acute STEMI: What are the 4 “other” symptoms?

Answer 10

Sweating

• Weakness
• Sense of impending doom
• Know that about 20% of people with STEMI experience NO symptoms

Question 11

What are considered the BEST serum markers for STEMI?

Answer 11

Troponin!–cardiac troponin I and cardiac troponin T

Question 12

Under normal conditions, troponin is NOT detectable in the blood. When do they come detectable?

Answer 12

2-4 hours after symptom onset and peaks 10-24 hours…they return undetectable again in 5-14 days.

Question 13

What happens to troponin when STEMI occurs?

Answer 13

100 fold or more above the lower limits of detection

Question 14

Measurements of troponin I and T are more -____ (sensitive or specific)

Answer 14

Sensitive

Question 15

Before troponins, the preferred biomarker for STEMIs were measuring the creatinine-kinase (CK-MB). Where is CK-MB found?

Answer 15

Primarily in cardiac muscle rather than skeletal muscle

Question 16

What does an increase in serum CK-MB mean?

Answer 16

Cardiac injury

Question 17

What medication must be given immediately to a client with a STEMI? What meds should be discontinued?

Answer 17

Aspirin can be given..all other NSAIDs should be discontinued!!!!

NSAIDs, with the exception of aspirin, have a BBW for increased risk of stroke and MI

Question 18

Why do we give aspirin immediately to a client with a STEMI?

Answer 18

Suppresses platelet aggregation (producing an immediate anti-thrombiotic effect)

Question 19

When should aspirin therapy begin and when should it end?

Answer 19

Aspirin therapy should begin immediately after onset of symptoms for a STEMI and it should be continued indefinitely!

Question 20

Why is chewable aspirin given for the first dose?

Answer 20

The first dose should be chewed to allow rapid absorption across the buccal mucosa

Question 21

What should the dose be for the chewable aspirin?

Answer 21

162-325 mg

Question 22

For prolonged aspirin therapy, what should the dose be? And why do we give aspirin indefinitely after STEMIs?

Answer 22

81-162 mg/d

Reduces the risk of re-infarction, stroke, and death

Question 23

What is the analgesic of choice for STEMIs?

Answer 23

IV morphine

Question 24

What does IV morphine improve?

Answer 24

Hemodynamics and relieves pain

Question 25

What does IV morphine reduce?

Answer 25

Cardiac PRELOAD by promoting venodilation

Question 26

Since IV morphine reduces preload, that means it ____ the work of the heart

Answer 26

Decreases

Question 27

IV morphine also may cause some reduction in after load by promoting _____

Answer 27

Arterial dilation

Question 28

IV morphines combined reduction in preload and after-load _____ cardiac oxygen demand and that helps preserve the ischemic myocardium

Answer 28

Lowers

Question 29

What BB reduces cardiac pain, infarction size, and short-term mortality?

Answer 29

Atenolol and metoprolol

Question 30

Continued use of oral BB _____ long term survival

Answer 30

Increases

Question 31

T/F: Nearly all patients can benefit from BB, but many don’t get them.

Answer 31

True

Question 32

T/F: The patients that DO get a BB, get a dose that is too high.

Answer 32

False. The patients that do get the BB usually has a dose that is too LOW

Question 33

As STEMI evolves, the HR and force of contraction rises substantially, _____ cardiac demand.

Answer 33

Increases