Final Power Point MI

8/4/2019 Final Power Point MI

1/13

MI with PVCs

post coronaryAngioraphy,

PTCA, CABG

Presented by: Group 4

8/4/2019 Final Power Point MI

2/13

Patients Data

Name: Mr. M.I

Ward: Cardiac ICU

Address: Quezon City, Metro Manila

Gender: Male

Civil status: Married

Age: 45 years old Nationality: Filipino

Religion: Roman Catholic

Occupation: Executive Assistant

Admission: November 8, 2010

Attending physician: Dr. House Admitting diagnosis: to consider MI

Principal diagnosis: MI with PVCs PCA, PTCA,CABG

8/4/2019 Final Power Point MI

3/13

BRIEF DESCRIPTIONMyocardial Infarction a.k.a. MI/heart attack

- result of severe oxygendeprivation of myocardial tissue leading to

necrosis or infarction.Diagnosis:

Criteria according to WHO 2(probable) or3(definite)

1. Clinical history of Ischemic type chest pain

lasting more than 20-30 minuites2. Changes in ECG

3. Rise and fall of cardiac triomarkers(CK-MBand troponin)

8/4/2019 Final Power Point MI

4/13

* Cardiac triomarkers are more reliable

1. ECG- provides graphicrepresentation of cardiac electricallevel.

-analysis

Determine HR

Determine heart rhythm

Analyze P waves

Measure P-R interval Measure QRS duration

Interpret the rhythm

8/4/2019 Final Power Point MI

5/13

2. Cardiac cath

Most definitive but most invasive

Pre: relieve anxiety; asses psychological readiness

Review purpose of the procedure

Inform about expected sensation during procedure

Standard pre-op tests (x-ray, ECG, CBC) NPO post midnight

Site shaved

VS, heart sounds, lung sounds and peripheral

pulses Assess history of allergy (seafoods/iodine)

Mild sedation prior to procedure

8/4/2019 Final Power Point MI

6/13

Intra-op:

Taken to cardiac cath lab

Supine positon on table and strapped Local anesthesia on insertion site

Instruct to support any felt secretion

Post-op:

Bedrest (4-6 hrs)

Extremity kept straight

Apply pressure on insertion site

Vs, peripheral pulses

Monitor urine output

Pain medications may be given

8/4/2019 Final Power Point MI

7/13

LAB

troponin- indicates caridiac tissue necrosis

Ck-MB- indicates tssue necrosis

Treatment:

Medications:

1. NTG

2. Morphine SO4

3. Beta blockers

4. Calcium channel blockers

5. Antiplatelet

6. Thrombolytics

8/4/2019 Final Power Point MI

8/13

Emergency Care:

1. Description of chest discomforts

2. VS

3. Vascular access

4. Standing orders

5. ECG

6. Pain relief meds

7. O2 therapya

8. Remain calm

9. Check every 5 mins.

10. Notify physician

8/4/2019 Final Power Point MI

9/13

3. Surgery

Coronary Artery Bypass Grafts

- most common type of cardiac surgery surgery andchoice of treatment of medications are not enough formanagement

Pre-op

Return demo on how to splint the chest incision, coughand deep breathing

Expect sternal incision chest tubes, foley cath,pacemakers wires, and hemodynamic monitoring; ET

tube for several hrs. post op Breath with the ventilator

Assess and relieve anxiety

8/4/2019 Final Power Point MI

10/13

Intra-op

Under general anesthesia and intubation

CPB-cannulation of IVC and SVC to provide oxygenationcirculation and hypothermia during induced cardial arrest

Temp. 32 C

Harvesting of blood vessels

Heart is rewarmed

Regaining of strength and rhythm

Closing of incision

8/4/2019 Final Power Point MI

11/13

Post-op

Mechanical vent for 3-6 hrs

Monitor HR and heart rhythm

Treat symptomatic dysrhythmia

8/4/2019 Final Power Point MI

12/13

ANATOMY AND PHYSIOLOGY

8/4/2019 Final Power Point MI

13/13

Systemic Circulation