AMI & AAA

Infarction

area of cellular death and muscle necrosis ECG- Q waves

AAA Diagnosis

-Abdominal ultrasound -CT scan -MRI -Presenting symptoms

AAA Causes

-Atherosclerosis -HTN -Blood vessel diseases -Infarction in the aorta -Trauma

AAA Risk Factors

-Smoking -Age -Caucasian -Male -Family Hx -Prior aneurysms

AAA S/S

-Sudden, intense and persistent chest or back pain -Pain that radiates to your back -Trouble breathing -Low blood pressure -Loss of consciousness -Shortness of breath -Trouble swallowing

BUN

10-20 mg/dL

MAP

1systolic+2diastolic/3

Injury

Area of tissue that surrounds that area of infarction, still viable tissue, tissue is dying ECG: elevated ST segment Myocardial Infarction

AAA Post-Op Care

Assess for MI, graft occlusion/rupture, hypovolemia, hemorrhage, renal failure, respiratory distress, paralytic ileus Elective repair: 5-10% mortality Emergency repair: 50% mortality -C&DB -Pain control -ambulation -monitor H&H, electrolytes -neuro checks

AAA Repair

Done when aneurysm is >5" or growing quickly -replace damaged area with an synthetic graft -endovascular repair: less invasive and more commonly done

AAA Medical Treatment

If aneurysm is small, follow up to monitor size -Control of HTN, diabetes or any other comorbids -lifestyle changes

Absolute Contraindications for Thrombolytics

Intracranial Hemorrhage Hx of hemorrhagic stroke within 3 months Head trauma, spinal surgery, known aneurysm Active bleeding

HGB

Male: 14-18 Female: 12-16

HCT

Males: 42-52% Females: 37-47%

Ischemia

Outer region, contains viable tissue, lack of oxygen ECG: inverted T waves, ST depression

AMI Assessment and Testing

Patient history: family, personal, work, significant life changes pain: OLDCARTS, accompanying symptoms, precipitating factors, PAPPA physical exam: vital signs (ABCs), monitor rhythm, mentation/affect, skin, auscultate heart and lungs, pulses blood work ecg echocardiogram angiogram

AMI Categories

STEMI (transmural) Involves all three layers, endocardium, myocardium and epicardium ECG changes are seen with this MI Non Q-Wave MI or NSTEMI Subendocardial (involves endocardium) Subepicardial (involves epicardium) Not always associated with ECG changes

AMI Lab Work

Troponin: <0.03 CK-MB: 3-5% LDH: 50-150 BNP: <125pg/nl CBC CMP

Relative contraindications for thrombolytics

Uncontrolled HTN Low platelet count Recent surgery within 3 weeks Pregnancy

AMI timeline

Window of opportunity for myocardial preservation is within 4 hours of ONSET of pain 6 hours: muscle is dead, becomes distended, pale and cyanotic 48 hours: Myocardium reddened, can form exudate, leukocytes carry away necrotic tissue 3-4 weeks: scare tissue forms, walls become fibrotic and stiff

AMI definition

irreversible cell death

Creatinine

males 0.6 - 1.2 mg/dL; female 0.5-1.1

Beck's Triad

muffled heart sounds, narrowed pulse pressure, JVD

AMI cause

usually caused by a rupture of an unstable plaque with formation of a platelet plug