Myocardial Infarction - Management

MEDICAL MANAGEMENT

Major goals of care for clients with AMI include the following:

• Initiating prompt care

• Reducing pain

• Delivering successful treatment for the acute pain and reperfusion of the myocardium

• preventing complications

• preventing remodeling and heart failure

• Rehabilitating and educating the client and significant others.

Treat the Acute Attack Immediately. Clients with manifestations of AMI must receive immediate treatment. Delays may increase damage to the heart and reduce the chance of survival. The goal for treatment of AMI is “door to needle” in less than 30 minutes, or specifically from on set of pain till thrombolytic therapy within 30 minutes or percutaneous angioplasty within 1 hour. Most communities have an emergency medical system (EMS) that responds quickly (call “911”) . Until EMS personal arrive, keep the client quiet and calm. It is recommended that, if conscious, a client chew an aspirin with the onset of manifestations, because mortality is reduced 23% with this action alone.

Reduce Pain. Upon admission, the client who complains of chest pain is admitted to the emergency department, given oxygen therapy, and placed on ECG monitoring. An 1V line is placed, serum cardiac makers are drawn, and a 12- lead ECG is undertaken within 10 minutes. Pain control is a priority, and pain is usually treated with 1V morphine. Continued pain is a manifestation of myocardial ischemia. Pain also stimulates the autonomic nervous system and increases preload, which in turn increases myocardial oxygen demand. Oxygen is used to treat tissue hypoxia.

Monitor Heart Rhythm. Because dysrhythmias are common, ECG monitoring is essential and antidysrhythmic medications should be at hand. A two-dimensional echocardiogram and test may be performed in the emergency department to aid in ruling in or ruling out AMI.

Improve perfusion. The general principles of pharmacologic treatment of AMI consist of anti-ischemic and antithrombotic therapies.

Surgical management

CABG –depends on patients condition and angiography report.

Nursing management

• The goals of nursing management after AMI are as follows:

• Recognize and treat cardiac ischemia.

• Administer thrombolytic therapy as ordered.

• Recognize and treat potentially life threatening dysrhythmias.

• Monitor for complications of reduced cardiac output.

• Maintain a therapeutic critical care environment

• Identify the psychosocial impact of AMI on the client and family

• Educate the client in life style changes and rehabilitation.

Category: Medicine Notes