Treatment of Myocardial Infarction
Treatment of Myocardial Infarction
The management of a myocardial infarction is with regard to alleviation of symptoms, prevention of extension of the infarct and detection / treatment of the complications of a myocardial infarct.
The first priority with these patients is to maintain a clear airway and breathing, monitoring will be established as soon as the patient arrives in the resuscitation room. (NB This will have already been initiated by the ambulance crew). It is also likely that intravenous access will have been established unless the patient was brought in by relatives.
A high percentage of prescribed oxygen will be administered via a facemask unless contraindicated by chronic respiratory disease. This will serve to optimise the patient’s oxygenation.
Chest pain and nausea are relived by diamorphine and an anti-emetic given intravenously. Diamorphine also acts by offloading the heart and reducing the preload and afterload. If the patient has pulmonary oedema, diuretics may also be given. A central line may be sited to monitor the central venous pressure; this will give an indication of the preload in the right side of the heart. Antiarryhthmics may be given if the patient is displaying arrhythmias. Any electrolyte imbalance will be treated immediately in order to stabilise the myocardium as much as possible.
Unless contraindicated, the patient may be given antithrombolytic agents such as streptokinase, Tissue Plasminogen Activator (tPA) in order to dissolve the clot in the coronary artery. When these are given bleeding must be monitored for.
Contraindications for thrombolytic therapy include:
Reference :
http://www.nursingtheory.nhs.uk
The management of a myocardial infarction is with regard to alleviation of symptoms, prevention of extension of the infarct and detection / treatment of the complications of a myocardial infarct.
The first priority with these patients is to maintain a clear airway and breathing, monitoring will be established as soon as the patient arrives in the resuscitation room. (NB This will have already been initiated by the ambulance crew). It is also likely that intravenous access will have been established unless the patient was brought in by relatives.
A high percentage of prescribed oxygen will be administered via a facemask unless contraindicated by chronic respiratory disease. This will serve to optimise the patient’s oxygenation.
Chest pain and nausea are relived by diamorphine and an anti-emetic given intravenously. Diamorphine also acts by offloading the heart and reducing the preload and afterload. If the patient has pulmonary oedema, diuretics may also be given. A central line may be sited to monitor the central venous pressure; this will give an indication of the preload in the right side of the heart. Antiarryhthmics may be given if the patient is displaying arrhythmias. Any electrolyte imbalance will be treated immediately in order to stabilise the myocardium as much as possible.
Unless contraindicated, the patient may be given antithrombolytic agents such as streptokinase, Tissue Plasminogen Activator (tPA) in order to dissolve the clot in the coronary artery. When these are given bleeding must be monitored for.
Contraindications for thrombolytic therapy include:
- History of gastric ulcers.
- Recent surgery (within 2 weeks).
- Previous treatment with streptokinase or tPA.
- Allergic reaction to thrombolytics.
- Recent trauma (within 2 weeks).
Reference :
http://www.nursingtheory.nhs.uk
