Care of Patient with an Acute Myocardial Infarction (MI) Tiffany Boyd BSN, RN, PCCN Staff Development Instructor

Pinnacle Health Case Study

Mrs. Rogers is a 63 year old Hispanic Female that was admitted to the ED with an Acute MI. She was experiencing vague heaviness for about 3 hours after a dinner party with co-workers. She really ate too much and the Mylanta helped a lot. She went to bed and was awakened feeling short of breath and noticed that her heart felt fluttery. The same chest heaviness returned. Mr. Rogers called 911. Case Study Cont. Past Medical History Anterior MI with stent in 2005 EF 45% Type 2 Diabetes High Cholesterol HTN Some wine on weekends BGMs 170s-190s

Case Study Cont. Its 4:30pm and the charge nurse calls that you are receiving a 63 year old female patient from the Cath lab, Mrs. Rogers Next, you get report from the Cath lab Case Study Cont. Hi. I am calling report from the cath lab. You are receiving Mrs. Rogers. She is a 63 year old Hispanic female who came directly to us from the ED as a CODE STEMI. She was at a party & felt indigestion like symptoms. She was diagnosed with an AWMI. We angioplastied & stented the proximal LAD with 2 DES. She was angiosealed in the right groin. The site is soft and flat without hematoma or ecchymosis. Her pedal pulse is strong on the right. Her PMH includes previous MI with stent, DM, High Cholesterol, & HTN. We gave her 25 of Fentanyl.

Her sheath was removed at 1500 and she can get out of bed at 2100. She has NSS infusing at 100ml/hr into a RFA peripheral IV. She had 600 mg of Plavix in the lab and still needs education on her MI. She will be arriving shortly. Any questions? SBAR Case Study Report Case Study Report

S- Hi, I am calling report on Mrs. Rogers who is 63 years old and came to us as a CODE STEMI, AWMI, from the ED. We angioplastied & stented the proximal LAD x2 DES. Her previous stent was patent. Her right groin was angiosealed. BAR SB- She was at a party and felt indigestion-like symptoms. Her right groin is soft and flat without hematoma or ecchymosis. Her pedal pulse is strong on the right. Her PMH includes previous MI with stent, DM, High cholesterol, & HTN. Her sheath was removed at 1500. She received 600mg of Plavix in the lab AR SBA- She can get out of bed at 2100. She has NSS infusing at 100ml/hr into a RFA IPID. She needs teaching about her MI. RCase Study Report Case Study Report

 SBA-

Case Study Report

R- She will be arriving shortly. Any questions? Admission to Telemetry Unit Frequent Vitals Telemetry Monitoring Frequent Groin Checks Frequent Neurovascular Checks (pedal pulses) EKGs Lead Changes & Wall Injury EKG Changes ST elevation in V1-V4 V1-V4 changes = ????? ST elevation & hyperacute T waves in V2-V4 = Acute MI (determining age of MI) EKG Changes ST elevation in V1-V4 V1-V4 changes = Anterior Wall MI ST elevation & hyperacute T waves in V2-V4 = Acute MI (determining age of MI) PHS Algorithm for Code STEMI Symptom Differences Male vs. Female Diabetics Male vs Female

Male

vs

Female

Have CP at younger ages Typical angina symptoms Crushing pain, elephant sitting on chest Seeks help sooner More likely to have ST elevated MIs 10 years older Less likely to have to typical angina Describes CP as sharp & burning Pain in throat, neck, jaw, back area Other symptoms include: nausea, GI symptoms, SOB, weakness, fatigue, & sleep disturbance, palpitations Usually underestimates importance of CP Diabetics Due to the automatic denervation of the heart with diabetes, most diabetics suffer from silent ischemia Some diabetics have blunted appreciation of ischemic pain, which may result in atypical anginal symptoms They wont have chest pain Symptoms more like SOB Diabetics During stress testing they wont have angina, but might have ischemia related to their prolongation of the anginal perceptual threshold Case Study Our patients symptoms: vague heaviness Indigestion like symptoms

SOB Fluttery heart (a-fib)

Are these typical symptoms? Are these symptoms likely for a female? Are these symptoms likely for a diabetic? Case Study

Would you have thought an Acute MI with this patient? What would you have treated her as? MI Indigestion A-fib