Heart attack, MI & AMI are common terms you might have heard all being associated to the heart. Each nursing or any medical care provider ought to be able to recognize myocardial infarction and take action as soon as possible because it is a life threatening emergency. Time and speed saves heart muscle damage.
Acute myocardial infarction (AMI) is a medical emergency requiring immediate hospitalization; patients suspected of having AMI should be admitted immediately to the coronary or intensive care unit for evaluation and potentially life-saving treatment. (Do you know how AMI is treated? Please tell us in comments section below)
The clinical presentation of AMI is characterized by chest pain, ECG changes, and serial elevation of cardiac biomarkers. (Do you know specific ECG/EKG changes indicate myocardial infarction? Tell us in comments section)
Serum cardiac enzymes and specific cardiac biomarkers may be elevated, indicating cardiac muscle damage, ischemia, necrosis, thereby aiding in the diagnosis of AMI.
Cardiac troponins level are considered the gold standard for diagnosing AMI. Why? Because two of the proteins that compose cardiac troponins have the greatest sensitivity and specificity for detecting myocardial damage. By sensitivity, it means even the slightest damage will show changes and with specificity, it means that the change can only be cardiac related and not any other part of the body. troponin levels are now considered the world criteria for defining and diagnosing AMI according to American College of Cardiology, the American Heart Association, the European Society of Cardiology, and the World Heart Federation
Creatine kinase (CK) & CK isoenzymes , specifically CK-MB (CK-2), found in cardiac muscle, are specific markers for myocardial damage or necrosis and are considered to be sensitive early markers of AMI if troponin assays are not available. That means if these biomarker levels start getting elevated, early intervention and evaluation should be started while troponin levels are pending.
Myoglobin levels have high sensitivity but poor specificity for detecting AMI. However, when used in conjunction with other studies, elevated myoglobin levels may be a useful marker. Normal myoglobin values are < 90 ng/L. Myoglobin level elevation to anyone presenting with chest pains whether radiating to the arms, shoulders, elbows and lower back or NOT should be considered positive unless otherwise ruled out.
- Discuss by posting a comment how you should treat AMI as soon as you suspect is
- Not all ECG/EKG changes indicate AMI. What EKG changes would alarm you that the patient could be having AMI?
- Do you have any mnemonics related to myocardial infarction?
- Close your comments by suggesting the next topic you would like us to discuss
sangita maharjan says
EKG changes in ST segment can help differentiate between STEMI and NSTEMI and it shows ventricular wall dyskinesia.
Treatment for MI includes pain management first,thrombolytic therapy within 3 hrs,PTCA is another option for opening blocked and narrowed arteries.
The important nursing objectives for MI pt,promoting comfort,rest and emotional well being,while caring MI pt.
as far as i know, initially you can apply O2 and give nitroglycerin to the patient accordingly.. or immediately give lytic therapy with new ST elevated MI..
Samar Al-Rayyis says
I think that MI is treatrd with anti coagilation. In terms of the EKG I think it is the ST elevation, but also there is MI that is non STMI, and those are diagnosed through the troponin elevation and some other tests such as adinosin stress test and a 2D echo.
Are my answers correct?
Sadam Zghool says
The general treatment for chest pain starts pain management, O2, then Nitro, and Aspirine.
this means MONA therepy
David Chasse says
Tx for CP (non-stemi): MONA- Morphine, Oxygen, Nitro, Aspirin.
Tx for CP (stemi): MONA- and immediate prep for cath lab in most cases.
Of course you need IV access in either scenerio (b4 nitro admin) nitro can cause hypotension and w/o IV access you can’t treat it.
Will Smiley says
An elevated ST wave elevation is indicative of MI, ST inversion is indicative of cardiac ischemia. MONA at the door. Morphine, O2, Nitroglycerin, and Aspirin when the pt comes in with S & S of MI if in ED. (Not necessarily in that order)
Wound care: wet-to- dry dressing. Is that even done anymore?
One mnemonic related to myocardial infarction is : M.O.N.A.
Antiplatelet therapy (aspirin)
dread lock says
Each people have to die. It is the role of our nature but now we have touch the nature by the scienctis by the help of doctor we almost safe from fie so we have to say to them as the god n also we all people of world i m really glad to be the people of this words.Than for giving this unity to write some thing thanks………………………………………
Acute myocardial infarction presented with tightnes or heavinees chest pain radiated to jaw,neck and left arm,vomiting,nausea,febrile,elevated BP,ECG changes with ST elevation,Q or non Q wave,elevated cardiac markers is treated by O2,thrombolytic agents,pain killer,PTCA or CABG if arteries occluded,non ST elevatin is accompanied mostly diabetic called silent MI.
Nitroglycerin is the first action for AMI. the seconed action to give the patient O2 to improve breathing, then we will give him pain releafier like Morphine.
I’d like to remind all nurses not to be fooled by the pt. who presents with atypical pain. I’ve seen pts. present w/nothing but mild pain between the shoulder blades or pain located in only the left elbow accompanied by slight indigestion. Both of these pts. had AMI’s. Crushing chest pain isn’t always how your pts. will come into the ER. Thanks for sharing the MONA.
Mary Christine says
Changes of St segment elevation could be an indicative of AMI
BuT ISN’T IT WE CAN’T RELY ONLY W/ THE ECG tracing alone?
we need to confirm by doing laboratory exams..like evaluating the result of CK – MB or troponin Tn1
moreover cardiac markers are not a diagnostic of AMI with single elevation
what to do next ? of course we can’t do anything w/o doctors order
But the treatment would be.. oxygen therapy …and pain control
Morphine to relieve pain and to provide anxiety relief
Nitroglycerine as vasodilator
position to semi fowlers
and encourage rest …
Chetana poudel says
I Want to member of this site.
Rosie Brag says
Thanks for your nice article. It is really providing great information to the readers. Early medical intervention helps prevent myocardial infraction and permanent damage to the heart tissue. In case of myocardial ischemia, the physician will advocate bypass surgery. I have read more about Acute Myocardial ischemia in one site. What do you think?
Rosie Brag says
Interesting topic!!! Much appreciated. Thanks to share it with us. Myocardial ischemia develops when the flow of blood to the heart diminishes due to partial or complete occlusion of the coronary artery. Consequently, the oxygen supply to the heart reduces and the heart muscles get impaired. As a result, the heart fails to pump efficiently, and you could have a cardiac arrest.
for patient c/o chest pain,history must be taken b4 giving measures for some are malingering…in case their really is a pain we should do EKG,depend on the result then we can give MONA..MI is a condition wherein there is a blockage in one of the coronary arteries,st elevation is the common hint in the EKG that a person is having MI…