NSTEMI

NSTEMI

Pathophysiology
1. Occurs as a result of sustained ischemia, which leads to irreversible myocardial cell death (text book)
2. Partial or complete coronary artery blockage (White & Chew, 2008)
3. 80-90% of MI's occur secondary to thrombus formation (Textbook)
  1. This thrombotic process decreases circulation to to coronary arteries leading to necrosis (White & Chew, 2008)
    1. The heart stops contracting in these necrotic areas (Textbook)
    2. Cardiac cells can last up to 20 minutes before cellular death takes place (Textbook)
      1. The most inner layer of the heart, subendocardium, becomes ischemic first (Textbook)
      2. If this ischemia continues the entire thickness of the heart will become necrossed in roughly 5 to 6 hours (Textbook)
4. Atherosclerosis is a build of plaque in the artery wall (Heart & Stroke, ?)
  1. Artery can narrow and become blocked
    1. Can lead to blood clots, which can block the blood from getting to the heart
Diagnostic Studies
1. Electrocardiogram
  1. 12 Lead ECG
  2. Will reveal ST segement depression
  3. Primary tool in detecting Myocardial Infarctions
  4. Reveals the time sequence of ischemia, infarction and the resolution of the infarction
  5. No pathalogical Q waves are developed (Text)
2. Serum Cardiac Markers
  1. Creatine Kinase (CK-MB)
    1. In an MI, plasma CK-MB levels rise about 4-6 after the onset of chest pain and typically peaks 12-24 hours after (Coven, 2016)
      1. Levels typically return to baseline after 24-48 hours (Coven, 2016)
  2. Troponin
    1. Regulatory protiens that are found in skeletal and cardiac muscle (Coven, 2016)
    2. A positive result is noted 4-8 hours after the onset of symptoms, and remains elevated for 7-10 days after (Coven, 2016)
    3. Cardiac Specific troponin is a myocardial muscle protein released into circulation after an myocardial injury (Text)
      1. Two different sub types: cardiac specific troponin I (cTnI) & cardiac specific troponin T (cTnT) (Text)
    4. Highly specific indicators of MI and have a greater sensitivity to detect (text)
3. Coronary Angiography
  1. Is an X-ray to determine if there are any blockages in the coronary arteries (NLH, 2016)
    1. A small catheter is inserted through an artery
  2. Determines most therapeutic treatment (text)
  3. Percutaneous Intervention (PCI) may be performed at this time (Text)
    1. intervention used to treat CAD
    2. A catheter with a balloon on the end is insterted and the inflated into the artery that is narrowed (Text)
      1. Elective procedure once the patient is stabilized (Text)
Nursing Assessments
1. Subjective Data
  1. Important health history
    1. Current health history
      1. Family history of heart disease (text)
      2. a sedentary lifestyle
      3. Use of tobacco
    2. Past health history/ history of
      1. CAD
      2. Hypertension
      3. Aortic Stenosis
      4. Diabetes
      5. MI
      6. Angina
      7. Heart failure
      8. Lung disease
      9. Hyperlipidemia
    3. Medications
      1. The use of:
        Aspirin
        Nitrates
        Beta Blockers and Calcium Channel Blockers
        ACE Inhibitors
        Herbal supplements or vitamins
        Anti-Hypertensive and Cholesterol Lowering medications
  2. Symptoms
    1. Chest pressure or pain
      1. May radiate to jaw, neck, shoulders, arms or back
    2. Heartburn, N/V, indigestion
    3. Dyspnea
    4. Dizziness and weakness
    5. Anxiety, heart palpatations and tiredness
2. Objective Data
  1. General
    1. Anxiety
    2. Restlessness
    3. Fear
  2. Integumentary System
    1. Cool, clammy and pale (text)
  3. Cardiac System
    1. Bradycardia or Tachycardia
    2. Pulses will alternate from weak to strong
    3. S3 & S4
    4. High or Low Blood Pressure
  4. Potential Findings
    1. Non-elevated or elevated cardiac serum markers
    2. Increased WBCs and serum lipids
    3. Cardiac enlargement
    4. Positive stress test results
    5. ECG abnormalities
    6. Pulmonary congestion or calcification seen on chest radiograph
    7. Positive findings on the coronary angiogram

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