Aaaaaaaadiagnosis Of An Ami
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DIAGNOSIS OF AN AMI
MYOCARDIAL INFARCTION
M.I. IS DEATH OR NECROSIS OF THE CARDIAC MUSCLE. RESULTS FROM INTERRUPTED OR DIMINISHED OXYGENATED BLOOD. THE HEART RECEIVES ITS BLOOD SUPPLY FROM THE RIGHT AND LEFT CORONARY ARTERIES.
IN A MAJORITY OF CASES OF ACUTE CORONARY OCCLUSION OCCUR AS A RESULT OF ATHEROSCLEROTIC HEART DISEASE. THICKENING OF THE LINING OF THE ARTERY DUE TO FATTY DESPOSITS, CALCIFICATION, NECROSIS, AND HEMORRHAGE. THIS LEADS TO NARROWING OR OCCLUSION OF THE CORONARY ARTERIES.
CLINICAL CHARACTERIZATION
PAIN, SUBSTERNAL, RADIATING IN LEFT ARM, UP INTO THE JAW DIAPHORESIS DURATION OF PAIN- LONGER THAN ONE HOUR SKIN TONE- PALLOR FEELING OF IMPENDING DOOM.
PAIN DOES NOT SUBSIDE WITH REST. PAIN IS NOT ASSOCIATED WITH EXERTION. SHORTNESS OF BREATH (DYSPNEA). CHEST FEELS AS IF IT IS BEING CRUSHED. NAUSEA AND/OR VOMITING.
ANGINA PECTORIS
HAS THE SAME SIGNS AND SYMPTOMS AS A MYOCARDIAL INFARCTION. PAIN LASTS LESS THAN ONE HOUR. REST EASES THE PAIN. NITROGLYCERIN TABLETS RELIEVE PAIN. TRIGGERED BY EXERTION.
DIAGNOSIS IS BASED ON…
HISTORY SERUM ENZYMES ELECTROCARDIOGRAPHIC CHANGES
HISTORY
“POSITIVE” HISTORY WILL USUALLY INCLUDE A DESCRIPTION OF CHEST PAIN AND ACCOMPANYING SYMPTOMS. NEED TO RULE OUT CHEST PAIN DUE TO DIFFERENT CONDITIONS. EVALUATE CHEST PAIN ACCORDING TO: LOCATION, QUALITY, DURATION, PRECIPITATING FACTORS, MODE OF RELIEF, ASSOCIATION TO RESPIRATIONS.
M.I. PAIN
LOCATION – SUBSTERNAL, MAY RADIATE TO BACK, NECK, ARM, AND JAW. QUALITY – PRESSURE, CHOKING, BURNING, TIGHTNESS, VISELIKE. DURATION – AT LEASE 30 MINUTES NAUSEA – MAY HAVE
FEEL WEAK OR DIZZY? – MAY HAVE SHORTNESS OF BREATH – MAY HAVE WAS THE PAIN RELIEVED WHEN YOU TOOK A DEEP BREATH? NOT AFFECTED DID YOU FEEL BETTER WHEN YOU SAT UP? NOT RELIEVED
SERUM ENZYMES
PROTEINS THAT ACT AS REGULATORS OF CHEMICAL AND METABOLIC ACTIVITY OF THE CELLS. IN THE PRESENCE OF CELL DESTRUCTION, ENZYMES ARE RELEASED INTO THE BLOODSTREAM AND SERUM ENZYME LEVELS INCREASE.
CARDIAC CELL ENZYMES
CREATININE PHOSPHOKINASE (CPK) SERUM GLUTAMIC OXALACETIC TRANSAMINASE (SGOT) LACTIC DEHYDROGENASE (LDH) ALPHA-HYDROXYBUTYRATE DEHYDROGENASE (HBD)
USUALLY IN THE PRESENCE OF CARDIAC NECROSIS, THERE WILL USUALLY BE ELEVATIONS IN THE SERUM ENZYMES. MAY BECOME ELEVATED IN THE PRESENCE OF ANY MYOCARDIAL INJURY, M.I., COUNTERSHOCK, CARDIAC MASSAGE, CARDIOPULMONARY BYPASS
ELEVATION OF A SINGLE ENZYME IS NOT AN INDICATION OF M.I. EACH ENZYME IS ALSO PRESENT IN OTHER BODY TISSUES. CPK IS FOUND IN SKELETAL AND BRAIN TISSUE. SGOT MAY BE RELEASED FROM MANY TISSUES. LIVER DISEASE, SHOCK, TACHARRHYTHMIAS, PULMONARY INFARCTION.
LDH IS NOT SPECIFIC FOR M.I. LDH IS FOUND IN RED BLOOD CELLS AND MAY BE RELEASED WITH HEMOLYSIS. HBD APPEARS TO BE MORE SPECIFIC THAN LDH AND SGOT FOR MYOCARDIAL INFARCTION.
Electrocardiogram
Used to help in the diagnosis of the M.I. Records electrical activity of the heart. Called an ECG or EKG. Placement of the EKG leads at different locations can help to identify the portions of the heart that have been damaged.
The P wave and PR nterval are important to understand due to the fact that a lot of nformation can be obtained on what the atria are doing.
The width of the gap between the Q and S wave will indicate problems with ventricular contraction.
Standard Leads
Electrodes are attached to the left arm, right arm, and either leg named I, II, III. Measures voltage between two points on the body: left arm vs. right arm (Lead I), left arm vs. foot (Lead II), and right arm vs. foot (Lead III)
Lead I measures the voltage between the left arm and right arm. Left arm is the positive pole. An electrical wave moving towards the left arm will cause an upward deflection. Most useful for seeing electrical activity moving in a horizontal direction.
Einthoven’s triangle Lead 1
Lead II
Connects the right arm to the leg. Best sees electricity moving down and leftward.
Lead 2
Lead III
Compares voltage in left arm and the leg. Will measure electricity moving down and rightward. Lead II and Lead III are positive at the foot.
Lead 3
Lead 4
Augmented Leads
Three additional limb leads can be obtained by mixing combinations of electrodes. Leads R, L, and F. Two electrodes are connected together to create an “average” electrode, then connected through the EKG machine to the remaining electrode.
eft arm and foot electrodes are onnected together. The voltage f this “ average” electrode is ompared to the right are lead. ook at a rightward and slightly pward position. Lead R will record downward wave.
The left arm electrode is positive, meaning that electricity moving to the left will cause an upward motion
Foot is the positive electrode. Upward movement on the EKG paper.
Chest Leads
“Sample” the electrical activity over small area of the heart. Look at the heart in a slightly offhorizontal plane around the front of the chest. Detect front-to-back and side-to-side electricity. The standard leads are in a vertical plane.
MYOCARDIAL INFARCTION
M.I. IS DEATH OR NECROSIS OF THE CARDIAC MUSCLE. RESULTS FROM INTERRUPTED OR DIMINISHED OXYGENATED BLOOD. THE HEART RECEIVES ITS BLOOD SUPPLY FROM THE RIGHT AND LEFT CORONARY ARTERIES.
IN A MAJORITY OF CASES OF ACUTE CORONARY OCCLUSION OCCUR AS A RESULT OF ATHEROSCLEROTIC HEART DISEASE. THICKENING OF THE LINING OF THE ARTERY DUE TO FATTY DESPOSITS, CALCIFICATION, NECROSIS, AND HEMORRHAGE. THIS LEADS TO NARROWING OR OCCLUSION OF THE CORONARY ARTERIES.
CLINICAL CHARACTERIZATION
PAIN, SUBSTERNAL, RADIATING IN LEFT ARM, UP INTO THE JAW DIAPHORESIS DURATION OF PAIN- LONGER THAN ONE HOUR SKIN TONE- PALLOR FEELING OF IMPENDING DOOM.
PAIN DOES NOT SUBSIDE WITH REST. PAIN IS NOT ASSOCIATED WITH EXERTION. SHORTNESS OF BREATH (DYSPNEA). CHEST FEELS AS IF IT IS BEING CRUSHED. NAUSEA AND/OR VOMITING.
ANGINA PECTORIS
HAS THE SAME SIGNS AND SYMPTOMS AS A MYOCARDIAL INFARCTION. PAIN LASTS LESS THAN ONE HOUR. REST EASES THE PAIN. NITROGLYCERIN TABLETS RELIEVE PAIN. TRIGGERED BY EXERTION.
DIAGNOSIS IS BASED ON…
HISTORY SERUM ENZYMES ELECTROCARDIOGRAPHIC CHANGES
HISTORY
“POSITIVE” HISTORY WILL USUALLY INCLUDE A DESCRIPTION OF CHEST PAIN AND ACCOMPANYING SYMPTOMS. NEED TO RULE OUT CHEST PAIN DUE TO DIFFERENT CONDITIONS. EVALUATE CHEST PAIN ACCORDING TO: LOCATION, QUALITY, DURATION, PRECIPITATING FACTORS, MODE OF RELIEF, ASSOCIATION TO RESPIRATIONS.
M.I. PAIN
LOCATION – SUBSTERNAL, MAY RADIATE TO BACK, NECK, ARM, AND JAW. QUALITY – PRESSURE, CHOKING, BURNING, TIGHTNESS, VISELIKE. DURATION – AT LEASE 30 MINUTES NAUSEA – MAY HAVE
FEEL WEAK OR DIZZY? – MAY HAVE SHORTNESS OF BREATH – MAY HAVE WAS THE PAIN RELIEVED WHEN YOU TOOK A DEEP BREATH? NOT AFFECTED DID YOU FEEL BETTER WHEN YOU SAT UP? NOT RELIEVED
SERUM ENZYMES
PROTEINS THAT ACT AS REGULATORS OF CHEMICAL AND METABOLIC ACTIVITY OF THE CELLS. IN THE PRESENCE OF CELL DESTRUCTION, ENZYMES ARE RELEASED INTO THE BLOODSTREAM AND SERUM ENZYME LEVELS INCREASE.
CARDIAC CELL ENZYMES
CREATININE PHOSPHOKINASE (CPK) SERUM GLUTAMIC OXALACETIC TRANSAMINASE (SGOT) LACTIC DEHYDROGENASE (LDH) ALPHA-HYDROXYBUTYRATE DEHYDROGENASE (HBD)
USUALLY IN THE PRESENCE OF CARDIAC NECROSIS, THERE WILL USUALLY BE ELEVATIONS IN THE SERUM ENZYMES. MAY BECOME ELEVATED IN THE PRESENCE OF ANY MYOCARDIAL INJURY, M.I., COUNTERSHOCK, CARDIAC MASSAGE, CARDIOPULMONARY BYPASS
ELEVATION OF A SINGLE ENZYME IS NOT AN INDICATION OF M.I. EACH ENZYME IS ALSO PRESENT IN OTHER BODY TISSUES. CPK IS FOUND IN SKELETAL AND BRAIN TISSUE. SGOT MAY BE RELEASED FROM MANY TISSUES. LIVER DISEASE, SHOCK, TACHARRHYTHMIAS, PULMONARY INFARCTION.
LDH IS NOT SPECIFIC FOR M.I. LDH IS FOUND IN RED BLOOD CELLS AND MAY BE RELEASED WITH HEMOLYSIS. HBD APPEARS TO BE MORE SPECIFIC THAN LDH AND SGOT FOR MYOCARDIAL INFARCTION.
Electrocardiogram
Used to help in the diagnosis of the M.I. Records electrical activity of the heart. Called an ECG or EKG. Placement of the EKG leads at different locations can help to identify the portions of the heart that have been damaged.
The P wave and PR nterval are important to understand due to the fact that a lot of nformation can be obtained on what the atria are doing.
The width of the gap between the Q and S wave will indicate problems with ventricular contraction.
Standard Leads
Electrodes are attached to the left arm, right arm, and either leg named I, II, III. Measures voltage between two points on the body: left arm vs. right arm (Lead I), left arm vs. foot (Lead II), and right arm vs. foot (Lead III)
Lead I measures the voltage between the left arm and right arm. Left arm is the positive pole. An electrical wave moving towards the left arm will cause an upward deflection. Most useful for seeing electrical activity moving in a horizontal direction.
Einthoven’s triangle Lead 1
Lead II
Connects the right arm to the leg. Best sees electricity moving down and leftward.
Lead 2
Lead III
Compares voltage in left arm and the leg. Will measure electricity moving down and rightward. Lead II and Lead III are positive at the foot.
Lead 3
Lead 4
Augmented Leads
Three additional limb leads can be obtained by mixing combinations of electrodes. Leads R, L, and F. Two electrodes are connected together to create an “average” electrode, then connected through the EKG machine to the remaining electrode.
eft arm and foot electrodes are onnected together. The voltage f this “ average” electrode is ompared to the right are lead. ook at a rightward and slightly pward position. Lead R will record downward wave.
The left arm electrode is positive, meaning that electricity moving to the left will cause an upward motion
Foot is the positive electrode. Upward movement on the EKG paper.
Chest Leads
“Sample” the electrical activity over small area of the heart. Look at the heart in a slightly offhorizontal plane around the front of the chest. Detect front-to-back and side-to-side electricity. The standard leads are in a vertical plane.
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