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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 off-
horizontal plane around the front of the
chest.
 Detect front-to-back and side-to-side
electricity.
 The standard leads are in a vertical
plane.