Myocardial infarction: Interior wall & ACLS management
Introduction
Myocardial infarction is still a major reason for death all over the globe. For years, coronary artery disease (CAD) has been the leading cause of morbidity throughout the world. Myocardial infarction is described as the irreversible necrosis of heart muscle emerging from a drop in blood supply to the heart due to coronary artery occlusion. Clinically MI is identified when ascending cardiac biomarkers notice the acute myocardial, and there is proof of acute myocardial ischemia (assisted by either patient signs, EKG changes, or imaging evidence). Reduction in blood supply to the anterior wall of the heart is related to anterior myocardial infarction.
Categorization of anterior myocardial infarction is established on EKG finding as follows. ST-segment elevation in leads V1 to V4 is considered anteroseptal, ST-segment elevation in leads V3–V4 is considered anteroapical (or mid-anterior), ST-segment elevation in leads V3 to V6 is categorized as Anterolateral, and extensive anterior is ST-segment elevation in leads V1 to V6.
Etiology and epidemiology
The left anterior descending (LAD) coronary artery provides vascular supply to the anterior myocardium. Sustained ischemia due to LAD artery occlusion causes MI. Atherosclerotic plaque rupture, followed by thrombus formation is the usual cause for anterior myocardial infarction. This acute cutback of blood provision to the myocardium results in necrosis of the heart muscle. Different elements are related to a higher prospect of CAD and MI. Major reasons for CAD are hypertension, hyperlipidemia, diabetes, obesity, and smoking. The existence of one or more risk factors increases the odds of cardiovascular occurrence.
Coronary artery disease (CAD) is a major health issue in the United States killing 382,820 people in 20201. According to 2020 data, about 2 in 10 deaths occured due to coronary artery diseases in adults less than 65 years old. The chances of CAD escalate with the age in both genders. The number of patients or not decreasing but the survival rate is increasing from MI. Advanced treatment strategies and better administration have played a major role in decreasing mortality from MI. According to a study, the occurrence of anterior ST-elevation MI (STEMI) is almost 33% of all STEMIs. 1
Time management for MI patients
Small health facilities can’t administer CAD that requires surgical intervention. Due to the absence of specialties and abilities, the patient must be moved to a medical facility with a cardiologist and cardiac catheterization laboratory available. If the patient is not transported as early as possible, their overall health will be affected. Reperfusion is required to repair damaged heart muscle. The immediate transfer should be made for favorable results and to stop the cardiac muscle from becoming ischemic.
According to the national standard of time, a patient suffering from ST-segment elevation myocardial infarction is to be transported from door to percutaneous coronary intervention in 90 minutes. Electrodiagram should be obtained in less than 10 min of the patient’s arrival. Standards also recommend medication should be administered upon instant identification of the myocardial infarction. Reducing the time for a patient to get a greater level of care and receive fibrinolytic or percutaneous coronary interventions can decrease the number of tissues that become ischemic. The decrease in intervention time should give better results for patients, and in turn, a better survival rate. 2
Summary
The frequency of coronary artery disease cases has not lowered for decades. Managing the risk factors is the right way to lessen the chance of CAD. Primary clinicians should inform patients about the prospect of CAD connected with these risk factors. A team effort including primary clinicians, nurses, pharmacists, dietitians, behavioral therapists, and social workers can educate patients to determine the risk factors. Early intervention and optimal medical therapy after reperfusion benefit anterior MI, like any other MI. A team approach involving ambulance service, emergency clinicians, hospitalists, cardiologists, and emergency and intensive care unit (ICU) nurses can decrease the time from door to PCI and provide early intervention.
This ACLS algorithm is considered as a general drill to deal with patient suffering from cardiac arrest.
References
This page was last reviewed and updated by
Lorraine Anne Liu, RN
on Apr 5, 2021.
Also written by this author: