A Short Note On Cardiovascular Risk Factors With Myocardial Ischemia / Reperfusion Injury, Preconditioning, And Postconditioning

Cardiogenic shock, according to Werden et al. (2012), is the most common cause of death from an acute myocardial infarction (AMI) and has a chance of mortality from thirty percent to eighty percent. Infarction-related cardiogenic shock (ICS) complicates approximately five to ten percent of acute myocardial infarctions (AMI) and remains the leading cause of death in patients hospitalized from an AMI (Kolte et al., 2014). Kolte et al. (2014) also states that the incidence of cardiogenic shock is higher in patients over the age of seventy-five, and has higher prevalence in women, Caucasians, Asians, and Pacific islanders. This paper will discuss the pathophysiology, clinical manifestations, tools used to diagnose, and therapeutic management of cardiogenic shock.

Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O ' Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since this time have focused on the influence of sedation protocols, and outcomes. This paper will review the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies. Also, explanations including a preliminary conclusion will be discussed.

Futterman LG, Lemberg L. The Significance of Hypothermia in Preserving Ischemic Myocardium. Amer J Crit Care 13: 79-84, 2004. Web. 29 June 2015.

These stated facts very well implicate an imperative need to investigate promising alternative treatment strategies as well preventive measures. Impairment in cardiac functions, organ (heart) failure or trigger of compensatory mechanisms (hypertrophy, neurohumoral system activation, autokrine, paracrine stimulation, etc) are the result of loss in cardiac myocytes predominantly due to myocardial infarction (Zimmermann and Eschenhagen, 2003). In addition to the traditional treatment of

American Heart Association (AHA) estimates that nearly 700 Americans die each day of sudden cardiac arrest (MI), or 250,000 every year, as many as 50,000 lives could be saved each year if certain critical interventions were made. (Freeman , 50) A patient who receives early life support measures and defibrillation within one to five minutes of arrest is much more likely to live and to retain normal brain function. The brain is often at a serious risk for irreparable brain damage related to anoxia and many other co-morbidities that are associated with cardiac arrest (MI). When a perfusing cardiac rhythm returns after a heart attack, the most important objective is to preserve brain function. The AHA and the Advanced Life Support Task Force of

Due to numerous etiologies that will lead to cardiac arrest there is a potential for variable mortality reporting and therefore it is conceivable this number is misrepresented. A more accurate estimation of the burden of cardiac arrests can be elucidated from ROC data where the incidence of EMS-treated OHCA was found to be 73.0 individuals per 100,000 population (95% CI, 71.2–74.7) for adults and 7.3 per 100,000 population (95% CI, 6.3–8.3) for children <18 years old (heart disease and stroke). As compared to an overall incidence rate, individuals who have received treatment by EMS have the most potential for survival as this excludes arrest events where signs of obvious death were present, or a DNR was in place. An Oregon-based study extrapolated a national risk-adjusted incidence of sudden cardiac death, due to a cardiac etiology to be 60 per 100,000 population (95% CI, 54–66) with a premature death burden for men of 2.04 million (95% CI, 1.86 – 2.23 million) and women 1.29 million years of potential life lost (95% CI, 1.13 – 1.45 million). (https://www.ncbi.nlm.nih.gov/pubmed/24610738). The CARES data report from 2005-2010 provides insight into the demographics of OHCA due to cardiac etiologies and their survival rates (see table 1). Mean socioeconomic status of the region was found to be a significant indicator of increased incidence of sudden cardiac arrest, with a two- to fourfold greater incidence in regions in the lowest economic quartile compared to the highest quartile in the US among people less than 65 years old (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193117/). The previous studies do not allow for a complete representation of the mortality that results from cardiac arrest due to selective populations studied. There is a clear necessity for

Mr. Steward’s priority problems include impaired cardiac tissue perfusion, impaired gas exchange, and pain. We are concerned about impaired cardiac tissue perfusion because the pt. is exhibiting signs of myocardial ischemia including chest pain and shortness of breath (Gillespie, 2012). Although we acknowledge that impaired cardiac tissue perfusion can decrease the function of the heart and will have the potential to affect the perfusion and delivery of oxygen to other end organs, our primary focus will be a focused cardiovascular assessment (House-Kokan, 2012). At 1800, Mr. Steward was SOB, had shallow and rapid breathing (RR = 44), and a SaO2 of 72% on RA. Due to the fluid buildup in his lungs, Mr. Steward has impaired gas exchange, and requires supplemental oxygen to maintain his SaO2; this warrants a focused respiratory assessment.

This allows the inhaled oxygen to be carried throughout the body to stimulate the release of growth factors and stem cells, which promote healing. The Advanced Wound Care Center is equipped with three hyperbaric oxygen chambers. Patients usually receive treatment for two hours a day over the course of six

There are many races, hurdles, and obstacles to contend with throughout the course of life such as: life itself, family and health. In the realm of Certified Nursing, I have become more intent on knowing more about the lifestyles of the people, and the good and bad results of daily tasks that ensure their happiness. Safety, and the many diseases/disorders that have been encountered by others, can only be counter-acted by better knowledge, resources, and means of assurance in providing ways of increasing the (ADLs). While reading, I came across the disorder of Myocardial Infarctions, and found the information to be remarkably interesting. First of all, I learned that infarctions are commonly known for being obstructions of the blood supply to the organs and tissues; whether by the thrombus or embolous. This obstruction causes tissues to die. ” (Medicine Net, 2015).There’s different kinds of infarctions, such as: Myocardial, Acute, Cerebellar, and Right Ventricular. Therefore, myocardial infarctions are “irreversible necrosis of heart muscle, which are secondary to prolonged ischemia” (emedicine, 2015). Therefore, myocardial infarctions are “irreversible necrosis of heart muscle, which are secondary to prolonged ischemia” (emedicine, 2015).

I am conducting biomedical research in the laboratory of cardiac physiology under the mentorship of Dr. Elizabeth Murphy. Cardiovascular disease is the major cause of death in the US; therefore, a better understanding of the mechanisms regulating cardiomyocyte death in ischemia and reperfusion injury are important. Mitochondrial calcium plays a crucial role in the normal functioning of many processes, including the regulation of cardiac biochemical pathways and mediating ischemia-reperfusion injury. The uptake of calcium into the mitochondrial matrix is regulated by the mitochondrial calcium uniporter (MCU). An endogenous enzyme, Ca2+ Calmodulin Dependent Kinase II (CaMKII) has shown to regulate cell death and have increased activity during

Early hemodynamic assessment on the basis of physical findings, vital signs, central venous pressure, and urinary output fails to detect persistent global tissue hypoxia. A more definitive resuscitation strategy involves goal-oriented manipulation of cardiac preload, afterload, and contractility to achieve a balance between systemic oxygen delivery and oxygen demand. End points used to confirm the achievement of such a balance (hereafter called resuscitation end points) include normalized values for mixed venous oxygen saturation, arterial lactate concentration, base deficit, and pH. Mixed venous oxygen saturation has been shown to be a surrogate for the cardiac index as a target for hemodynamic therapy. In cases in which the insertion of a pulmonary-artery catheter is impractical, venous oxygen saturation can be measured in the central circulation (p. 1368).

After being reminded by the instructor, I was aware of my mistakes and noticed that I failed to maintain patient’s safety. An oxygen below 90% can be very dangerous for the patient, especially for a post-op day #1 patient, because prolonged hypoxemia can cause fatigue, headache, acute respiratory failure, cardiac problems (increased heart rate,

This includes CPAP therapy, non-invasive ventilation, and lifestyle modification. The article includes a randomized control study to find the most efficient therapy for OHS. A CPAP therapy group and a NIV group were compared while the lifestyle modification group was the control. The study came to the conclusion that both CPAP therapy and NIV were more effective than the lifestyle modification group (Masa et al., 2015, p. 88). This study showed non-invasive ventilation was a better treatment since it improved respiratory functions (Masa et al., 2015, p. 95). However, the article does disclose long term treatment has yet to be studied and that is essential to proving NIV is superior to CPAP therapy (Masa et al., 2015, p. 93). I am happy I found this article due to the large patient base they used for their study. Overall, 351 patients were studied and since a lot of data was collected and compared, I trust their

A heart attack, also known as a myocardial infarction, usually occurs when a blood clot forms inside a coronary artery at the site of an atherosclerotic plaque. The blood clot severely limits or completely cuts off blood flow to part of the heart. In a small percentage of cases, blood flow is cut off when the muscles in the artery wall contract suddenly, constricting the artery. This constriction, called vasospasm, can occur in an artery that is only slightly narrowed by atherosclerosis or even in a healthy artery. Regardless of the cause of a heart attack, the oxygen deprivation is so severe and prolonged that heart muscle cells begin to die for lack of oxygen. About 1.1 million people in the United States have a heart attack every year;

Mr. R is a 69-year-old male admitted to the cardiac intensive care unit with angina pectoris. He has a history of coronary artery disease, hyperlipidemia, and hypertension. The patient is planned to have a coronary artery bypass graft (CABG) this afternoon to repair his ventricular function. My preceptor and I spent the morning preparing Mr. R for his approaching surgery.