Percutaneous Coronary Intervention (PCI)

According to the NICE guidelines (2013) as Mr Jones was presented with symptoms associated with a ST-segment-elevation myocardial infarction (STEMI) the recommended emergency treatment that is preferred is percutaneous

Early recognition of signs and symptoms and taking the right steps to identify, distinguish, and manage subtypes (STEMI and NSTEMI/UA) will improve Mr James outcomes (Bradley E.H., 2006)Recognizing the signs and symptoms such as chest pain or shortness of breath suggestive of an MI and obtaining an ECG as soon as possible (goal of less than 10 minutes following presentation of a patient) should be the standard of practice to manage this patient It has been demonstrated that reperfusion of the infarct-related artery in the very first hour (golden hour) of MI reduces mortality rates (Ayrik et al. 2006, Van de Werf et al. 2008). fact, every 30 minutes of delay time, the 1-year mortality risk increases by (DeLuca et al. 2004).According to triage and first assessment guidelines (Wrightet. al. 2011) Patients who complain of chest pain , pressure , tightness or heaviness require immediate assessment by the triage nurse and should be referred for further evaluation.

Patients experiencing chest pain require immediate assessment, including a twelve lead ECG within the time frame of ten minutes, will provide vital evidence of a cardiac, plueretic or musculoskeletal event (Acute Coronary Care Clinical care standards 2014).

Currently at Northeast Methodist Hospital (NEMH), the coordination of care of patients having outpatient coronary CTA is fragmented. At least one known patient experienced bleeding from the IV site and near syncopal episode within 10 minutes post discharge from the radiology department, which required a return to the facility for treatment. Inconsistencies in the current pre-, intra-, and post-procedure care of the patient, and risks associated, have been identified. The lack of an evidence based coronary CTA protocol within the facility contributes to the fragmented care.

In the evaluation of patients with chest pain, the preliminary ECG is a more clear-cut tool for early risk stratification with more recent recommendations indicating that ECG should be performed as early as possible, within 10 minutes of ED admittance. Early indicators associated with MI or ischemic complication such as ST segment elevation or depression allows rapid treatment aligning with the indicated complication. While the ECG may reveal significant indicators in certain situations, in other circumstances findings may be limited due to low diagnostic sensitivity

Fibrinolytic therapy uses drugs to break up blood clots. This therapy is used with heart attack patients to remove the blockage that caused the myocardial infarction. Another treatment option is percutaneous coronary intervention (PCI). PCI involves the placement of a catheter into the blocked artery to allow blood to flow. The purpose of this paper is to examine the outcomes of these two procedures and to suggest that percutaneous coronary intervention is superior to fibrinolytic therapy.

“Vasodilatation reduces cardiac preload and afterload and decreases the myocardial oxygen requirements needed for circulation. Vasodilatation of the coronary arteries improves blood flow through the partially obstructed vessels as well as through collateral vessels” (Bolooki and Askari, 2014). Nitrates, such as nitroglycerin reverse the vasoconstriction associated with thrombosis and coronary occlusion. Morphine is the analgesic opioid of choice for ischemic cardiac pain. Morphine has been shown in studies to decrease cardiac workload and decrease the anxiety and fear associated with chest pain. The heart is influenced by the needs of the body. Bed rest is important during the acute phase of a myocardial infarction because when a person is at rest, the organs, muscles and tissues will require a reduced amount of blood and oxygen (Peate and Jones, 2014). This results in a decrease workload of the heart and myocardial oxygen consumption, decreased blood pressure, and decreased heart rate. Vital signs should be closely monitored after a STEMI to monitor for any potential complications. Hypotension is a potential complication when using vasodilators such as nitroglycerin and in the use of opioids such as morphine sulfate to control pain associated with MI’s. Blood pressure also needs to be closely monitored because heart failure is a serious complication after a STEMI. Cardiac monitoring should be included for the first 24 hours after a STEMI for early detection

Coronary heart disease is one of the leading killers in America. I will later discuss why this is the case, and how the choices of Americans will inflict the ultimate price of death. Aside from bad decisions, the anatomy of where this disease takes place is fragile in regards to bodily malfunctions. The reason it is called coronary heart disease is because it takes place in the coronary arteries. These arteries are what supplies the heart with oxygenated blood. So you can guess that if something goes wrong with these arteries, it could be detrimental for the entire body because the heart pumps blood to the whole body. The right and left coronary arteries branch from the aorta, which is the main supplier of blood to the systemic circuit. The

The purpose of this paper is to discuss a new best practice, the necessary steps for implementing the new practice, and support this change in practice with current literature. Heart disease is the leading cause of death in the United States. Evidence-based clinical practice guidelines regarding patients with ST-segment elevation myocardial infarction (STEMI) seek to reduce variation in practice and improve outcomes for this patient population (O 'Gara et al., 2013). Current evidence-based practice includes immediate reperfusion therapy to the involved coronary artery in this patient population. However, it is often challenging for emergency department nurses to implement the initial steps of this evidence-based practice, which includes obtaining a 12-lead electrocardiogram within ten minutes of arrival, as some patients present with symptoms other than chest pain, or atypical symptoms. For instance, atypical presentations include shortness of breath, altered mental status, upper extremity pain, upper back pain, generalized weakness, and abdominal pain (Glickman et al., 2012). Ultimately, this results in delays of reperfusion therapy.

Providing care for post percutaneous coronary intervention (PCI) patients has evolved and the guidelines and protocols have been heavily influenced by research and evidence based practice (EBP). Unfortunately, coronary heart disease has become a major issue for the health status of Americans across the lifespan. According to the CDC, “About 610,000 people die of heart disease in the United States (U.S.) every year – that’s 1 in every 4 deaths.” In addition, treating coronary heart disease patients has negatively impacted the economic status of U.S. healthcare. Therefore, to manage

Heart disease is the leading cause of death in the United States, and diagnosis and treatment can involve invasive procedures including coronary angiography and percutaneous coronary intervention (PCI). In several European countries and Asia the majority of heart catheterizations are performed using transradial artery access (TRA); however, in the United States, the transfemoral artery approach remains the preferred method for coronary angiography and PCI. The purpose of this paper is to review the current literature and discuss the use of TRA for PCI including the history of TRA, comparisons of many important aspects of TRA with the tradition femoral approach, and discuss recommendations and future implications for use of TRA in the

This study was completed to determine the effectiveness of the current guidelines for the treatment of a myocardial infarction. “Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI” is about the door-to-ballon time that has become a performance measure in the treatment of MI’s, the recommended door-to-ballon time is 90 minutes or less. This title clearly states what the article is about, the abstract is also broken down to include what is detailed in greater depth in the body of this article.

Warfarin is another source of medicine that’s given by doctors. This medicine is given when there’s excessive blood clots formed in the vessel. Warfarin doesn’t dissolve blood clots, but instead helps prevent more clots from forming in the blood vessels. The inotropic therapy is a heart pump medicine used to make the heart pump harder under. This is used to make contractions stronger, as well as speeding the heart's rhythm. Inotropic therapy is often used when other drugs or medications aren’t strong for the person anymore. Meaning that the disease has reached to a serious stage. This heart pump drug is occasionally given to individuals who are in wait for a heart transplant. The danger of death rises in the event if they're taking

Another form of PCI is artherectomy. This is a procedure that has a cardiologist using a cutting blade that spins rapidly or a laser beam to cut away or burn away plaque that is blocking a branch of the coronary arteries.

Coronary artery disease (CAD) is caused by fatty buildup in the arteries of the heart. Your arteries are made to carry oxygen infused blood to your heart and other parts of your body if it is filled up with plaque, which is the fatty substance that clogs and blocks up the arteries. If it gets clogged enough to where your heart is not receiving fresh oxygen, you could have a heart attack that could cause very serious damage to your body and could even kill you. When you are younger, you can begin to grow plaque in your blood vessels from not eating right and not exercising regularly. When your arteries are being filled up with plaque they become more narrow and harder for blood to get through as easily as it is supposed to be. When you have