Nursing

The diagnosis is Coronary artery disease . Acute inferior infarction There are several pathognomic symptoms , which can be used as the diagnostic criteria : chest pain , ECG changes (ST elevation in the inferior leads . Other information (hypotony and bradycardia ) was provided in the case study can be useful for understanding of the severity of the condition

The risk of death is (heart rate x [age /10]2 /SBP 16 .9 , consequently the risk of death in the first 24 hours is up to 0 .4 / death at the hospital -1 .5 and in 30 days

- 1 .9 (see Annex , tab . 1

By the definition using in the MESH database , the myocardial infarction is a gross necrosis of the myocardium , as a result of interruption of the blood supply to the area . The interruption of blood supply often is caused by the thrombus appearing in the vessels damaged by the atherosclerotic process . The occlusion by the blood clot can be subchanges mechanical resistance and elasticity of the vessel . This narrow spot will make the blockage of blood supply more likely . Thrombus resorption may be followed by collagen accumulation and smooth muscle cell growth . Thus the blood clot will form on the atheroma easier Sometimes a clot forms in the cavity of the heart and goes in a coronary artery with the flow of blood

Rarely myocardial ischemia can be caused by the spasm of the coronary arteries . Slowly accruing stenosis of epicardial coronary arteries may proceed to complete occlusion but do not usually lead to the myocardial infarction because of the development over time of a rich collateral network . With time the resultant thrombus can completely occlude the epicardial infarct artery . If there is an insufficient collateral supply , a wave front of myocardial necrosis begins within 15 minutes and spreads from the endocardium toward the epicardium . This may be modulated by the extent of collateral flow and determinants of myocardial oxygen consumption , affording opportunity for significant myocardial salvage

Depending on the evidence of the myocardial lesion we can distribute all causes of an acute coronary syndrome in the following diagnoses unstable angina , myocardial infarction without ST elevation (NSTE-MI and myocardial infarction with ST elevation (STEMI (see Annex , fig . 1 .The main determinants of acute myocardial infarctions are an acute parietal vascular lesion local coronary vasoconstriction and a platelet and fibrin thrombus . The coronary spasm and the thrombotic cascade can be triggered by the parietal fissuration

A key concept in the pathophysiology of acute myocardial infarction is ventricular remodeling - changing size , shape , and thickness of the ventricle walls involving both the damaged and intact segments of the ventricle . Acute dilatation and thinning of the area of infarction that is not due to additional myocardial necrosis is referred to as infarct expansion . An extraload is placed on the residual functioning myocardium , which results in compensatory hypertrophy . Thus inhibition of the renin-angiotensin-aldosterone system is is a key therapeutic maneuver in patients with infarction . Additional important pathophysiological concepts in patients with infarct include cardiac arrhythmias such as those...