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| Angiogram of occluded coronary artery |
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Monitoring Patients After an Acute Coronary Event
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Early recurrent angina, especially after successful reperfusion, may occur in up to 58% of patients1 |
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Reinfarction has been reported to occur in approximately 10% of patients during the first 10 days, but only in up to 3% to 4% of patients who have undergone thrombolytic therapy and received aspirin1 |
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80% of all sudden cardiac deaths occur in patients with known cardiovascular disease1 |
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It is exceedingly clear that patients who experience an acute coronary syndrome have the potential to experience another ischemic and possibly catastrophic event. Therefore, early general measures for patients who have experienced an acute coronary syndrome focus on:1
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Monitoring for adverse events |
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Preventing such events through protective measures |
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Treating adverse events when they do occur |
Protection against adverse events involves a variety of measures aimed at minimizing myocardial damage by maintaining a balance of oxygen supply and demand. Limiting early physical exertion and minimizing sympathetic stimulation are methods of minimizing oxygen demand when coronary blood flow is limited.1
“Coronary precautions”, designed to limit physical exertion and sympathetic stimulation, became the standard in the 1960s. These included the restriction of iced and hot fluids as well as stimulant beverages, rectal temperature measurements and examinations, and vigorous back rubs, as well as assistance with eating and enforced bed rest. Despite the fact that research does not support their use, a recent national survey indicates that coronary precautions are still in practice across the United States.1
In fact, there is a considerable amount of variation among countries in the management of MI, across and within geographic regions of the United States, across medical specialties, among patients of differing race and gender, and between young and old patients. These variations highlight the need for contemporary guidelines in clinical practice and regular updating of local hospital protocols and critical pathway maps.1
Towards that end, the American College of Cardiology and the American Heart Association have issued guidelines for appropriate patient monitoring, which can help reduce the cost of caring for acute MI patients. Examples of these guidelines follow:1
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Pulse oximetry is currently routine for continuous monitoring of oxygen saturation and has been proven to be extremely helpful in providing early warning signs of hypoxemia.1
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Blood pressure should be measured repeatedly; however, actual frequency will be dependent upon the severity of illness. For most patients, non-invasive monitoring is adequate. There are, however, clinical situations where invasive arterial monitoring is preferred.1
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Electrocardiographic monitoring is an essential role of staff who must be adept at rhythm interpretation, lead selection based on infarct location and rhythm, as well as lead placement for detection of left ventricular involvement.1
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Diagnostic testing is one of the most important determinants or resources for the management of MI patients. However, this may be an expenditure that may not be necessary in low-risk MI patients and that may prolong hospital stay.1
The ready availability of cardiac marker measurements, coupled with significant advances in techniques for rapidly measuring markers that rise into the abnormal range in less than 6 hours (i.e., Myoglobin and Troponin I and T) now enable the physician to diagnose or exclude MI in uncertain cases within 8 to 12 hours from onset of chest discomfort. Use of such rapid biochemical techniques has been shown to reduce the length of stay in CCUs and clinicians are encouraged to assess their current laboratory testing protocols with a goal of more accelerated decision making.1
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Hemodynamic monitoring, such as with a balloon flotation catheter, is often helpful in the management of acute MI and concomitant hemodynamic instability, including low cardiac output, hypotension, persistent tachycardia, pulmonary edema and apparent cardiogenic shock.1 |
To learn more about monitoring patients after an acute coronary event, visit:
Reference
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