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Pathogenesis related to acute STEMI
The diagnosis of Mr. White shows that the chest pain he suffered, which radiated to his jaw and left arm, was not due to simple indigestion but the development of an acute STEMI, requiring immediate treatment. Acute anterior STEMI, or ST Elevation Myocardial Infarction, occurs when the coronary arteries that supply blood to the heart become occluded. Atherosclerosis is the primary disease responsible for the development of Acute Coronary Syndrome cases (Fitzgerald et al., 2018). When a thrombus obstructs a person’s artery due to common causes such as erosion, plaque rupture, fissuring, or dissection, it can lead to an abrupt disruption in normal blood flow. Symptoms such as chest pain, discomfort, or breathing constriction might be mistaken for signs of fatigue or indigestion.For those requiring further support in understanding and elaborating on this subject, assignment help and dissertation writing services can provide tailored guidance to ensure comprehensive and well-structured academic work on topics such as cardiovascular diseases, their diagnosis, and treatment.
A person who has family history of heart problems or more specifically coronary artery diseases, has diabetes mellitus, taken hypertensions, indulged in smoking or has dyslipidemia have a higher chances of developing Myocardial Infraction. When a person contracts acute coronary syndrome than the chances of that person developing myocardial infraction is much higher with an approximate figure of 42% people with acute coronary syndrome. When there is a complete and regular occlusion of blood flow in a person, it leads to an elevated STEMI being developed (Dai and et.al., 2017). It can be inferred that timely action is the key aspect in avoiding damage to the Myocardial because immediate action can help in avoiding development of serious problems as opposed to the delay in the action or taking the symptoms lightly.
An acute STEMI is a very risky and serious heart attack which can lead to the increased exposure towards some life threatening diseases such as sudden cardiac arrest, ventricular fibrillation etc. When a person develops chest pain which was acute in the case of Mr. White, it can be stated that an immediate electrocardiogram i.e. ECG should be performed and the troponin level should also be tested. After the diagnosis of acute STEMI in the patient, intravenous access must be obtained and the cardiac monitoring needs to be started immediately (Tadic and et.al., 2020). There is an increased risk of patients developing hypoxemia and therefore, it is necessary that they should undergo Percutaneous coronary intervention (PCS) within preferable 60 minutes or otherwise within 120 minutes as a maximum limit. If PCS can't be given within the specified range, then the patient should be given fibrinolytic therapy i.e. it should be initiated within the 30 minutes of arrival of the patient at hospital.
The ECG treatment or findings of the acute STEMI often shows an elevation in the ST segment in the interior leads i.e. V3 and V4 at J point. Sometimes, it can also occur in septal or lateral leads and depends entirely on the extent of Myocardial Infraction. When the elevation of the ST segment is concavely downward then it quite frequently overwhelms what is called as T wave. This description is often referred as tomb stoning because of the familiar shape to tombstone. It can also cause, in the inferior leads, a Reciprocal ST Segment depression.
If a person develop myocardial infraction then there are chances that they can develop three major life threatening complications which is ventricular free wall rupture, acute mitral regurgitation or inter ventricular septum rupture (Fitzgerald and et.al., 2018). The chances of a person developing ventricular free wall rupture is very high where 90% of the cases contract this followed by rupture of the inter ventricular septum in 50% patient cases and the chances of acute mitral regurgitation is even lower. Collectively, if treated immediately the mortality rate within the patients can reduce.
Nursing Strategy
After the onset of STEMI, patients who have been treated with fibrinolytic therapy or with PCI can be recommended with reperfusion strategy as the best nursing care strategy that can be also be suggested for Mr. White in current scenario. Repurfusion strategy will help in quicker recovery of the patient but then this will assist only if the criticality of time factor is kept in mind. The door to balloon strategy i.e. D2B is the most effective strategy which should be used within the 90 minutes and helps in opening up the blocked arteries by pumping in the air whereas door to needle strategy should be executed within 30 minutes (Berry and et.al., 2017). Amongst the reperfusion strategies that are available under STEMI, there are two major strategies that can be adopted which are PCI i.e. Percutaneous Coronary Intervention and fibrinolysis. Both of these strategies are effective in reducing the mortality rate but primary PCI is a much effective strategy than other reperfusion strategies that are available.
However, if the nurse implement PCI, its implication is a complex procedure and if Fibrinolysis is done, than despite its limited effectiveness, it is relatively easier to perform and can be quickly administered as well. There is however a risk of blood loss in fibrinolysis. In some cases CABGs can also be recommended but the most crucial thing is that the CODE STEMI must be activated as quickly as possible.
The nursing strategy must be devised as quickly as possible and it should be implemented quickly because time is the muscle in cases such as Acute STEMI and therefore this can assist in restoring the health of the patient with minimum effects (Shuman And et.al., 2019).
Arterial Blood Gas results
The analysis of Arterial blood gas helps in the measurement of pressure of the oxygen and carbon dioxide and the pH levels in an individual. This normally indicates the acid balance of the patient, the state or effectiveness of the ventilatory control and the state of gas exchange. For Mr. White the analysis can be made in following way:
pH: The pH indicates the presence of alkalaemia and since pH of Bill is within the range at 7.32, it depicts stable pH level.
PaO2 and PaCO2: Since PaO2 is less than the normal level of 80 to 100 mmHg, i.e. it is 70, this indicates that there are increased chances of hypoxemia in Mr. White. Since it can be further analysed that the PaCO2 level in Mr. White is normal at 33 mmHg, this collectively shows that the alveolar ventilation level is adequate in Mr. White and therefore the cause of hypoxaemia in him is due to occlusion or the disturbance in the ventilation perfusion.
HCO3: This is referred as bicarbonate and is treated as a weak base where the metabolic component in the arterial blood is measured (Harhash And et.al., 2019). This acts together with carbon dioxide and therefore it can be interpreted that the range of is close to normal in Mr. White. It can be stated that the respiratory system of the patient is at normal level i.e. the rate at which blood is pumped to and fro form the heart is at normal level.
BE: Base excess is derived collectively from pH and PaCO2 and signifies the acid requirement in order to restore the blood levels. In the patient, the BE is negative 3 and falls out of the normal range of -2 to +2 mmol/L. It can be said that there is metabolite disorder in the patient but it cannot be used to give any conclusive evidence.
Therefore, the interpretation of the ABG's shows that the patient shows the indications of developing Acute STEMI yet the acid levels and metabolism of the patient is strong showing that patient might contract ventricular free wall rupture but yet the mortality rate can be controlled because of the quick control and admission in ECG within an hour allowing the treatment to begin before the completion of the critical time of the patient.
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