Million People in This Country Term Paper

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Intravenous access should be obtained and 12 lead ECG/continuous monitoring plus blood draw for enzymes. The patient with angina will respond to sublingual nitroglycerine given 0.3 mg to 0.4 mg repeated every 5 minutes for up to three doses. If pain persists after the third dose, suspicion for MI should be high (Harvey, 2004). An ECG is the next step in assessment of the patient with angina vs. MI, although it should be noted that only 45% of all the patients with MI will have obvious ischemic changes on their ECG. Patients should be monitored for minor changes. ST segment elevations with tall T. waves will usually be the first changes (Docherty, 2003). Evaluators should also be sensitive to ST segment depression in leads which are opposite the site of the injury. T-wave inversion and the development of Q. waves are considered to be pathologic evidence of evolving MI. Changes like these will appear within hours of the infarction and the changes may remain on the ECG indefinitely or eventually resolve. It should be noted that in patients with non-ST segment elevation MI the changes on the ECG will be much less specific.

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No one serological test can identify MI from angina. Serological markers can be used to evaluate for myocardial infarction. Troponin T. And Troponin I may be sensitive for the smallest amount of myocardial damage. Troponin levels usually begin to elevate 2-3 hours after the onset of myocardial damage.

Creatinine Kinase (CK) and the iso-enzyme CK-MB are frequently used, but are nonspecific. Myoglobin elevations may be noted up to two hours after the onset of ischemic muscle damage but is nonspecific as well.

Conclusions

Discerning angina from a myocardial infarction is a difficult task, requiring the rapid use of evaluation skills as well as the prompt administration of treatment. More than 6 million people in the United States have angina, but a history of angina does not rule out the diagnosis of MI. Rapid diagnosis and intervention can literally be the difference between life and death.

Reference:

Docherty, B. (2003). 12-lead ECG interpretation and chest pain management: 1. British Journal of Nursing, 12(21), 1248-1255.

Harvey, S. (2004). The nursing assessment and management of patients with angina. British Journal of Nursing, 13(10), 598-601.

Sommers, M & Johnson, S. (2002)......

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