Infarcting Ivan — Myocardial Infarction
Crushing pain unrelieved by rest — MONA, then reperfusion
Ivan feels an elephant sit on his chest while shoveling snow. The pain runs down his left arm, he sweats through his coat, and the muscle of his heart begins to die minute by minute.
Ivan's coronary artery occludes. Crushing substernal pain radiating to the jaw and left arm, diaphoresis, nausea, impending doom. Troponin confirms, ECG localizes. Aspirin and oxygen if hypoxic, nitrates, morphine — and reperfusion within 90 minutes.
Read Infarcting Ivan's full story →The story arc
The setup
Smoking, high cholesterol and a family history build plaque for twenty years. This morning one plaque ruptures.
The turn
Crushing substernal pressure radiating to the jaw and left arm, unrelieved by rest or three nitroglycerin tablets.
The crisis
ST elevation in leads II, III and aVF. Troponin rising. Heart rate 52 with hypotension.
The save
Chewable aspirin, cardiac monitoring, IV access, and straight to the cath lab — door-to-balloon under 90 minutes.
NCLEX study section — Myocardial Infarction
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.