Analysis of Percutaneous Coronary Intervention in a CCU Case Study

This case study presents the scenario of a 47-year-old woman, C.B., admitted to the CCU with a STEMI. The assignment analyzes her 12-lead ECG, cardiac markers, and the rationale for various treatments including intravenous nitroglycerin, heparin, amiodarone, metoprolol, aspirin, and norepinephrine. It explores the significance of elevated creatine phosphokinase and CK-MB levels, and discusses potential complications like cardiogenic shock and heart failure. The case also addresses oxygen therapy, patient education on self-management, the importance of platelet count before clopidogrel therapy, and social support for the patient. The study provides a comprehensive overview of the patient's condition, treatment, and nursing interventions within the context of percutaneous coronary intervention.

Running head: Percutaneous Coronary Intervention
Percutaneous Coronary Intervention
Name of the student
Name of the university
Author’s name

Percutaneous Coronary Intervention
Answer 1:
12 Lead ECG report of C.B shows anterior axillary line on the same horizontal level as
V4 and Mid-axillary line on the same horizontal level as V4 and V5.
Answer 2:
Cardiac markers- Cardiac markers are proteins, also called cardiac enzymes that leaks out
into the bloodstream from the myocardial cells that are injured. The cardiac markers like MB
subtype of the enzyme creatine kinase and cardiac troponins T and I are thus, widely used in
detecting MI since they becomes more specific for myocardial injury.
Answer 3:
a. Intravenous (IV) nitroglycerin (NTG) - Nitroglycerin injection is used to treat high blood
pressure in patients who have a heart attack or hypertension while surgery. It can also be used to
produce low blood pressure (hypotension) during operation. For people who have been
diagnosed with other drugs that have not functioned properly, the use of Nitroglycerin Injection
is sometimes used to relieve angina (chest pain). Nitroglycerin is one of the nitrates categories of
medicine. It works by relaxing blood vessels and increasing blood and cardiac oxygen supply,
while reducing their workload. Intravenous nitroglycerin reduces the pressure of the left
ventricular pump in patients with acute myocardial infarction and systemic vascular resistance.
Nitroglycerin is primarily a vasodilator at lower infusion levels (less than 30 micrograms / min)
while a healthy venous and arterial dilating impact is seen at higher infusion rates (Ferreira &
Mochly-Rosen, 2011).

Percutaneous Coronary Intervention
b. IV heparin- It is a complex thrombin (AT, formerly AT III) indirect thrombin inhibitor which
converts AT from a slow to a fast inactivator (factor Xa) and, to a lesser extent, factors XIIa, XIa
and IXa (Onwordi, Gamal & Zaman, 2018).
c. IV amiodarone- Treatment with amiodarone extended RR intervals decreases possible
dispersion in the area of infarction and a mean number of ectopic beats. Some adverse effects are
identified with amiodarone on heart production and blood pressure. In the first few minutes of
acute myocardial infarction, amiodarone is a potential drug candidate to prevent VF (Sattler et
al., 2019).
d. IV metoprolol- Beta-blocker treatment prevents early on infarction and early mortality, which
reduces the risk of death of patients with acute myocardial infarction (MI) following long-term
continuity (Rosenson, Reeder & Kennedy, 2018).
e. Aspirin, chewed and swallowed- It is an antiplatelet drug used in the prevention of
cardiovascular diseases (Dai & Ge, 2011).
f. IV norepinephrine- It is used for correcting hypotension as a result of depressed vascular tone
for patients with cardiovascular disorder (Wang, Cao & Hou, 2019).
Answer 4:
The normal Creatine Phosphokinase (CK) Levels range from 22 to 198 U/L (units per
liter), whereas, C.B. has a higher Creatine Phosphokinase (CK) Levels 4175 units/L which is
much higher indicating muscle damage as a result of acute muscle injury or chronic diseases.
Normal reference value for CK-MB Isoenzymes ranges from 3-5% or 5 to 25 IU/L which was
reported to be 216% in case of C.B which is much higher indicating serious co-morbid disease
like volume depletion, acidosis or sepsis.

Percutaneous Coronary Intervention
Answer 5:
Cardiogenic shock: Cardiogenic shock is one of the most severe and life-threatening
complications of STEMI during which the blood pressure level lowers due to low cardiac output.
The assessments used to detect the risks are Echocardiogram or angiogram.
Heart failure: Heart failure can be caused as a result of myocardial infraction including
pulmonary rales or peripheral edema. Echocardiography is used to assess the condition.
Answer 6:
Such higher SpO2 at 6L/min by nasal cannula indicates that the patient was having severe
respiratory distress as most of the cannulae provides oxygen at a lower flow rate 5 litres per
minute delivering oxygen concentration of 28–44% (Sharma, Danckers & Chakraborty, 2019).
Answer 7:
Oxygen therapy must be given to her to manage her oxygenation. If her breathing still
cannot be controlled then she can be given non-rebreather mask with a minimum flow of oxygen
at 10L/min.
Answer 8:
Cardiac patients must be made educated on the importance of self-management strategies
in order to improve their health outcome. The patient here must be given information on
medicine adherence, making healthy choices and adopting to a healthy lifestyle that will help the
patient in the recovery process.

Percutaneous Coronary Intervention
Answer 9:
It is important to check Platelet count prior to the clopidogrel therapy (Lenk & Spannagl,
2014). Thus, the answer will be option C (Platelet count).
Answer 10:
She must be encouraged to take part in the social program and activities in order to create
social identity. The client must socialize with people of the community and communicate with
them that will increase the patient’s self-esteem and help her with anxiety issues.

Percutaneous Coronary Intervention
References
Dai, Y., & Ge, J. (2011). Clinical use of aspirin in treatment and prevention of cardiovascular
disease. Thrombosis, 2012.
Ferreira, J. C., & Mochly-Rosen, D. (2011). Nitroglycerin use in myocardial infarction
patients. Circulation Journal, 1110281443-1110281443.
Lenk, E., & Spannagl, M. (2014). Platelet function testing-guided antiplatelet
therapy. EJIFCC, 24(3), 90.
Onwordi, E. N., Gamal, A., & Zaman, A. (2018). Anticoagulant therapy for acute coronary
syndromes. Interventional Cardiology Review, 13(2), 87.
Rosenson, R. S., Reeder, G. S., & Kennedy, H. L. (2018). Acute myocardial infarction: Role of
beta blocker therapy. UpToDate [serial on the Internet]. c.
Sattler, S. M., Lubberding, A. F., Skibsbye, L., Jabbari, R., Wakili, R., Jespersen, T., & Tfelt-
Hansen, J. (2019). Amiodarone treatment in the early phase of acute myocardial
infarction protects against ventricular fibrillation in a porcine model. Journal of
cardiovascular translational research, 12(4), 321-330.
Sharma, S., Danckers, M., & Chakraborty, R. K. (2019). High flow nasal cannula.
Wang, X., Cao, L., & Hou, M. (2019). MiR-223-3p alleviates vascular endothelial injury by
targeting IL6ST in Kawasaki disease. Frontiers in pediatrics, 7, 288.

Percutaneous Coronary Intervention