MPI scan guided revascularization in acute anterior wall Myocardial Infarction

Mercy1, Priyadhashini2, Bindiya Sophiya 3

1Critical Ward Nursing Incharge, Kauvery Heartcity, Trichy, India

2Critical Ward Senior Staff Nurse, Kauvery Heartcity, Trichy, India

3Critical Ward Staff Nurse, Kauvery Heartcity, Trichy, India

*Correspondence: M: +91-8508698000: Email: nursing.heartcity@kauveryhospital.com

Abstract

A Patient had complaints of chest pain associated with profuse sweating for which, he initially went to an outside hospital where he was diagnosed as ACS – AWMI, lysed with Inj.SK then developed breathlessness hence referred to Kauvery Hospital for further management. Here we took CAG revealed Double Vessel Disease and advised for viability revascularization. Then MPI (Myocardial Perfusion Imaging) scan was done and planned for PTCA. This paper will discuss the early assessment, the significance of MPI scan and the nursing care given to the patient.

Case Presentation

A 61-year-old patient was admitted in Kauvery Heart city Hospital, with coronary artery disease, cardiogenic shock, acute pulmonary edema, newly Diagnosed Type II Diabetes Mellitus, Systemic Hypertension, Dyslipidemia and acute kidney injury.

On Examination

VitalsResult
CVSS₁ S₂ (+)
SPO₂85%↓(RA)
RSBAE (+)
BP90/60 mmHg
P/ASoft
HR124 b/min
CNSWithin Normal limits
RR22 b/min
TempAfebrile
GCS15/15
GRBS212 mg/dl

Diagnostic Reports

ECG

 

 

 

ECHO Report

CAG Report

MPI Scan Report

Myocardial perfusion imaging (Nuclear stress)

  • Myocardial perfusion imaging is a non-invasive imaging test that shows how well blood flows through your heart muscle.
  • It can show areas of the heart muscle that are not getting enough blood flow.
  • It can also show how well the heart muscle is pumping.  This test otherwise called as nuclear stress test.

There are two types of MPI

  • Single photon emission computed tomography (SPECT)
  • Positron emission tomography (PET)

MPI is useful in people with chest discomfort to see if the pain comes from lack of blood flow to the heart muscle caused by narrowed or blocked heart (Coronary) arteries.

This type of pain is known ad angina MPI does not show the heart arteries themselves but can tell your health care professional if and how many arteries are blocked.  The rest can also show if you have previously had a heart attack.

If you have chest pain and an abnormal MPI test, the next step may be performing a coronary angiogram (PDF). If the MPI test is normal, your health care professional will look into other causes of your chest pain.

Why do people have MPI test?

  • Have narrowed or blocked heart arteries.
  • Have heart damage from a heart attack
  • Should have a Coronary angiogram.
  • Would benefit from a coronary stent or bypass surgery to treat your chest discomfort or help your heart pump normally.

The MPI test can also show

  • If a heart procedure you had to improve blood flow (Stent, bypass) is working.
  • How well your heart can handle physical activity.

What are the risks of an MPI test?

MPI tests are generally safe for most people. MPI studies expose you to a low dose of radiation.  Experts disagree if radiation at such low doses can cause cancer, but the possibility exists that no dose of radiation however low is completely safe.

Discuss whether to undergo the test with your health care professional based on your risk of heart disease. If you are pregnant or think, you might be pregnant, or if you are a nursing mother, tell your healthcare professional before you have this test. It could harm your baby.

PTCA Report

Nursing Management

Pre-Operative

  • BP stabilized with inotropes and IABP. Nurses maintained an hourly IABP and BP chart.
  • Routine investigations like CBC, RFT, Urine Routine, Chest SX-ray, were taken.
  • Fluid restriction was advised for the patient 1-1.2l/day.
  • Nephrologist opinion was obtained in view of elevated renal parameters and his orders were carried out.
  • USG abdomen was taken showed grade I fatty change in liver prostatemegaly.
  • After medical stabilization patient was taken up for CAG, which revealed Double Vessel Disease and advised for viability revascularization.
  • MPI scan was done which showed no evidence of significant viable myocardium in the apex apico anterior, anterior, septal, antero-septal, inferior and inferior lateral segments and planned for PTCA.
  • Patient underwent elective PTCA with stenting to Mid LCX and proximal ramus with successful results.

Post-Operative

  • Nurses monitored radial and femoral site for any complications like active bleeding, Hematoma.
  • Patient was treated with dual antiplatelet, IV anticoagulants, stations, β-blockers, diuretics, antibiotics, nephron protectives, hypoglycemic agents, PPI and sedatives.
  • Renal function was optimized after the procedure with effective fluid restriction and I/O chart maintenance.
  • Nurse’s care for the patient’s activities of daily living (ADL) developed a good rapport with the attenders and patients, which aids in early prognosis.
  • Diversional therapy was provided to the patient (Listening to music, watching TV or reading Newspapers).
  • Nurses used AIDET technique (Acknowledge, Introduce, Duration, Explanation and Thank you).  While communicating with the patient and attenders to gain their confidence and to improve the satisfaction.

Advice on discharge

  • 1500 – Kcal, low – fat
  • Salt-restricted and diabetic diet

Outcome

The patient was asymptomatic patient’s vitals were stable. There was no post-MI/failure/Dysrhythmia. He is being discharged in a stable state. He went full of happiness.

Ms. Mercy
Critical Ward Nursing Incharge

Ms. Priyadharshini
Critical Ward Senior Staff Nurse

Ms. Bindya Sophiya
Critical Ward Staff Nurse

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