Management of patients with acute myocardial infarction with ischemic stroke

G. Vijayalakshmi1* Arul kumar B2

¹Nursing Incharge, Kauvery Heartcity, Trichy, India

²Senior Executive Nursing, Kauvery Heartcity, Trichy, India

*Correspondence: +91 85086 98000;E-mail: [email protected]

Case Presentation

A 69 years old male, with diabetes and hypertension, had complaints of giddiness since 04:00 pm on 05.01.2023, associated with slurring of speech and weakness of the right upper and lower limb. He initially went to a hospital that referred him to Kauvery Heartcity for further management.

Chief complants

Giddiness
Slurring of speech
Weakness of right upper and lower limb

Vital Signs

On examination,
BP – 100/60mm Hg, HR – 96 bpm, RR – 20/mt, SpO2 – 98%
CNS – Right sided hemiplegia
RS – BAE, P/A – Soft
CVS – Sí¢â€šÂ Sí¢â€šâ€š normal

Investigation

ECG – ST elevation in inferior Leads
ECHO – Mild LV Dysfunction
Urea – 28mg/dl, Creatinine – 1.36mg/dl
Hemoglobin – 11.4
Serology – Non reactive
MRI Brain – Acute infarct left MCA territory. Age related cerebral atrophy.

Diagnosis

Coronary Artery Disease
Acute Coronary Syndrome – Acute Inferior Wall Posterior Wall Myocardial Infarction (ACS IW PW MI)
Mild LV Dysfunction
Right Hemiplegia consequent of Acute Infarct, Left MCA territory
Type II Diabetes Mellitus
Systemic Hypertension

ECG: 1

ECG: 2

ECG: 3

Coronary Angiogram

CAG on 05.01.23 – Double vessel disease.

Primary PTCA with stenting was done to RCA (05.01.23)

CAG Report

MRI Report

CT scan Report

ECHO Report

Treatment

In view of above findings patient was diagnosed to have ACS – IW PW MI (Window period 4 h) and advised primary PCI for further management. After an informed written consent patient was taken up for CAG on 05.01.23, which revealed double vessel disease. He underwent primary PTCA with stenting to proximal to Mid RCA and Mid to Distal RCA on 05.01.23 with successful results. There were no procedural and post procedural complications and his post procedural period was uneventful.

Neurologist opinion was obtained in view of slurring of speech with weakness ad giddiness. His MRI brain revealed acute infarct in left MCA territory age related cerebral atrophy. His multi slice CT brain revealed no demonstrable acute infarct/hemorrhage/SOL. Old calcified granuloma in external capsule age related cerebral atrophy.

Patient was treated with antiplatelets, anticoagulants, diuretics, PPI and other supportive measures.

Nature of the disease and risk of restenosis were well explained to patient’s attenders. Patient condition is improved and is being discharged in a stable state.

Nursing Management of MI with Stroke

Assess mental status and level of consciousness
Observe for neurological deficits with frequent and serial neurological assessments
Measure and monitor pupil size
Assess breathing
Monitor vital signs
Assess higher function like speech, memory and cognition
Provide a quiet environment with the head of the bed elevated
Elevate bed rails to prevent falls
Leave the nurse bell button at the side of the bed in case the patient needs to go to the bathroom
Prevent constipation and straining with stool softeners
Watch for seizures
Observe for changes in mood
Provide deep vein thrombosis (DVT) prophylaxis
Ability to swallow
Ability to void urine
Muscle strength and mobility
Mood and behavior

Discharge Advice given

Education regarding the causes of stroke
Education regarding modifiable risk factors for stroke
Education regarding blood pressure and glucose management
Education regarding healthy dietary intake
Emphasizing medication compliance
Ensuring patient’s and caregivers understand potential complications of therapy, especially bleeding, if they are discharged on blood thinners

Health Education given

Eat healthy foods
Do not lead a sedentary life style
Observe compliance with medications
Follow up with a clinician
Do not smoke
Control blood pressure, blood glucose and hyper lipidermia
Participate in regular exercise

Discussion

When the blood supply to the brain is interrupted causing a part of the brain to die it’s called a stroke or “Brain Attack”.

Stroke is similar to an Acute Myocardial Infarction but it affects the blood vessels in the brain instead of the heart.

Discharge Medication

Tab. Ticagrelor 90 mg 1-0-1
Tab. Ecosprin 75 mg 0-1-0
Tab. Aztor 40 mg 0-0-1
Tab. Gilipride 5 mg 1-0-1
Tab. Ceftron 250 mg 1-0-1 × 5 days

Recovery

After a stay of 3 days in the hospital, patient became stable with the efficient care of nurses and went home happily with good prognosis.

Ms. G. Vijayalakshmi

Nursing Incharge

Mr. B. Arul kumar

Senior Executive Nursing

Management of patients with acute myocardial infarction with ischemic stroke