Transcript Stroke and AMI: Are the Brain and the Heart Related?

STROKE AND AMI: ARE THE BRAIN AND HEART RELATED?
Jeanie Krause-Bachand, Ed. D., MSN, RN
LOGO
York College of Pennsylvania
Department of Nursing
PRACTICE QUESTION
What are the best methods to facilitate the
identification of an acute myocardial infarction
in association with an ischemic stroke, in
patients who do not present with cardiac
symptoms?
BACKGROUND
• The association between ischemic stroke and
AMI has been recognized for decades
•Estimated at about 1% of patients
• Appears to be underestimated and the issue
does not receive the clinical recognition it
deserves
• Mortality is astronomical, about 30-40%
• When stroke occurs with AMI, the outcome is
worse and the cost is greater
EVIDENCE
• The relationship between stroke and AMI is most likely
multifactorial
• Older age
• History of previous stroke, diabetes, or hypertension
• Size and location of infarct
• Ventricular dysfunction
• More common in women
• The atypical nature of cardiac symptoms experienced by women
causes them to be unable to link the symptoms to heart disease
CHART or PICTURE
CHART or
PICTURE
RECOMMENDATIONS
EBP MODEL
Stetler Model of Research Utilization to
Facilitate Evidence-Based Practice
•Prescriptive approach that emphasizes the key
roles of critical thinking and decisions making
skills to facilitate safe and effective utilization
of research findings
•Phases of the Stetler Model:
•Preparation
•Validation
•Comparative Evaluation/Decision Making
•Translation/Application
•Evaluation
•Initial Diagnostic Studies and Laboratory Testing:
•CK, MB, Troponin on admission to ED (X3)
•Electrocardiogram (ECG).
•Nursing Education:
•Senior BSN nursing students
•Mandatory for ED and Neuro ICU nurses
•Identification of an AMI by ECG
•Location where infarct is occurring
•12 Steps to 12 Leads
REFERENCES
CHART or
PICTURE
Stephens, K. E., Anderson, H., Carey, M. G. & Pelter M. M.
(2007). Interpreting 12 –lead electrocardiogram for acute STelevation myocardial infarction: What nurses know. Journal
of Cardiovascular Nursing, 22 (3), 186-193.
Stetler, C. B. (2001). Updating the Stetler Model of Research
printed by
utilization to facilitate evidence- based practice. Nursing
Outlook, 49 (6), 272-279.
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