Heart attack (myocardial infarction) interventions and treatment | NCLEX-RN | Khan Academy

Aug 26, 2023

Heart attack (myocardial infarction) interventions and treatment | NCLEX-RN | Khan Academy

Created by Vishal Punwani.

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Content

1.573 -> - In addition to treatment with medications

3.856 -> after a heart attack,

5.445 -> as part of your overall treatment,

7.407 -> you might also have some procedures done.

9.614 -> And these range from smaller interventional procedures

13.11 -> to big open heart surgeries.

15.413 -> Generally these are reserved

16.754 -> for patients with STEMIs,

18.482 -> ST-Elevation Myocardial Infarcts

20.821 -> The more serious type of Infarct.

23.471 -> But they can be done for patients with NSTEMIs,

26.013 -> Non ST-Elevation Myocardial Infarcts, as well,

29.217 -> if they're not responding

30.367 -> to treatment with medication alone,

32.813 -> or if they have a lot of risk factors

34.848 -> for bad coronary vessel disease.

37.455 -> So, once you've been given some medications

39.689 -> to deal with your myocardial infarct,

42.29 -> the first thing that happens,

43.613 -> from a interventional point of view,

45.25 -> is you'll get a coronary angiogram done.

47.979 -> Which is where an interventional cardiologist,

50.974 -> a specialized heart doctor,

52.692 -> will take a sort of unique type of x-ray

55.793 -> of your heart's blood vessels.

58.367 -> And normally on a normal x-ray

60.609 -> you can't really see people's blood vessels,

63.056 -> so in an angiogram, the cardiologist will inject

66.274 -> a special type of dye into the patient's circulation.

70.524 -> And that dye will help the cardiologist

72.846 -> to really see the blood vessels of the heart

75.029 -> really clearly.

76.53 -> So, coronary angiograms are to check

78.673 -> how badly, and also where your coronary arteries

81.786 -> are blocked or narrowed.

83.985 -> And depending on how the bad the clogging is

86.208 -> inside the coronary arteries,

88.031 -> the cardiologists will then make a recommendation

90.771 -> for what procedure that you need to go on to next

93.538 -> to fix the underlying problem with your heart.

96.06 -> So, this is what a coronary angiogram looks like.

99.726 -> You can see, it's really a cool, sort of, dynamic picture.

103.17 -> You can get a real-time look

104.609 -> at how healthy the person's coronary arteries are.

107.853 -> So, yes, these are blood vessels

109.788 -> and this is actually the outline of the heart here.

113.015 -> In this coronary artery here,

114.401 -> there's a pretty severe blockage,

116.159 -> a pretty severe narrowing of this coronary artery.

119.504 -> And over here on the right, it's resolved,

122.187 -> it's opened up.

123.649 -> And that's after treatment.

125.746 -> So depending on how bad the clogging is

128.304 -> inside a given person's coronary arteries,

131.589 -> the cardiologist will then go on

133.342 -> to make a recommendation

134.805 -> for what procedure to move on to next

137.231 -> to fix the underlying problem with someone's heart.

141.088 -> So, let's actually have a look

142.218 -> at a few of these procedures.

143.965 -> Percutaneous Coronary Intervention, or PCI,

147.749 -> is where a doctor will insert a catheter.

150.247 -> So, here I'm drawing a catheter now,

151.964 -> this purple thing.

153.391 -> So this is actually a wire-like tube

156.109 -> that a doctor will thread into your femoral artery,

159.348 -> or actually sometimes some other arteries,

161.147 -> but usually the femoral artery.

163.271 -> So, he'll thread it into your artery,

164.804 -> sort of put it into your artery,

166.348 -> and thread it up to your heart

167.962 -> and into your coronary vessels.

170.15 -> Which, as it probably sounds like,

171.921 -> it takes a lot of skill and knowledge to do this.

175.098 -> And depending on what they find in your coronary vessels,

177.609 -> depending on how bad the blockage in your vessels is,

180.187 -> they'll either just do something called an angioplasty,

182.984 -> which is where they blow a balloon up,

184.969 -> that's on the end of the catheter.

186.491 -> So, there's a balloon on the end of the catheter

188.441 -> and when they blow it up,

189.729 -> it sort of opens up the blockage,

191.482 -> pushes all that atherosclerotic plaque aside,

194.645 -> and allows blood through again.

196.683 -> Or they'll do an angioplasty,

199.063 -> so what we saw here,

200.225 -> and insert a stent,

202.302 -> which is a tough, mesh-like cylinder

205.066 -> made out of metal,

206.459 -> that gets left behind in your coronary vessel

209.272 -> to prop it open.

210.469 -> So that's PCI, that's Percutaneous Coronary Intervention.

214.225 -> Either just angioplasty,

216.06 -> so opening up a clogged artery with a balloon

219.519 -> by using a catheter with a balloon on the end,

221.887 -> or by doing angioplasty, so the ballooning technique,

225.567 -> plus inserting a stent and leaving it

227.577 -> in there long-term.

228.769 -> So, i.e., forever, right, indefinitely.

230.951 -> So, that's PCI.

232.799 -> Now, the next sort of grade up,

237.143 -> in terms of interventions,

238.64 -> is Coronary Bypass Grafts.

241.284 -> So, this one is really a whole different ball game.

243.724 -> This is an open heart surgery.

245.919 -> So, let me clear off some space here.

247.404 -> Let me clear off some room here.

248.742 -> Because now this is the big time.

252.154 -> So, here I'll draw in some more coronary arteries here.

255.005 -> And the reason I'm drawing more on,

256.998 -> is because I just want to show you that

259.285 -> Coronary Artery Bypass Grafts,

261.271 -> or cabbage, as the acronym sort of

264.513 -> allows us to pronounce it, cabbage,

267.156 -> is really only done in patients

269.131 -> who have really severe coronary artery disease.

272.035 -> And so by severe coronary artery disease I mean

274.831 -> if they have pretty significant plaques built up

278.255 -> in at least three of their coronary vessels.

280.56 -> And we call this condition triple vessel disease.

283.362 -> And so you can just kind of imagine that

285.593 -> if somebody has triple vessel disease

287.729 -> it's really not going to be easy for them

289.678 -> to get oxygen, say, from their coronary artery up here,

294.185 -> right, down to this part of the heart down here

296.499 -> because there's this huge blockage in the way.

299.364 -> And that's the same sort of thing goes

302.148 -> for this plaque and this plaque right here.

305.949 -> So, in the situation like this,

307.546 -> you've got huge areas of heart,

309.752 -> so basically all of this area of heart

311.853 -> that this vessel supplies,

313.673 -> actually it supplies more than that

314.952 -> but I won't bother drawing it in,

316.758 -> and, you know, all of this area of heart

319.608 -> and all of this area of heart,

321.314 -> that's essentially being deprived of oxygen.

325.399 -> So, we have to do something about that.

326.933 -> That's really, really serious.

328.512 -> So, what happens?

329.349 -> What happens in Coronary Artery Bypass Grafting?

332.639 -> Well, just as the name suggests, bypassing,

335.954 -> we take blood vessels from elsewhere in the body

339.38 -> and use them to bypass the atherosclerotic plaque.

343.547 -> So, I'll draw some on here

344.708 -> to show you exactly what I mean.

346.036 -> And I'll actually use pink to draw

347.889 -> on the new blood vessels.

349.909 -> So a blood vessel might be sort of attached on here

352.568 -> before the plaque,

354.774 -> and then sort of used to re-route blood

357.292 -> around the plaque,

358.381 -> so it'd be obviously attached again

360.67 -> on the other side, after the plaque.

362.897 -> And by doing this, you can restore blood flow

365.825 -> to that affected area that I sort of highlighted before,

369.096 -> that wasn't getting much oxygen at all.

371.549 -> And so the same sort of procedure will happen

373.812 -> with the rest of your blocked vessels.

375.47 -> And, let me just say, that I'm not drawing it

377.342 -> exactly how it's done in theater, in the operating theater,

380.523 -> but this is really the general idea of what happens.

383.692 -> So, just for interest's sake, blood vessels are

385.507 -> usually taken from three main places.

388.596 -> So, on the inside of your rib cage.

390.91 -> So, what I'm drawing now is on the inside,

393.189 -> not on the outside, on the inside of your rib cage,

395.581 -> there's one that's really popular

397.508 -> for use in bypass graft.

399.351 -> That's called your internal mammary artery

401.607 -> and there's one on each side.

403.96 -> In the forearm, you've got a good one.

405.689 -> So, in the forearm you've got a radial artery.

408.72 -> And on your inner leg and thigh,

410.768 -> you've got another one,

411.969 -> a vein, called the great saphenous vein.

416.231 -> And, again, just to reiterate,

417.64 -> the purpose of Coronary Artery Bypass Grafting

420.394 -> is to re-route blood around plaques.

423.718 -> So, the blood can get to the heat muscle

425.174 -> where it's needed.

426.351 -> So this is a really cool surgery.

427.648 -> I mean it sounds super complex and difficult

430.255 -> and it really is.

432.092 -> But I remember the first time I scrubbed

433.764 -> into one of these procedures,

435.166 -> and the whole time I was really just amazed

436.864 -> at the skill and the composure of the surgeons

439.074 -> who were doing it.

440.27 -> They're really well trained.

441.316 -> So the rate of complications is low.

Source: https://www.youtube.com/watch?v=dLtFP6t99yo