Information about Disease

A sudden onset of chest pain can be caused by many factors such as, for example, a disease of pulmonary system, GI system, disease of the cardiac muscle, or coronary artery disease. The main factor of Acute Coronary Syndrome is due to the results of coronary occlusion or lack of blood from the narrowing of artery to supply the heart muscle. This intern caused cardiac muscle to die very rapidly or called muscle necrosis in 6 hours. Heart muscle that lacked of blood supply more than 90% with only 10% of good blood supply to heart muscle will eventually develop sudden of acute heart failure, acute myocardial infarction, and patient could be dead in a matter of time. Patient who has somewhat warning symptoms should seek an emergency medical attention. Physician will treat Acute Myocardial Infarction by opening up the occluded coronary vessel or vessels to safe the remaining of good heart muscle. This procedure can safe the life of patient and prevents any complication that may arise.

Acute MI Clinical Pathway is a Clinical Pathway that established for all health care personnel to provide standard care to all chest pain patients with acute coronary occlusion by following the policy accordingly to the Clinical Pathway.

Mission

Acute MI Clinical Pathway Mission is to provide high quality of Acute MI care in a compassionate environment through integrated trained health care team.

Goal

To ensure proper care for Acute MI patient by providing up to standard treatment and quick reperfusion therapy.

Objectives

1. To be standard of treatment and continually care for Acute MI patient.
2. To guide the clinical care to all healthcare personnel involved.
3. To communicate among patient, family members and multidisciplinary care team.
4. Provide education to achieve self management.
5. Process and outcomes measurement, evaluation and management.

Targeted groups/relevant persons

1. All chest pain patients who present to emergency room, Heart Clinic, OPD, or IPD.
2. Age more than or equal 18 years.
3. Symptom onset less than 24 hours.

Criteria

Criterion for Acute Myocardial Infarction Pathway (Key decision point)

Inclusion criteria:

1. Patient with a warning sign of chest pain or chest discomfort. These symptoms are:
   • Heavy pressure in the chest or squeezing, burning sensation inside the chest.
   • Usually occur from the chest and radiating to the rib cages.
   • Pain sometimes radiate to arm, shoulder, neck, jaw, inside the throat, or to the back.
   • Feeling of indigestion
2. The Acute MI Pathway can be started at the ER, OPD, or at the Wards when having patient with chest pain by physician or nurse In-charge. If chest pain onset is within 24 hours, nurse should immediately start Acute MI pathway without physician’s order.

Exclusion criteria:

1. Patient with chest pain from injury or accident related to muscle or joint per se.
2. Patient who has asked for transfer.
3. Patient refused treatment that against the medical advice.
4. Dead patient.
5. Age less than 18 years

Needs Immediate Attention

1. Chest pain(angina-like)
2. Heart rate faster than 150 beats/minute with shortness of breath or new irregular heart rate
3. Swelling or weight gain more than 1 to 2 pounds in a day for 2 days
4. Persistent bleeding or oozing from incisions
5. Reddened wounds, warm to touch, swollen or any drainage

Emergency please call 081-3752222 (Heart Coordinator) or 1719