The Critical Care Nurse’s Role in the Noninvasive Assessment of Myocardial Reperfusion

Thrombolytic therapy is rapidly becoming the standard of care for the treatment of acute myocardial infarction (AMI). The goal of thrombolytic therapy is clot dissolution in the infarct artery that results in re-establishing blood flow to affected ischemic myocardium. Confirmation of the occurrence of reperfusion can only be established by direct visualization of the coronary artery. Clinical reperfusion markers (dysrhythmias, chest pain relief, ST segment normalization, CK peak values) have also been associated with myocardial reperfusion. These markers are noninvasive and are routinely relied on in the clinical setting. However, a review of the literature reveals that the noninvasive reperfusion markers individually lack reliability in successfully predicting reperfusion status. Because of the importance of establishing the success of reperfusion therapy early in the treatment of AMI, it is critical that the nurse at the bedside be aware of the criteria that can be established to improve the reliability of the reperfusion markers and their limitations.