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Enfarte agudo do miocárdio com elevação do segmento ST : Evolução das características clínicas
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Abstract(s)
Introdução: O relatório, na primeira parte, descreve o percurso do estágio de natureza profissional enquanto estudante do 1º Curso de Mestrado em Enfermagem Médico-Cirúrgica, na área da Pessoa em Situação Crítica (CMEMC-EPSC) da Escola Superior de Saúde de Viseu; na segunda parte uma investigação com foco na identificação das artérias coronárias mais frequentemente lesadas em indivíduos com EAMcST e os valores de FEVE entre 2014-2024.
Objetivo: Demonstrar as competências especializadas adquiridas; identificar as artérias coronárias mais frequentemente lesadas em indivíduos com EAMcST e os valores de FEVE ao longo dos últimos dez anos.
Métodos: Expor as competências adquiridas nos estágios, com recurso à metodologia descritiva e crítico-reflexiva. Ao nível da investigação, estudo, observacional, quantitativo e retrospetivo. A população em estudo foram todos os doentes com EAMcST atendidos numa Unidade Local de Saúde da região Norte de Portugal, no período compreendido entre 1 de janeiro de 2014 e 31 de dezembro de 2024. Os dados foram recolhidos pela consulta do processo clínico dos doentes.
Resultados: Amostra de 1420 doentes (65,45±13,07 anos de idade), predominantemente masculina (74,3%). Os valores mais elevados de oclusão para cada tipo de artéria ao longo dos anos mostram que a artéria coronária direita teve o maior valor em 2014 (47,8%) e a artéria descendente anterior em 2015 (50,8%). Na globalidade, as variações mais significativas ocorreram nas artérias coronária direita e descendente anterior, com picos iniciais em 2014-2015, enquanto as artérias oblíqua marginal e póstero-lateral apresentaram picos mais recentes em 2020 e 2024, respetivamente (p=0,000). Em relação à FEVE na alta, os valores mais “graves” ocorreram em 2015 (5,1%) e 2019 (6,3%); a “moderada” foi mais comum em 2018 (24,1%) e 2024 (23,3%); a “ligeira” em 2020 (39,8%) e 2017 (39,7%) e a “normal” com percentuais mais elevados em todos os 10 anos, destacando-se 50,0% em 2022 e 45,8% em 2015.
Conclusão: Os estágios foram cruciais para a aquisição de competências especializadas em EMC-EPSC. O estudo empírico confirmou a artéria descendente anterior como a mais frequentemente obstruída, seguida da coronária direita. Na admissão, os valores de FEVE grave e moderada reduziram em casos na alta, com mais indivíduos com FEVE ligeira e a normal/conservadora na alta.
Palavras-chave: Enfarte Agudo do Miocárdio; elevação do segmento-ST; Artérias ocluídas; Fração de Ejeção Ventricular Esquerda; Enfermagem Médico-Cirúrgica.
Abstract Introduction: The first part of this report describes the course of the professional internship as a student on the 1st Master's Degree in Medical-Surgical Nursing, in the area of People in Critical Situations (CMEMC-EPSC) at the Escola Superior de Saúde de Viseu; the second part is an investigation focusing on identifying the coronary arteries most frequently damaged in individuals with STEMI and the LVEF values between 2014-2024. Objective: To demonstrate the specialized skills acquired; to identify the most frequently injured coronary arteries in individuals with STEMI and the LVEF values over the last ten years. Methods: To present the skills acquired during the internships, using descriptive and critical-reflective methodology. In terms of research, the study was observational, quantitative and retrospective. The study population was all patients with STEMI seen at a Local Health Unit in the northern region of Portugal, between January 1, 2014 and December 31, 2024. Data was collected by consulting the patients' clinical records. Results: Sample of 1420 patients (65.45±13.07 years old), predominantly male (74.3%). The highest occlusion values for each type of artery over the years show that the right coronary artery had the highest value in 2014 (47.8%) and the anterior descending artery in 2015 (50.8%). Overall, the most significant variations occurred in the right coronary and anterior descending arteries, with initial peaks in 2014-2015, while the marginal oblique and posterolateral arteries showed more recent peaks in 2020 and 2024, respectively (p=0.000). Regarding LVEF at discharge, the most “severe” values occurred in 2015 (5.1%) and 2019 (6.3%); “moderate” was more common in 2018 (24.1%) and 2024 (23.3%); “mild” in 2020 (39.8%) and 2017 (39.7%) and “normal” with higher percentages in all 10 years, highlighting 50.0% in 2022 and 45.8% in 2015. Conclusion: Internships were crucial for acquiring specialized CME-EPSC skills. The empirical study confirmed the anterior descending artery as the most frequently obstructed, followed by the right coronary artery. On admission, severe and moderate LVEF values were reduced in cases at discharge, with more individuals with mild LVEF and normal/conservative LVEF at discharge. Keywords: Acute Myocardial Infarction; ST segment elevation; Occluded arteries; Left Ventricular Ejection Fraction; Medical-Surgical Nursing.
Abstract Introduction: The first part of this report describes the course of the professional internship as a student on the 1st Master's Degree in Medical-Surgical Nursing, in the area of People in Critical Situations (CMEMC-EPSC) at the Escola Superior de Saúde de Viseu; the second part is an investigation focusing on identifying the coronary arteries most frequently damaged in individuals with STEMI and the LVEF values between 2014-2024. Objective: To demonstrate the specialized skills acquired; to identify the most frequently injured coronary arteries in individuals with STEMI and the LVEF values over the last ten years. Methods: To present the skills acquired during the internships, using descriptive and critical-reflective methodology. In terms of research, the study was observational, quantitative and retrospective. The study population was all patients with STEMI seen at a Local Health Unit in the northern region of Portugal, between January 1, 2014 and December 31, 2024. Data was collected by consulting the patients' clinical records. Results: Sample of 1420 patients (65.45±13.07 years old), predominantly male (74.3%). The highest occlusion values for each type of artery over the years show that the right coronary artery had the highest value in 2014 (47.8%) and the anterior descending artery in 2015 (50.8%). Overall, the most significant variations occurred in the right coronary and anterior descending arteries, with initial peaks in 2014-2015, while the marginal oblique and posterolateral arteries showed more recent peaks in 2020 and 2024, respectively (p=0.000). Regarding LVEF at discharge, the most “severe” values occurred in 2015 (5.1%) and 2019 (6.3%); “moderate” was more common in 2018 (24.1%) and 2024 (23.3%); “mild” in 2020 (39.8%) and 2017 (39.7%) and “normal” with higher percentages in all 10 years, highlighting 50.0% in 2022 and 45.8% in 2015. Conclusion: Internships were crucial for acquiring specialized CME-EPSC skills. The empirical study confirmed the anterior descending artery as the most frequently obstructed, followed by the right coronary artery. On admission, severe and moderate LVEF values were reduced in cases at discharge, with more individuals with mild LVEF and normal/conservative LVEF at discharge. Keywords: Acute Myocardial Infarction; ST segment elevation; Occluded arteries; Left Ventricular Ejection Fraction; Medical-Surgical Nursing.
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Competência profissional Doença da artéria coronária Enfarte do miocárdio com elevação do segmento ST Enfermagem médico cirúrgica Coronary artery disease Medical surgical nursing Professional competence ST elevation myocardial infarction
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