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Myocardial Infarction: - Mercy Grace Ducusin

Myocardial infarction, commonly known as a heart attack, refers to necrosis of heart muscle caused by prolonged ischemia. It occurs when a coronary artery is severely blocked, limiting oxygen supply to heart tissue. Signs and symptoms include chest pain and shortness of breath. Diagnosis involves troponin and EKG tests showing elevated cardiac enzymes and ST segment changes. Treatment focuses on pain relief, reducing workload on the heart, and opening blocked arteries to restore blood flow and limit damage. Nursing care monitors for complications and educates on post-MI lifestyle changes.

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Melinda Cariño Ballon
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45 views17 pages

Myocardial Infarction: - Mercy Grace Ducusin

Myocardial infarction, commonly known as a heart attack, refers to necrosis of heart muscle caused by prolonged ischemia. It occurs when a coronary artery is severely blocked, limiting oxygen supply to heart tissue. Signs and symptoms include chest pain and shortness of breath. Diagnosis involves troponin and EKG tests showing elevated cardiac enzymes and ST segment changes. Treatment focuses on pain relief, reducing workload on the heart, and opening blocked arteries to restore blood flow and limit damage. Nursing care monitors for complications and educates on post-MI lifestyle changes.

Uploaded by

Melinda Cariño Ballon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Myocardial

Infarction
-Mercy Grace Ducusin
Myocardial
Infarction
-Refers to a dynamic process by which one or
more regions of the heart muscle experience a
severe and prolonged decrease in oxygen
supply because of insufficient coronary blood
flow. The affected muscle tissue subsequently
becomes necrotic.
Myocardial
Infarction
-Onset may be sudden or gradual, and the process
takes 3 to 6 hours to run its course.
-Myocardial infraction is the most serious
manifestation of acute coronary syndrome, a
complication of coronary artery disease (CAD).
Myocardial
Infarction
Pathophysiology
•Ischemia denotes diminished volume of perfusion,
while infarction is the cellular response to lack of
perfusion (aka tissue death).
•Ischemia can lead to necrosis of myocardial tissue
if blood flow is not restored. Infarction does not
occur instantly but evolves over several hours. As
the cells are deprived of oxygen, ischemia develops,
cellular injury occurs, and lack of oxygen leads to
infarction or death of the cells.
Pathophysiology
•Obvious physical changes do not occur in the heart until 6 hours
after the infarction, when the infarcted area appears blue and
swollen.
•After 48 hours, the infarct turns gray, with yellow streaks
developing as neutrophils invade the tissue.
•By 8 to 10 days after infarction, granulation tissue forms.
•Over 2 to 3 months, the necrotic area develops into a scar; scar
tissue permanently changes the size and shape of the entire left
ventricle.
Risk Factors
Atherosclerosis Obesity
Coronary artery disease Physical inactivity
Elevated cholesterol levels Age (men above 45, women
Smoking above 55)
Hypertension Impaired glucose tolerance
Stress
Causes
The cause of MI primarily stems from the vascular system.
Vasospasm. This is the sudden constriction or narrowing of the
coronary artery.
Decreased oxygen supply. The decrease in oxygen supply
occurs from acute blood loss, anemia, or low blood pressure.
Increased demand for oxygen. A rapid heart rate,
thyrotoxicosis, or ingestion of cocaine causes an increase in
the demand for oxygen.
Signs and Symptoms
•Chest pain (Cardinal symptom of MI)
Persistent and crushing substernal pain that may radiate to the left
arm, jaw, neck, or shoulder blades. Pain is not relieved by rest or
medications, it is usually described as heavy, squeezing, or
crushing and may persist for 12 hours or more.
•Shortness of breath.
Because of increased oxygen demand and a decrease in the
supply of oxygen, shortness of breath occurs.
Signs and Symptoms
•Indigestion.
Indigestion is present as a result of the stimulation of the
sympathetic nervous system.
•Tachycardia and tachypnea.
To compensate for the decreased oxygen supply, the heart rate
and respiratory rate speed up.
•Catecholamine responses.
The patient may experience such as coolness in extremities,
perspiration, anxiety, and restlessness.
Signs and Symptoms
•Fever.
Unusually occurs at the onset of MI, but a low-grade temperature
elevation may develop during the next few days.
Diagnostics
Troponin level (3 hrs – 7 to 10 days)
Total creatine kinase level (6 hrs, peaks within 18 hrs)
CK-MB isoenzyme (18 hrs, declines after 48 to 72 hrs)
Myoglobin (2 hrs, declines after 7 hrs)
LDH level (24 hrs to 48 to 72 hrs, declines in 7 o 14 days)
White blood cell count (2nd day – 1 week).
Electrocardiogram (ST elevation, T wave inversion, Q wave).
Medical Management
The goals of medical management are to minimize myocardial
damage, preserve myocardial function, and prevent
complications.
Pharmacologic Therapy
Morphine: Morphine administered in IV boluses is used for
MI to reduce pain and anxiety.
ACE Inhibitors: ACE inhibitors prevent the conversion of
angiotensin I to angiotensin II to decrease blood pressure and
for the kidneys to secrete sodium and fluid, decreasing the
oxygen demand of the heart.
Medical Management
Thrombolytics: Thrombolytics dissolve the thrombus in the
coronary artery, allowing blood to flow through the coronary
artery again, minimizing the size of the infarction and
preserving ventricular function.
Percutaneous Coronary Intervention
The procedure is used to open the occluded coronary artery
and promote reperfusion to the area that has been deprived of
oxygen. PCI may also be indicated in patients with unstable
angina and NSTEMI for patients who are at high risk due to
persistent ischemia.
Nursing Priorities
Relieve pain, anxiety.
Reduce myocardial workload.
Prevent/detect and assist in treatment of life-threatening
dysrhythmias or complications.
Promote cardiac health, self-care.
Nursing Interventions
Administer oxygen along with medication therapy to assist with relief of
symptoms.
Encourage bed rest with the back rest elevated to help decrease chest
discomfort and dyspnea.
Encourage changing of positions frequently to help keep fluid from
pooling in the bases of the lungs.
Check skin temperature and peripheral pulses frequently to monitor tissue
perfusion.
Provide information in an honest and supportive manner.
Monitor the patient closely for changes in cardiac rate and rhythm, heart
sounds, blood pressure, chest pain, respiratory status, urinary output,
changes in skin color, and laboratory values.
Nursing Diagnosis
Ineffective cardiac tissue perfusion related to reduced coronary blood flow.
Risk for ineffective peripheral tissue perfusion related to decreased cardiac
output from left ventricular dysfunction.
Deficient knowledge related to post-MI self-care.

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