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Myocardial Infarction

Myocardial infarction (MI), or heart attack, occurs when blood flow to the heart is blocked, leading to tissue death. It can be classified into STEMI (complete blockage) and NSTEMI (partial blockage), with various risk factors and clinical manifestations including chest pain and shortness of breath. Immediate treatment involves medications like morphine and aspirin, and may require surgical interventions such as PCI or CABG to restore blood flow.

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23 views

Myocardial Infarction

Myocardial infarction (MI), or heart attack, occurs when blood flow to the heart is blocked, leading to tissue death. It can be classified into STEMI (complete blockage) and NSTEMI (partial blockage), with various risk factors and clinical manifestations including chest pain and shortness of breath. Immediate treatment involves medications like morphine and aspirin, and may require surgical interventions such as PCI or CABG to restore blood flow.

Uploaded by

kaurnavneetnk87
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

Submitted To: Submitted By:


Mam Ms Sandhya Navneet Kaur
Assistant Professor MSN M. Sc. Nsg 1 st
yr
SPHE CON Gharuan Mohali
Intoduction
• A myocardial infarction occurs
when an atherosclerotic plaque
slowly builds up in the inner
lining of a coronary artery and
then suddenly ruptures, causing
catastrophic thrombus formatio
n, totally occluding the artery
and preventing blood flow
downstream to the heart
muscle.
Definition

• Myocardial infarction (MI),


commonly known as a heart
attack, occurs when blood
flow decreases or stops in
one of the coronary
arteries of the heart,
causing infarction (tissue
death) to the heart muscle.
Types of Myocardial Infarction

1.
• A complete blockage: ST-elevation
myocardial infarction (STEMI)

2.
• A partial blockage: Non-ST elevation
myocardial infarction (NSTEMI)

•Coronary spasm or unstable


3. angina
Etiology

Non
Modifiable modifiable
risk factors risk factors
Hypertension
Diabetes
/ Abnormal
mellitus lipid levels

Alcohol Modifiabl
consumptio e Risk Smoking
n Factors

Obesit Stress
y Physical
inactivity
Non Modifiable Risk Factors
Age:
>40 yrs

Sex: 3
Family times
history more in
men
Clinical Manifestations
 Pressure or tightness in
the chest
 Levine's sign, in which a
person localizes the chest
pain by clenching one or
both fists over
their sternum
Clinical Manifestations
 Pain or discomfort in the jaw,
neck or in one or both the
arms, back, shoulders and
upper part of the stomach.
 Shortness of breath
 Diaphoresis, cool, clamy and
moist skin
 Nausea, vomitting
Clinical Manifestations
 Fever- Temp increase to 100.4˚
F
 Anxiety
 Feeling like you’re going to
faint
 A fast heart rate and
respiratory rate
 Sense of impending doom
 Decreased urine output
Complications of MI
 Heart failure
 Arrhythmias
 Cardiogenic shock
 Left ventricular aneurysm
 Papillary muscle rupture or dysfunction
 Ventricular septal wall rupture
• Dressler’s syndrome – Dressler syndrome is an autoimmune
inflammatory response that occurs in response to damage to
the heart muscle after MI. It is pericarditis fever that occurs
after 1-8 weeks after MI.
 Pericarditis
Diagnostic Evaluation
• History
• Physical Examination
• Echocardiogram: This test uses
sound waves to create an image of
the heart. It can show how well the
heart is pumping and identify any
areas of damage.
• Coronary angiography: This test
can help identify blockages in the
arteries.
Conti...

• Electrocardiogram (ECG)
Cardiac Biomarkers
1.Creatinine Kinase MB (CK –MB):
Muscle enzyme, released into the bloodstream
from the necrosed myocardium. CK-MB appears
in the bloodstream 4 to 6 hours after onset of
chest pain and peaks between 10 and 12 hours
after the myocardial infarction (MI)
2. Myoglobin: can be detected in the blood 1 hour
after myocardial injury, peaks within 4 to 12
hours, and immediately returns to baseline levels
3. Cardiac Troponins
 Troponins are the contractile proteins in muscle
cells, which present very early in the bloodstream, 3
to 9 hours post infarct.
 2 types of troponins are there: Trop T and Trop I
 Cardiac troponin (cTn) I, increases in 4 to 6 hours,
peaks at 12 hours, and returns to basal levels in 3 to
10 days, whereas troponin-T stays elevated for 12 to
48 hours and falls to normal in 10 days
Medical Management
Immediate Treatment Of MI
Medical Treatment

Immediate Measures:

• M- morphine
• O- oxygen therapy
• N- nitroglycerine
• A- aspirin

In-Hospital Treatment:

• Monitoring
• Medications
Immediate Measures:

– Oxygen Therapy: Supplemental oxygen


is administered to ensure adequate
oxygen supply to the heart tissue.
– Aspirin: Aspirin is given immediately as
it helps to prevent further blood clotting.

– Nitroglycerin: This medication helps to


widen the blood vessels, improving
blood flow to the heart and relieving
chest pain.
– Pain Relief: Morphine or other pain
medications may be used to manage
severe chest pain.
In-Hospital Treatment:
1. Monitoring: Continuous monitoring of the heart's
electrical activity (ECG), blood pressure, and
oxygen levels is crucial.
2. Medications:
• Antiplatelet Agents: Medications like clopidogrel
or ticagrelor are added to aspirin to further prevent
blood clot formation.
• Anticoagulants: Heparin or other anticoagulants
may be used to prevent the formation of new clots.
• Beta-blockers: These medications help to slow the
heart rate and reduce the workload on the heart.
• ACE Inhibitors: These medications help to lower
blood pressure and protect the heart.
• Statins: These medications help to lower cholesterol
levels and stabilize plaques in the arteries.
Surgical Treatment
• Reperfusion Therapy: This is a critical step in
restoring blood flow to the blocked artery.
– Percutaneous Coronary Intervention (PCI): A catheter is
inserted into a blood vessel and guided to the blocked artery.
A balloon is inflated to open the artery, and a stent (a small
mesh tube) is often placed to keep the artery open.
– Coronary Artery Bypass Grafting (CABG): This surgical
procedure involves taking a healthy blood vessel from
another part of the body and using it to create a bypass
around the blocked artery. This allows blood to flow freely
to the heart muscle.
Percutaneous Coronary Intervention
(PCI):
Coronary Artery Bypass Graft (CABG)
1. Nursing diagnosis: Acute Pain Related to
Myocardial ischemia and tissue damage as evidenced
by chest pain

Interventions :
 Assess and document the characteristics of the pain (location,
intensity, duration, and precipitating factors).
 Administer prescribed pain medications (e.g., morphine).
 Position the patient comfortably to reduce cardiac workload.
 Provide a calm and quiet environment to minimize anxiety.
 Encourage relaxation techniques, such as deep breathing
exercises.
 Monitor for nonverbal cues of pain in patients who are unable to
verbalize it.
2. Nursing diagnosis: Decreased Cardiac Output Related to
decreased blood flow due to myocardial infarction as evidenced
by Hypotension; tachycardia; weak or irregular pulse; cool,
clammy skin.
Interventions :
 Monitor vital signs closely, including blood pressure, heart rate,
and rhythm.
 Assess cardiac output by evaluating peripheral pulses, capillary
refill, and urine output.
 Administer medications as prescribed, such as oxygen,
antiplatelet agents, anticoagulants, beta-blockers, ACE
inhibitors, and statins.
 Monitor for signs of heart failure, such as crackles in the lungs,
jugular venous distention, and edema
 . Maintain the patient on bed rest to reduce cardiac workload.
3. Nursing diagnosis: Ineffective Tissue Perfusion
related to related to reduced blood flow to the heart
muscle as evidenced by chest pain, shortness of breath

Interventions
 Administer oxygen therapy as prescribed to improve
oxygenation.
 Monitor respiratory rate, depth, and rhythm.
 Assess oxygen saturation levels continuously.
 Monitor for signs of respiratory distress, such as dyspnea,
tachypnea, and use of accessory muscles.
 Position the patient to promote optimal lung expansion.
 Encourage deep breathing and coughing exercises.
 Monitor arterial blood gases (ABGs) as ordered.
4. Nursing diagnosis: Anxiety Related to pain,
and perceived threat to life as evidenced by
restlessness; irritability;
Interventions
 Provide a calm and reassuring environment.
 Encourage the patient to express their fears and concerns.
 Provide accurate information about the MI and treatment
plan.
 Teach relaxation techniques, such as deep breathing and
guided imagery.
 Offer emotional support and reassurance.
 Involve family members or significant others in providing
support.
Lifestyle modification
Follow the below-given precautions to avoid any cardiac problems
 Avoid smoking Stay away from smoking and second-hand smoke to
improve your heart health.
 Control blood pressure and cholesterol levels .
 Get regular medical checkups .
 Exercise Regular : Physical activities help to improve heart muscle
function.
 Maintain a healthy weight.
 Eat a nutritious diet with less salt to avoid heart conditions.
 Control diabetes - Keep your blood sugar levels in check.
 Reduce stress: Participate in activities which can reduce your stress
levels, such as yoga classes, sports, family time, etc.
 Avoid or reduce alcohol
Bibliography
• https://en.wikipedia.org/wiki/
Myocardial_infarction
• https://www.mayoclinic.org/diseases-conditions/
heart-attack/symptoms-causes/syc-20373106
• https://pmc.ncbi.nlm.nih.gov/articles/
PMC6957084/
• https://www.healthdirect.gov.au/heart-attack
• https://www.healthline.com/health/acute-
myocardial-infarction

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