MYOCARDIAL INFARCTION Health Teaching Medication Compliance - Take medications exactly as directed. Don t skip doses.

. It is important to take aspirin or other similar drugs for as long as the doctor advises Low to Moderate Risk exercise at least 3x a week Eat a healthy diet that is low in fat, salt, and cholesterol Stop smoking Allow periods of rest Avoid stressful environment Avoid Lifting heavy objects Do regular check up with your cardiologist Find a support group Advised client to maintain his religious habit Activities involving sex should be first consulted with the doctor Check incision for signs of infection (redness, swelling, drainage, or warmth) every day for a week. It is normal to have a small bruise or bump where the catheter was inserted. Contact Physician if there are:
y y y y y y y y

Bleeding at the catheter insertion site that does not stop when you apply pressure. Swelling at the catheter site. Leg or arm below where the catheter was inserted changes color, becomes cool to touch, or is numb. Small incision for the catheter becomes red or painful, or yellow or green discharge is draining from it. Chest pain or shortness of breath that does not go away with rest. Irregular pulse -- very slow (fewer than 60 beats), or very fast (over 100 to 120 beats) a minute. Dizziness, fainting, or you are very tired.. Chills or a fever over 101 F.

Possible Complications After Discharge Infection

The development of stent infection following coronary angiography is rare but represents a very severe complication. There have been only 11 reported cases in the literature since the introduction of coronary stents 20 years ago. Regular checking and dressing of puncture site and reporting for any swelling and redness is important.

Constipation
It was commonly associated with increasing age, smoking, high cholesterol, family history of myocardial infarction, obesity, hypertension and low fiber intake. Patients who had myocardial infarction needs to control this condition that may lead to straining. The control of constipation is particularly important because it will increase intra abdominal pressure, increase the cardiac vascular resistance and the heart cannot tolerate the changes in heart rhythm that straining can cause. In order to prevent this, patients need to control their diet, drink more fluids, eat more fiber and doctors may prescribe stool softeners.

Thrombosis and embolic complications

Deep vein thrombosis and pulmonary embolism can happen if there is prolonged bed rest because of myocardial infarction. Prophylactic doses of a low molecular weight heparin and compression stockings should be used for prevention. Treatment should be with therapeutic doses of a low molecular weight heparin followed by oral anticoagulation for 3 to 6 months.

Depression
Significant depression occurs in about 20% of patients following myocardial infarction. It has been found to be more than triple the risk of mortality in the first six months following MI. In order to prevent this, an open communication between family members is important. Depression can be treated by psychotherapy that can increase a person s social support and help the patient develop more positive thinking patterns. Relaxation and stress management techniques can also help manage depression.

Pericarditis Pericarditis is an inflammation of the pericardium. pericarditis is the result of the body mistakenly producing an inflammatory response to the pericardium. When the body senses blood in the pericardial sac or dead or severely damaged heart tissue (as with a heart attack), it triggers an inflammatory response. Cells from the immune system try to

clean up the heart after injury, but, in some cases, the cells can attack healthy tissue by mistake.

Symptoms:
y y y y y y

Sharp, piercing chest pain over the center or left side of your chest Shortness of breath when reclining Low-grade fever An overall sense of weakness, fatigue or feeling sick Dry cough Abdominal or leg swelling

Two Types: Immediate Pericarditis- Pericarditis that develops in the first 2 to 4 days following infarction. Usually produces only mild symptoms. o Late Pericarditis- occurs weels to months after MI and is characterized by recurrent bouts of fever and peuropericardial pain. It was initially described by Dressler, thus the name Dressler s Syndrome, and had an incidence of 3% to 4% in the past. It is now extremely rare. Dressler s Syndrome is also called postpericardiotomy, postmyocardial infarction syndrome and post-cardiac injury syndrome. The treatment for Dressler's syndrome includes:  Acetaminophen for pain, Nonsteroidal anti-inflammatory medications for pain, Narcotic pain medication
o

Prevention There are no known ways to prevent this condition after a heart attack. A person with known heart disease should be seen by the healthcare provider regularly to lower the risk of a heart attack. Restenosis Restenosis occurs when the treated vessel becomes blocked again. It usually occurs within 6 months after the initial procedure.1 Compared with balloon angioplasty alone, where the chance of restenosis is 40%, stents reduce the chance of restenosis to 25%.2,3 Therefore, the majority of patients having angioplasty today are treated with stents. Restenosis can occur after the use of stents, and physicians refer to this as instent restenosis.

New Techniques to Prevent Restenosis: Drug-Eluting Stents

During the last year, a breakthrough for the prevention of in-stent restenosis occurred in the form of a new generation of drug-eluting stents. These stents carry a special drug on their surface that prevents scar tissue growth in the artery where the stent is placed, and they therefore markedly reduce the occurence of in-stent restenosis. Recent data demonstrated that patients treated with drug-eluting stents had decreased incidence of in-stent restenosis compared with those who received bare metal stents.6 Drug-eluting stents are not yet approved by the FDA, and the results of further studies are awaited. Determine proper placement. First, it is important to know if the stent was actually placed and expanded properly. An intravascular ultrasound examination can help determine if the stent was properly deployed. If the stent wasn't properly placed, sometimes simply re-expanding it is all that is needed. If the stent was well-expanded and tissue regrowth has occurred within the stent, using a different type of drug-eluting stent is generally the best option. Long-term anticoagulation therapy. Almost all coronary interventional procedures involve the use of stents. Until the artery around the stent has healed there is a risk of blood clots forming on the metal. With bare metal stents, clopidigrel needs to be taken for at least 4 weeks and with DES, at least a year. Randomized trials are ongoing to better clarify the optimal duration of clopidigrel and related medications. In addition, in some patients prasugrel may be a better choice than clopidogrel. Talk to your doctor about the latest information about this choice. Aspirin is known to reduce the risk of heart attack in anybody with coronary artery disease bad enough to require a stent and should be taken indefinitely.

Heart Failure Patients who suffer very large heart attacks have a very high risk of developing heart failure, and its onset can be quite acute, often within the first few hours or days of the MI. But even people with only a moderate amount of muscle damage can eventually experience heart failure. For these individuals, appropriate drug therapy and lifestyle changes can be critical in delaying or preventing the onset of heart failure. If a large area of the heart muscle is damaged, then the pumping ability of the heart may be reduced. Less blood than usual is then pumped around the body, especially when extra blood is needed when you exercise. Symptoms such as breathlessness, tiredness, and swollen ankles may develop. Mild heart failure can often be treated with medication. Severe heart failure can be serious and even life-threatening.

You can reduce your chance of getting heart failure by: y not smoking y losing excess weight y doing regular physical activity aim for 30 minutes on at least five days a week y eating a healthy, balanced diet without too much salt y not drinking more than four units of alcohol a day for men or three units for women