Myocardial

Infarction (MI)

By :Pushparathi.
M.sc (Psy.), M.sc (N), Bsc. (N), DPHN, RN, RM
 Expected outcomes

• Understand pathophysiology of MI
• Identify the risk factors of MI
• Formulate nursing care plan in relation to MI
 Myocardial infarction(MI)
• Commonly which occurs when there is marked
reduction or loss of blood flow through one or more of
the coronary arteries, resulting in cardiac muscle
ischemia and necrosis.
• Myocardial infarction is a broader category of disease
known as acute coronary syndrome, results from
prolonged myocardial ischemia due to reduced blood
flow through one of the coronary arteries.
 Definitions
• It is the state at which the myocardium or part of myocardial muscles is unable to contract
effectively or fails to contract and coordinate due to inadequate supply of oxygen and nutrients to
the part or inability to meet the demands of the body .
• Find more ?????
• In cardiovascular diseases, the leading cause of death in
the United States and western Europe usually results from
the cardiac damage or complications of MI.
• Mortality is high when treatment is delayed and almost
one-half of sudden deaths due to an MI occur before
hospitalization, within one hour of the onset of symptoms.
• The prognosis improves if vigorous treatment begins
immediately.
Risk factors

Modifiable factors Non modifiable factors

• Stress • Age
• Obesity • Gender
• Sedentary lifestyle • Family history
• Tobacco , and smoking
• Hypertension
• DM
• Dyslipidemia
 Pathophysiology
Plaque ruptured/thrombus formation

– Occlusion of artery

– Vasospasm of the blood vessels

– Decreases oxygen supply

– Increases oxygen demand

– Myocardial infarction
 Etiology
• Blockage from coronary artery (plague formation)
• Coronary spasm due to drug induced or HTN
• Damage to coronary artery due to coronary
dissection (tear in the inner layer of artery)
Classification of MI

– ST elevation MI (STEMI)
– Non-ST elevation MI (NSTEMI
 Signs and symptoms
Subjective
• Chest Pain
• Chest Pressure/Squeezing
PQRST pain assessment
• P- provoke, precipitate, palliate
• Q- quality
• R- radiate
• S- severity, symptoms
• T- time
• Patient may report a feeling of impending doom
• Shortness of Breath
Objective
• ST elevation on the ECG- Called a STEMI
• Decreased oxygenation
• Signs of left ventricular failure such as crackles in the lungs or S3 heart sound
• Tachycardia (Bradycardia can be seen if patient is having an inferior MI)
• Elevated Cardiac Enzymes
Brain storm????????????
 GOAL
• Relieve chest pain
• Stabilize heart rhythm
• Reduce cardiac workload
• Revascularize the coronary artery
• Preserve myocardial tissue
• Restore life
• Minimize agony
REMEMBER TIME IS MUSCLES!
 Diagnostic evaluation
• Physical assessment
• Cardiac markers
• TROPONIN- a protein releases from heart after 2-4 hours of injury and
increase upward with damage
• CKMB-heart specific enzyme which release after 4 hrs. of injury
• CK-a protein release when muscles damage not specific to heart muscles
• Echocardiogram
• Cardiac catheterization
• Stress test

• ECG
 Medical management
Oxygen supply
Respiratory management
Hemodynamic stability
Thrombolysis (streptokinase )
Pain management (Morphine Oxygen Nitrates Aspirin)
Elimination
Nutrition
Psychological status
Treatment of underlying cause
Surgical management
• Cardiac catheterization with percutaneous coronary intervention (PCI)
including stenting
• Balloon angioplasty
• Thoracotomy
• CABG
 Nursing management
• Strict bedrest
• Mange pain
• Meet oxygen demand (anticipate for artificial ventilation)
• Continuous cardiac monitoring with special emphasis on ST segment and T wave)
• Monitor hemodynamic stability (BP,HR for arrythmias)
• Maintain fluid volume
• Send blood for cardiac enzymes according to guidelines
• Access life line
• Anticipate CPR and cardioversion
• Administer medications and watch for side effects(bleeding)
• Meet nutritional and elimination needs
• Maticulus psychological support and positive reassurance
 Complications
Immediate
• Severe arrhythmias
• Cardiac failure
• Ventricular wall rupture
• Shock and Death

Delayed
• Pulmonary /cerebral embolism
• Pericarditis
• Angina pectoris
• Recurrent infarction
• Ventricular hypertrophy
• Cardiomyopathies
• Mental disturbance
 Nursing diagnosis
• Acute Pain
• Activity Intolerance
• Fear/Anxiety
• Risk for Decreased Cardiac Output
• Risk for Ineffective Tissue Perfusion
• Risk for Excess Fluid Volume
• Deficient Knowledge
Any questions???
– https://www.youtube.com/watch?v=eZBtQ0rDnG4
– https://www.heartfoundation.org.nz/your-heart/heart-conditions/about-heart-
attacks