MYOCARDIAL

INFARCTION

BASE LINE DATA

Name : Mr.Venkatesh
Age : 59yrs
Sex : Male
Ip no :1169288
D.O.A : 13.07.2010
Ward : CCU
Diagnosis : Myocardial Infarction
Date of care stat : 14.07.10
Date of care end : 18.07.10

Chief complaints:- patient came with the

history of chest pain and breathlessness since
1 day and pedal edema present over both legs.

PHOI:- patient is conscious and oriented and

he is on room ventilation maintaining
saturation upto 92%.

Past medical history:- patient known history

of HTN since 3yrs and he is on medication
like Tab Betaloc 25mg 1-0-1/2 tab.Aten 50mg
1-0-0.

Surgical history:- there is no evidence of past and

present surgical history.

Family history:-there is no family history of CAD,

MI and any cardiac disease and also any other
communicable diseases.

Physical examination:CVS-ECG shows that ST segment elevation

present, bradhycardia HR-42b/m.
Respiratory system:-crepitation present in left lower
lung region.
Musculo skeletal system:- pedal edema present over
both legs.

Investigation:-Elevated CPK(177IU/mt), Troponin

positive, FBS-144mg/dl, Triglycerides268mg/dl,HDL-86mg/dl

ECG-ST elevation present in 2nd lead.

Echo cardiogram-Anterior wall myocardial

infarction. Coronary artery disease.

X-ray Homogenous opacity in left lower zone,

pleural effusion.

Inj . Magnex 1gm iv BD

Tab . Imdur 30mg 1-0-1
Tab . Lasix 40mg 1-1-0
Tab . Ramipril 2.5mg 1-0-1
Tab . Atorva 10mg 0-0-1
Tab . Deplatt 75mg 0-1-0

DEFINITION

Myocardial infarction is life threatening

condition it is also called as heart attack and
characterized by death of myocardial cells
from inadequate oxygenation often cost by a
sudden and complete blockage of coronary
artery.

ETIOLOGY

Book picture
Atherosclerosis
Occlusion of an artery by
embolus or thrombi.
Coronary artery spasm
Decreased oxygen supply
due to blood loss, anemia,
low BP.
Increased demand of oxygen
rapid heart rate, ingestion
of coccin

Patient picture
Coronary artery disease.

RISK FACTORS

1.
2.
3.
4.

Book picture
NON MODIFIABLE
FACTORS
Hereditary
Age over 40 years
Sex more in males
Race blacks

Patient picture
Age -57yrs
Sex - male

MODIFIABLE FACTORS
1.
2.
3.

4.
5.
6.

Book picture
Environment
Elevated serum
cholesterol
Hypertension
Cigarette smoking
Diabetes

Patient picture
Environment
Elevated s.cholestrol
HDL 86mg/dl,
Triglyceride 286mg/dl.
HTN BP 180/100mm of
hg.

CONTRIBUTING FACTORS
1.
2.
3.

Obesity
Lack of exercise
Stress

PATHOAHYSIOLOGY

Changes in the condition of plaque in the coronary artery

Activation of platelets
Formation of thrombus
Ischemia of tissue in the region supplied by the artery
Myocardial cell death
Altered repolarization of the myocardium
Releases of enzymes
Myocardial irritability
Decreased contractility
Decreased left ventricular failure
Decreased cardiac output

CLINICAL FEATURES

BOOK PICTURE
CVS:Chest pain
Palpitation
Increased jugular vien
distention
Cardiogenic shock
ST segment and T wave
changes
ECG shows
tachycardia,bradycardia
&dysrhythmia.
Heart failure.

PATIENT PICTURE
Chest pain
Palpitation
ST segment changes
elevated in 2nd lead
ECG shows bradycardia.
BP- 180/100mm of hg.

RESPIRATORY SYSTEM
1.
2.
3.
4.
5.

6.

Book picture
Shortness of breath
Dyspnoea
Tachypnea
Crackles caused by
pulmonary congestion
Pulmonary edema

Patient picture
Dyspnoea
Crackle present in left
lower lobe of the lung.

1.
2.

BOOK PICTURE
GI SYSTEM
Nausea
Vomiting

GENITO URINARY
SYSTEM

1.

Decreased urine output

PATIENT PICTURE
Absent

Decreased urine output

20ml/hr

1.
2.

1.
2.

3.
4.

Book picture
SKIN
Cool, clammy skin
Pale appearance
NEUROLOGICAL SYSTEM
Anxiety
Decreased cerebral
oxygenation
Cardiogenic shock
Headache, visual disturbance
PHYSIOLOGICAL
Fear
anxiety

Patient picture
Pedal edema present

Headache
Anxiety

Fear
Anxiety

DIAGNOSTIC EVALUATION

BOOK PICTURE
History collection
physical examination
Electrocardiogram
Echocardiogram
Laboratory testes
CKMB, TROPONINE,
MYOGLOBIN.
MRI

PATIENT PICTURE
History collection
Physical examination
ECG
Echo cardiogram
Labs
CKMB,TROPONIN
X-ray

MEDICAL MANEGEMENT

1.
2.

GOALS
Prevention of further attack
Rehabilitation and education of the client

ACUTE MANAGEMENT
1.
2.
3.
4.
5.
6.
7.

Immediate admission to the hospital with in ICU

Pain control administer morphine
Oxygen administration
Continuous ECG monitoring
Administer anti-dysrhythmias
Anticoagulant are given to decrease the risk of embolism
Thrombholytic therapy

MEDICAL MANAGEMENT
Thrombolytic therapy:-thrombolytic are medication when are usually administered
intravenously, although some may be given directly into the coronary artery in cath
lab.

The purpose of thrombolytic is to dissolves

the lyses the thrombus in a coronary artery

Allowing the blood flow through the coronary artery

Minimize the size of the the infarction

Preserving the ventricular function

Thrombolytic must be administered as early as possible after the onset of the

symptoms
Eg;-streptokinase, urokinase, tissu plasminogen activator

continued

Angiotensin converting enzyme inhibitor;-Eg;Ramipril

Emergent percutaneous coronary intervention;Suspected MI may refer to percutaneous
coronary intervention. It may be used open the
occluded coronary artery. It will helps to treat
the underlying atherosclerosis lesion and also
promote reperfusion to the area that has been
deprived by oxygen.

Analgesics;-the analgesic of choice is

Morphine sulphate administered through IV.
Morphin reduces the pain and anxiety,and also
relaxes bronchioles to enhance oxygenation.

COMPLICATION
1.
2.
3.
4.
5.
6.
7.

Bleeding
Allergic reaction
Stroke
Dysrrhythmic
Cardiogenic shock
Heart failure
pericarditis

NURSING DIAGNOSIS
1.
2.
3.
4.
5.
6.
7.

Pain related to MI with reduced blood flow.

Decreased cardiac output related to MI
Impaired gas exchange related to decreased cardiac output.
Activity intolerance r/t imbalance between the oxygen
supply
Fear and anxiety r/t hospitalization and death
Risk for heart failure r/t disease process.
Deficit knowledge r/t disease condition and treatment.

Reference
Medical and surgical nursing Joyce .M.Black
Medical and surgical nursing Brunner and
Suddarths
Nursing drug referance - Mosby