Myocardial

infarction
Myocardial infarction
Muscle Tissue death from
lack of blood flow
Heart
 Myocardial infarction
• Also called as: Acute Coronary
Syndrome, Coronary occlusion and
Heart attack.
• Is an emergent situation characterized by
an acute onset of myocardial ischemia
that results to myocardial death
Epidemiology
 Heart disease is the leading cause of mortality covering
12.7 percent of all deaths in 2016 and STEMI has the
highest rate of cardiovascular diseases with an average
mortality rate of 10 percent based on the health facility
records in the Philippines.
 more than 42,000 people were admitted to hospitals due
to acute myocardial or coronary syndrome, while 3,800
die every year of heart attack based on 2017 PhilHealth
data
Coronary artery
Pathophysiology
Atherosclerosis Coronary artery spasm Coronary artery dissection

Rupture of plaque

Formation of blood clot/ Obstruction

Thrombosis

Reduced oxygen
delivery to
myocytes

Necrosis

MYOCARDIAL
INFARCTION
Symptomatology
 Chest pain
 Dysrhythmias  Cool, Pale and

 Shortness of breath
moist skin
 Increased RR and
 Indigestion
HR
 Nausea
 Types of ACS/MI
1. Unstable Angina – The patient has clinical manifestations of
coronary ischemia, but ECG and cardiac biomarkers show no
evident of MI
2. STEMI – The patient has ECG evidence of Acute MI with
characteristic changes in two contiguous leads of 12-lead ECG. In
this type of MI, there is significant damage to the myocardium.
3. NSTEMI – The patient has elevated cardiac biomarkers but no
definite ECG evidence of MI, there may be less damage of the
myocardium.
Diagnostic
Tests
1. ELECTROCARDIOGRAM (ECG)
- The 12 lead ECG provides information that assists in
ruling out or diagnosing an acute MI. It should be obtained
within 10 mins from the time a patients reports pain or
arrives the Emergency Dept. By
monitoring serial ECG changes over
time, the location, evolution, and
resolution of an MI can be identified
and monitored.
Diagnostic
Tests

Effects of ischemia, injury, and infarction on ECG recording. Ischemia causes inversion of T wave because of
altered repolarization. Cardiac muscle injury causes elevation of the ST segment and tall, symmetrical T waves.
With Q-wave infarction, Q or QS waves develop because of the absence of depolarization current from the
necrotic tissue and opposing currents from other parts of the heart.
Diagnostic
Tests
2. ECHOCARDIOGRAM
- The echocardiogram is used to evaluate ventricular
function. It may be used to assist in diagnosing an MI,
especially when the ECG is nondiagnostic. The
echocardiogram can detect
hypokinetic and a kinetic wall
motion and can determine the
ejection Fraction.
Diagnostic
Tests
3. LABORATORY EXAMINATION
a. Troponin
- is a protein found in the
myocardial cells, regulates the
myocardial process. An increase level
of troponin in the serum can be
detected within few hours during
acute MI.
Diagnostic
Tests
3. LABORATORY EXAMINATION
b. Creatine Kinase and its isoenzymes
- CK-MB is the cardiac – specific
isoenzyme; it is found mainly in
cardiac cells and therefore increase
when there is damage to these cells.
Elevated CK-MB is an indicator of
acute MI.
Diagnostic
Tests
3. LABORATORY EXAMINATION
c. Myoglobin
- is a heme protein that helps transport
oxygen. Like CK-MB enzyme,
Myoglobin is found in the cardiac and
skeletal muscle. An increase in
myoglobin is not very specific in
indicating an acute cardiac event;
however, negative results can be used to
rule out an acute MI.
 Medical
Management
A. PHARMACOLOGIC THERAPY
1. Thrombolytics are medications that are usually
administered intravenously, although some may also be
given directly into the coronary artery in the cardiac
catheterization laboratory. The purpose of thrombolytics is
to dissolve and lyse the thrombus in a coronary artery
(thrombolysis), allowing blood to flow through the coronary
artery again (reperfusion), minimizing the size of the
infarction, and preserving ventricular function.
 Medical
Management
A. PHARMACOLOGIC THERAPY
2. The Analgesic of choice for acute MI is morphine
sulfate (Duramorph, Astramorph) administered in
intravenous boluses. Morphine reduces pain and
anxiety. It reduces preload, which decreases the
workload of the heart. Morphine also relaxes
bronchioles to enhance oxygenation.
 Medical
Management
A. PHARMACOLOGIC THERAPY
3. ACE inhibitors (ACE-I) prevent the conversion of
angiotensin from I to II. In the absence of angiotensin
II, the blood pressure decreases and the kidneys
excrete sodium and fluid (diuresis), decreasing the
oxygen demand of the heart. Use of ACE inhibitors in
patients after MI decreases the mortality rate and
prevents the onset of heart failure.
 Medical
Management
B. EMERGENT PERCUTANEOUS CORONARY
INTERVENTION (PCI)
PCI may be used to open the
occluded coronary artery in an acute
MI and promote reperfusion to the
area that has been deprived of
oxygen. PCI treats the underlying
atherosclerotic lesion.
 Medical
Management
EMERGENT PERCUTANEOUS CORONARY
INTERVENTION
 Nursing
Management
Nursing Diagnosis: Ineffective cardiopulmonary tissue perfusion related
to reduced coronary blood flow
1. Initially assess, document, and report to the physician the following:
a. The patient’s description of chest discomfort, including location, intensity,
radiation, duration, and factors that affect it. Other symptoms such as nausea,
diaphoresis, or complaints of unusual fatigue.
b. The effect of chest discomfort on cardiovascular perfusion—to the heart
(eg, change in blood pressure, heart sounds), to the brain (eg, changes in
LOC), to the kidneys (eg, decrease in urine output), and to the skin (eg, color,
temperature).
 Nursing
Management
2. Obtain a 12-lead ECG recording during the symptomatic event, as
prescribed, to determine extension of infarction.
3. Administer oxygen as prescribed.
4. Administer medication therapy as prescribed and evaluate the patient’s
response continuously.
5. Ensure physical rest: use of the bedside commode with assistance; backrest
elevated to promote comfort; diet as tolerated; arms supported during upper
extremity activity; use of stool softener to prevent straining at stool. Provide
a restful environment, and allay fears and anxiety by being supportive, calm,
and competent. Individualized visitation, based on patient response.
 Nursing
Management
Nursing Diagnosis: Anxiety related to fear of death, change in
health status
1. Assess, document, and report to the physician the patient’s and
family’s level of anxiety and coping mechanisms.
2. Assess the need for spiritual counseling and refer as appropriate.
3. Allow patient (and family) to express anxiety and fear:
a. By showing genuine interest and concern
b. By facilitating communication (listening, reflecting, guiding)
c. By answering questions
 Nursing
Management
4. Use of flexible visiting hours allows the presence of a supportive
family to assist in reducing the patient’s level of anxiety.
5. Encourage active participation in a cardiac rehabilitation program.
 Nursing
Management
OTHER RELATED NURSING DIAGNOSIS:
 Ineffective cardiopulmonary tissue perfusion related to reduced
coronary blood flow from coronary thrombus and atherosclerotic
plaque
 Potential impaired gas exchange related to fluid overload from left
ventricular dysfunction
 Potential altered peripheral tissue perfusion related to decreased
cardiac output from left ventricular dysfunction
 Anxiety related to fear of death
 Deficient knowledge about post-MI self-care
THANK YOU!!