MYOCARDIAL INFARCTION

• Acute coronary syndrome

ALLY WOOD
2019
OBJECTIVES

• To gain understanding of MI: STEMI vs NSTEMI

• Causes
• Management for each ACS
• Ongoing medical management
• PPM/ICD
• To understand role of Physiotherapy
ACUTE CORONARY SYNDROME-
ACS

• Unstable angina
• NSTEMI
• STEMI
CAUSES

• Sudden interruption to blood supply to the heart

• Muscle is damaged/dies// area large enough will result in
cardiac arrest
• Coronary heart disease- leading cause of heart attacks
• Atherosclerosis - plaque breaks off, clot forms= disruption of
blood supply
• Risk factors: smoking, high fat diet, diabetes, high
cholesterol, high BP, obesity
NSTEMI

• Non- ST- elevation myocardial infarction

• ST refers to the ST segment on ECG
DIAGNOSIS

• Cardiac troponins- elevation in Troponin I (0-56)

• ECG- ST elevation, ST depression, T wave inversions,
pathological Q wave- all used in diagnosis of ischaemia
and infarction
• Symptoms: typical ischaemic chest pain, dyspnoea,
nausea, unexplained weakness or combinations + feeling
of impending doom.
TREATMENT OF UNSTABLE
ANGINA AND NSTEMI

• Bed/chair rest for 48 hours

• Cardiac monitoring for 48 hours
• O2 therapy unless indicated otherwise
• Serial ECG + if pain present
• Bloods tests- troponin- takes up to 2 hours to increase.
• Troponin I- peaks 12-18 hours post but 6 hours can be taken as ‘peak’ (0-
56)
• Repeat trop 6 hours post most severe symptoms
STEMI

• ST- elevation myocardial infarction

• One of the hearts major arteries is blocked
TREATMENT OF STEMI
• ACS PROTOCOL
• Bed rest
• Cardiac monitoring
• ECG
• O2 therapy
• Analgesia
• Bloods- troponin
• Transfer to pPCI- Papworth
COMPLICATIONS POST ACS

• Ventricular arrhthmias
• Complete heart block
• Hypotension
• R ventricular infarction
• Cariogenic shock
• Acute pulmonary oedema
PPM/ICD INSERTION
ATRIAL FIBRILLATION
PHYSIOTHERAPY

• Maintain function within limits of ACS protocol

• ACS day 1
• ACS day 2
• ACS day 3
• ACS day 4
• ACS day 5
• Physio role tends to be more cautious within this patient group: physiological reserve is reduced and
fatigue/stress is higher
• Pacing techniques+++
• If in doubt seek clarity from medics
• Patients on monitoring- majority are not to be disconnected from monitoring unless in the the medical plan.
• PPM/ICD precautions