Myocardial Infarction 1 coyright 2004 Anna Story 1

Outlines Introduction PATHOPHYSIOLOGY Causes Clinical manifestation Dignostic evaluation Medical management Complication Nursing process

Introduction Myocardial Infraction (MI): Is the term used to describe irreversible myocardial necrosis (cell death) that result from an abrupt decrease or total cessation of coronary blood flow to a specific area of the myocardium

PATHOPHYSIOLOGY Inflammation Plaque rupture Thrombus formation Irreversible damage starts in 20 to 40 minutes. This process will continue for several hours 4 coyright 2004 Anna Story 4

causes Atherosclerosis Hypertension Smoking Use of oral contraceptive

Clinical manifestation Sudden chest pain over the lower sternal region and upper abdomen is the presenting symptoms Pain increased to reach the level of heavy rise like pain which may radiate to shoulders and down the arm (usually left arm)

Clinical manifestation The pain begins spontaneously The pain is accompanied by SOB,pallor dizziness, nausea and vomiting

Diagnostic evaluation History ECG Echocardiogram Serial enzyme studies include CK,LDH,troponin

Medical managment Pharmacotherapy vasodilators: to treat myocardial pain as nitroglycerine Anticoagulants : as heparin Thrombolytics : use to dissolve any thrombus as streptokinase

Medical managment 2 Oxygen therapy 3 Analgesics: as morphin

MONA greets all patients. M= Morphine==== 2-4mg q 5-15 min slow IV. Initial treatment: MONA greets all patients. M= Morphine==== 2-4mg q 5-15 min slow IV. Maintain BP more than 90 mmHg. Relief pain. Reduce PVR & work load on the heart. b. A=Aspirin (160-325mg) PO. Chewed & swallowed if possible. Determine if hypersensitive to ASA. 11 coyright 2004 Anna Story 11

N= Nitroglycerine SL for the 1st 24 hrs. O= Oxygen via NC 2-5 L/M. Continuous cardiac monitoring. Hematology, chemistry, & lipid profile. X-ray, Echo… Care of MI patients bed rest with HOB elevated, beside commode. Calm environment (limit stimuli & visitors, quite, calm environment). 12 coyright 2004 Anna Story 12

complication Dysrhythmias Acut pulmonary edma Congestive heart failure thromboembolism

Nursing procss Nursing diagnosis: Chest pain R/T reduced coronary blood flow Potential altered tissue perfusion R/T decreased cardiac output Anxiety R/T fear of death

Nursing intervention Relieving pain Administer oxygen Assess vital signs Provide complete physical rest Reduce anxiety

Anterior MI V1, V2, V3, V4 Anterior infarct with ST elevation Left Anterior Descending Artery (LAD) V1 and V2 may also indicate septal involvement which extends from front to the back of the heart along the septum Anterior septal MI most common type. Left bundle branch block Right bundle branch block 2nd Degree Type2 Complete Heart Block. Reciprocal changes (II, III, aVF).

Lateral MI I, AVL, V5, V6 Lateral Infarction with ST elevations Left Circumflex Artery Rarely by itself Usually in combo. Reciprocal changes (II, III, aVF).

Inferior MI leads II, III, AVF Inferior Infarct with ST elevations Right Coronary Artery (RCA) 1st degree Heart Block 2nd degree Type 1, 2 3rd degree Block N/V common, Brady

pain Begin in center of chest & may radiated to shoulders, neck, jaw or arm. Last more than 15-20 minutes and is not relieved with rest or nitroglycerin. 20 coyright 2004 Anna Story 20

Chest Pain Anginal Pain: Sudden associated e other factors. Squeezing, vice like. Substernal, may radiated to back or arms. Usually lasts less than 15 min. Relieved with rest, nitrates, or oxygen. 21 coyright 2004 Anna Story 21

Chest Pain MI pain: sudden, without precipitating factors. Intense, stabbing, vice like pressure, severe. Substernal, may radiate to back, arms, jaw, neck. Last more than 30 min. Relieved with opioids. 22 coyright 2004 Anna Story 22

Anterior MI 23 coyright 2004 Anna Story 23

Lateral MI 24 coyright 2004 Anna Story 24

Posterior MI 25 coyright 2004 Anna Story 25

Inferior MI 26 coyright 2004 Anna Story 26