1. Myocardial Infarction1
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2. Outlines Introduction PATHOPHYSIOLOGY Causes Clinical manifestation
Dignostic evaluation
Medical management
Complication
Nursing process

3. 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

4. PATHOPHYSIOLOGY Inflammation Plaque rupture Thrombus formation
Irreversible damage starts in 20 to 40 minutes. This process will continue for several hours 4
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5. causes
Atherosclerosis
Hypertension
Smoking
Use of oral contraceptive

6. 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)

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

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

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

10. Medical managment
2 Oxygen therapy
3 Analgesics: as morphin

11. 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 ( mg) PO.
Chewed & swallowed if possible.
Determine if hypersensitive to ASA. 11
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12. 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
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13. complication Dysrhythmias Acut pulmonary edma Congestive heart failure
thromboembolism

14. 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

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

16. 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).

17. 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).

19. 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

20. pain
Begin in center of chest & may radiated to shoulders, neck, jaw or arm.
Last more than minutes and is not relieved with rest or nitroglycerin. 20
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21. 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
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22. 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
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23. Anterior MI 23
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24. Lateral MI 24
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25. Posterior MI 25
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26. Inferior MI 26
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