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Infarction
Prepared by:
Dr Rajesh T Eapen
ATLAS HOSPITAL
MUSCAT
Definition
Otherwise know as heart attack
An MI occurs when there is a diminished
blood supply to the heart which leads to
myocardial cell damage and ischemia.
Contractile function stops in the necrotic
areas of the heart.
Ischemia usually occurs due to blockage
of the coronary vessels.
Definition cont.
This blockage is often the result of
thrombus that is superimposed on an
ulcerated or unstable atherosclerotic
plaque formation in the coronary artery.
MIs are described by the area of
occurrence.
Anterior, Inferior, Lateral or Posterior.
MI Classifications
MIs can be subcategorized by anatomy
and clinical diagnostic information.
Anatomic
Transmural and Subendocardial
Diagnostic
ST elevations (STEMI) and non ST
elevations (NSTEMI).
Risk Factors
The presence of any risk factor is
associated with doubling the risk of an MI.
Non Modifiable
Age
Gender
Family history
Risk Factors
Modifiable
Smoking
Diabetes Control
Hypertension
Hyperlipidemia
Obesity
Physical Inactivity
Smoking
Tobacco use increases the risk of
coronary artery disease two to six times
more than non smokers.
Nicotine increases platelet thrombus
adhesion and vessel inflammation.
Hyperlipidemia
Elevated levels of cholesterol, LDLs or
triglycerides are associated with the
increased risk of coronary plaque
formation and MI.
Almost 50% of the
population has some
form of dyslipidemia.
Chest Pain
The most common initial manifestation is
chest pain or discomfort.
This is not relieved by rest, position
change or nitrate administration.
Pain is described by heaviness, pressure,
fullness and crushing sensation.
Not everyone experiences this sensation.
Chest Pain
PQRST assessment for chest
pain
P- Precipitating events
Q- Quality of pain
R- Radiation of pain
S- Severity of pain
T- Timing
Cardiovascular Changes
Initially the BP and pulse may be elevated.
Later, BP will drop due to decreased
cardiac output.
Urine output will decrease
Lung sounds will change to crackles
Jugular veins may become distended and
have obvious pulsations.
Diagnostics
After collecting patient health history, a
series of ECGs should be taken to rule
out or confirm MI.
12 lead ECG can help to distinguish
between ST-elevation MIs and Non-STelevation MIs.
STEMI
ST segment elevations
T wave changes
Q wave development
Enzyme elevations
Reciprocals
NSTEMI
ST segment
depressions
T wave changes
No Q wave
development
Mild enzyme elevations
No reciprocals
CPK
Creatine Phosphokinase
Begin to rise 3 to 12 hours after acute MI.
Peak in 24 hours
Return to normal in 2 to 3 days
Troponin
Myocardial muscle protein released into
circulation after injury.
These are highly specific indicators of MI.
Troponin rises quickly like CK but will
continue to stay elevated for 2 weeks.
Myoglobin-lacks cardiac specificity.
Treatment Options
The immediate goal for any acute MI is to
restore normal coronary blood flow to
vessels and salvage myocardium.
There are a variety of medical and
medicinal therapies to treat an MI.
Morphine
Oxygen
Nitroglycerin
Aspirin
Fibrinolytic Therapy
Indicated for patients with STEMI MIs.
Should be given within 12 hours of
symptom onset.
Fibrinolytics will break down clots found
within the vessles
Contraindications: post op surgical
patients, history of hemorrhagic stroke,
ulcer disease, pregnancy, ect.
Cardiac Catheterization
A diagnostic angiography which includes
angioplasty and possible stenting.
Performed by an interventional
cardiologist with a cardiac surgeon on
stand by.
Percutaneous procedure through the
femoral or brachial artery.
Myocardial infarction
Nursing process
Assessment
A careful history
Description of symptoms (chest pain,
palpitation, dyspnea, syncope or
sweating). Each symptom must be
evaluated with regard to time, duration,
precipitating & relieving factors. In
addition complete physical assessment
for:
level of consciousness
Nursing Management of MI
Nursing interventions for a patient with acute MI
focus on:
Achieving a balance between myocardial oxygen
supply and demand: This means that in the acute
phase, there is a need to increase myocardial oxygen
supply by oxygen administration to prevent tissue
hypoxia. Myocardial oxygen supply can be enhanced
by the administration of coronary artery vasodilators
(nitroglycerin).
Prevention of complications: Nurses need to apply
cardiac monitoring of patient to detect early
ventricular dysrhythmias. In addition, nurses should
continue to assess for signs of ischemic pain.
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