Acute myocardial infarction (AMI)

AMI is the process of myocardial ischemia caused by the blockage of a coronary

artery by a thrombus which was having atherosclerosis
Clinical manifestations:

precordial chest pain with or without spread to the left arm, left shoulder and neck, back
Identify pain, constant or intermittent
ST segment elevation> 1mm in 2 or more leads with or without changes in Q wave
Changes in cardiac enzyme CK-MB, troponin-I, troponin-T
peripheral cold, clammy skin, diaphoresis
Blood glucose
tightness, rapid breathing, cyanosis
Tachycardia, blood tension
Oliguria or anuria
Nausea, vomiting

Complication that may accur :

Arrhythmia (12 lead ECG or ECG monitor)

Pulmonary edema (thoracic photo)
Hypotension / cardiogenic shock
Septal or ventricular rufture
Pericarditis
Management:
total bedrest with semifowler position
hospitalization in intensive care unit
Oxygen 2-5 liters /minit
liquid diet (1 day) then soft foods
thrombolytic (streptase)
heparine, walfarine
nitroglycerin
aspirin
analgesics (morphine, pethidin)
sedative
laxative
beta-blockers
ECG monitoring. Monitor of vital signs and consciousness
Overcome the cause (hypertension, diabetes mellitus, hyperlipidemia, gout)
Pathophysiological Mechanism
Arterosklerosis
coronary artery blockages
Supply O2 and nutrients to the heart
Ischemia of myocardial cell
Acute myocard infarc
myocardial tissue damage hypoxic/anaerobic pump faillure
leak of myocardial cell bocor anaerobic metabolism resistance in the pulmonary vein
irritating substances
CK-MB end of free nerve lactic acid pulmonary fluid excess
troponin-T/I
Talamus end of free nerve pulmonary edema
Chest pain stimulation of parasympathetic and sympathetic nervous
Adrenalin dan noradrenalin

GI Peristaltik gastric acid kortisol&glukagon sweat glands

Duodenal distensian/irritation glikolisis,glukoneogenesis peripheral cold, diaphoresis
Vomite center blood glukose
Nausea, vomiting
tachicardia vascular vasoconstriction blodd tension
blood flow
O2 tissue perfusion
Tissue hipoxic
metabolism CO2 released renal perfusion
energi temperature PO2(n), PCO2 renin angiotensin
weakness peripheral cold chinestoke aldosteron vasoconstriction
oliguri dyspnea reabsorption of Na,water