Myocardial infarction

My objectives are:• Define MI or heart attack • Identify people at risk• Know pathophysiology of MI• Know the sign & symptom • Learn the way that diagnoses MI• Identify treatment that given to person who has

MI

What is heart attack or MI ???……

• Its the death of apportion of heart muscle in an area where there is sudden loss of blood supply.

Introduction

• Myocardial infarction is the most common disease which spread in this world it must take more important as subject to know about it

Myocardial InfarctionCauses

• Chest pain

• resulting in rapid& disorganized heart beat (ventricular fibrillation(

• electrical instability of heart muscle tissue

Pathophysiology

• Caused by a complete block of a coronary artery by a blood clot forming This block related to accumulation of fat on the wall of the blood vessel

• Increase demand for O2

• Decrease oxygen supply

• Sudden constriction of coronary artery

Signs & symptoms

• Severe chest pain

• Increase B.P or decrease B.P

• Tachycardia,bradycardia ,dyshythmia

• Shortness of breathing ,dyspnea,tachypnea,pulmonary edema

• Decrease U .O

• Nausea and vomiting

Signs & symptoms

• Anxiety , fear, headache, visual disturbances, altered speech

• Skin cool, clammy, pale ,diaphoresis, moist skin

Classification of M.I

• The location of the injury mostly to the left ventricular wall

• Anterior v3, v4

• Inferior L2 ,L3, AVF

• Posterior or lateral wall L1,AVL.V 6,or V5

Diagnoses of M.I

• ECG (electrocardiogram)

• Laboratory test : cardiac enzyme

• Creatinine kinase (ck) isoenzymes

• CK_MB(heart muscle)

• Troponin : regulate the myocardial contractility

• LDH

Risk factor

• Smoking

• Lack of exercise

• Hyper lipidemia

• Obesity

• Diabetes

• Stress

• Hypertension

Medical management for M.I

• M.I can treat by open the blocked artery & restore blood flow to the affected area of the heart muscle by :

• Reperfusion : established in the first 4_6 hrs of heart attack by using (percutanous transluminal coronary angioplasty (PTCA) or thrombolytic medication :

Pharmacological Treatment

• Streptokinase

• Increase amount of plasminogen activator clump & clot

• Increase amount of blood circulation

• ATP

• ACE Inhibitor

Pharmacological Treatment

Antiplatelets medicine like aspirin to reduce tendency of platelets in the blood to clump&clot.

Nitroglycerine: vasodilator .

Complications

Heart block.

Acute pulmonary edema.

Cardiogenic shock

Congestive heart failure (CHF).

Myocardial rupture.

Pericardial effusion & cardiac temponade.

Nsg process for pt with MI

assessment

A systemic assessment include careful history , particularly as it related to symptom. Each symptom must be evaluated with regard to time , duration , factors that precipitate the symptom and relieve it

Nsg diagnosis

1. Ineffective cardiopulmonary perfusion related to reduced coronary blood flow

2. Potential impaired gas exchange related to fluid overload from L.V

3. Potential altered peripheral tissue perfusion related to decreased cardiac output

4. Anxiety related to fear of death

Nsg diagnosis

The major goals of the pt include relief the pain , prevention of further myocardial damage , absence of respiratory dysfunction , reducing anxiety and absence of recognition of complications

Nsg interventions

1. Relieve pain and other symptom of ischemia : collaboration among the pt , nurse and physician is critical in assessing the pts response to therapy

2. Improving respiratory function : encouraging the pt to breathe deeply and change position frequently helps keep fluid from pooling in the bases of the lungs.

Nsg interventions

3. Promoting adequate tissue perfusion : checking skin temp and peripheral pulses frequently is important to ensure adequate tissue perfusion

Evaluation

Expected pt outcomes may include

1 .Relief of angina

2 .No signs of respiratory difficulties

3 .Adequate tissue perfusion

4 .Decreased anxiety

5 .Absence of complications

Summary

Myocardial infarction is the process by which area of myocardial cells in the heart are permanently destroy and death due to sudden loss of blood supply

MI maybe was: 1- anterior :V3,V4

2 -inferior II III AVF

3-lateral: V6.V5.AVL

.

Summary

MI caused sever chest pain radiation in Lt arm and lower jaw ,short of breathing, nausea, vomiting , tachy-bradycardia

diaphoresis , anxiety , pale , dysrhythmia , fear.

The key of tools for diagnosis MI was ECG which indicate may change in waves and cardiac enzyme and history

SummaryMedical treatment was try to open blocked artery and restore blood flow to affected area and preventing future damage and complication.

The thrombolytic medication : streptokinase , morphine , aspirin , nitroglycerine.

NSG intervention to relief chest pain give good care put him in semi sitting position

Summary

• O2 mask apply if necessary MI cause fatal disease which should be treated immediately to prevent any complication may be happened such as heart block ,acute pulmonary edema , CHF