21
MYOCARDIAL INFARCTION

Myocardial Infarction

Embed Size (px)

Citation preview

Page 1: Myocardial Infarction

MYOCARDIAL INFARCTION

Page 2: Myocardial Infarction

What it is???

process by which myocardial tissue is destroyed.

necrosis of a portion of the heart muscle

Also called as coronary occlusion- heart attack

Page 3: Myocardial Infarction

RISK FACTOR

Page 4: Myocardial Infarction

Pathophysiology

Page 5: Myocardial Infarction
Page 6: Myocardial Infarction
Page 7: Myocardial Infarction
Page 8: Myocardial Infarction

Clinical Manifestation

Pain is the cardinal symptom of an MI

Anxiety and fear of impending death

Nausea and vomiting

Breathlessness

Collapse/syncope

Page 9: Myocardial Infarction

Signs of sympathetic activation: pallor, sweating, tachycardia

Signs of vagal activation: nausea,vomiting, bradycardia

Signs of impaired myocardial function: hypotension, oligurea, cold peripheries

Signs of complications: e.g. mitral regurgitation, pericarditis

Page 10: Myocardial Infarction
Page 11: Myocardial Infarction
Page 12: Myocardial Infarction

Diagnostic evaluation

Electrocardiogram (ECG) Blood test (Cardiac enzymes) Echocardiogram Nuclear scan Chest radiographs Coronary angiography Exercise stress test. Cardiac computerized tomography (CT) or

magnetic resonance imaging (MRI).

Page 13: Myocardial Infarction
Page 14: Myocardial Infarction

Medical Management

Page 15: Myocardial Infarction

EARLY MANAGEMENT The patient’s history and 12-lead ECG are the primary methods used

to determine initially the diagnosis of MI. The ECG is examined for the presence of ST segment elevations of 1

mV or greater in contiguous leads. 1. Administer aspirin, 160 to 325 mg chewed. 2. After recording the initial 12-lead ECG, place the patient on a

cardiac monitor and obtain serial ECGs. 3. Give oxygen by nasal cannula.

Page 16: Myocardial Infarction

4. Administer sublingual nitroglycerin (unless the systolic blood pressure is less than 90 mm Hg or the heart rate is less than 50 or greater than 100 beats/minute).

5. Provide adequate analgesia with morphine sulfate. Provide adequate analgesia with morphine sulfate.

Page 17: Myocardial Infarction

Thrombolytic Therapy

Thrombolytic drugs lyse coronary thrombi by converting plasminogen to plasmin.

Thrombolytic therapy provides maximal benefit if given within the first 3 hours after the onset of symptoms.

Significant benefit still occurs if therapy is given up to 12 hours after onset of symptoms.

Page 18: Myocardial Infarction

Primary Percutaneous Transluminal Coronary Angioplasty (PTCA)

(PTCA) is an effective alternative to reestablish blood flow to ischemic myocardium.

Primary PTCA is an invasive procedure in which the infarct-related coronary artery is dilated during the acute phase of an MI without prior administration of thrombolytic agents.

Primary PTCA may be an excellent reperfusion alternative for patients ineligible for thrombolytic therapy.

Page 19: Myocardial Infarction

The nurse must carefully monitor the patient after a primary PTCA for evidence of complications.

These complications can include retroperitoneal or vascular hemorrhage, other evidence of bleeding, early acute reocclusion, and late restenosis.

Page 20: Myocardial Infarction

Nursing InterventionsReducing Pain Handle patient carefully while providing initial care, starting I.V. infusion,

obtaining baseline vital signs, and attaching electrodes for continuous ECG monitoring.

Maintain oxygen saturation greater than 92%. Administer oxygen by nasal cannula if prescribed Encourage patient to take deep breaths may decrease incidence of

dysrhythmias by allowing the heart to be less ischemic and less irritable; may reduce infarct size, decrease anxiety, and resolve chest pain.

Page 21: Myocardial Infarction

Administer opioids as prescribed (morphine: decreases sympathetic activity and reduces heart rate, respirations, BP, muscle tension, and anxiety).