NURSING MANGEMENT CLIENT WITH MYOCARDIAL

INFARCTION (MI) HEART ATTACK

ANILKUMAR BRLECTURER

MEDICAL-SURGICAL NURSING

Introduction

• MI or Heart attack are terms used anonymously, but the preferred term is MI.• In an MI an area of the myocardium is permanently destroyed.• MI is usually caused by reduced or decreased blood flow in a coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thromus.

Etiopathophysilogy

• MI refers to the processes by which myocardial tissue is destroyed in regions of the heart that are deprived of an adequate blood supply because of reduced coronary artery blood flow.

• Eighty percent to 90% of all acute MI are secondary to thrombus formation.• When thrombus develops , perfusion to the myocardium

distal to the occlusion is halted,resulting in necrosis.

Continue

• The acute MI process takes time. Cardiac cells can withstand in ischaemic conditions for approximately 20 minutes before cellular death begins.• The earliest tissue to become ischemic is the sub endocardium (the innermost layer of tissue in the cardiac muscle)• If ischemia persists,it takes approximately 4 to 6 hours for the entire thickness if the heart muscle to become necrosed.

Areas of the necrosis ( white arrow)

Continue....

• Infractions are usually described based on location if damage ( anterior,inferior,posterior,or lateral wall).• Descriptions are used to further identify an MI:the type of MI ( ST- segment elevation myocardial infraction STEMI and non-segment-elevation myocardial infraction NSTEMI

Clinical manifestations of MI

1) CARDIOVASCULAR• Chest pain : chest pain occurs suddenly,severe immobilizing chest

pain that not relieved by rest ,position change,and medications.• Increased jugular venous distention• BP may be elevated because of sympathetic stimulation or

decreased BP because of decreased contractility, development if cariogenic shock

• Decrease pulse rate• ST- segment and T-wave changes, ECG may show tachycardia,

bradycardia, or dysrhythmias.

Respiratory

• Shortness of breath (SOB)• Dyspnea, tachypnea, and crackles if MI has caused pulmonary congestion.• Pulmonary edema

Gastrointestinal or GIT

• Nausea and vomiting

Genitourinary

Decreased urinary output may indicate cariogenic Shock

Skin

• Cool.,clammy,diaphoretic, and pale appearance on skin

Neurologic symptoms

• Anxiety,restlessness,and light headness

Psychological

• Fear with feeling of impending doom or patient may deny that anything is worng

Complications

• Dysrhythmias ( the most common complications after an MI in 80% of MI cases.• Acute pulmonary edema• Heart failure • Cariogenic shock• Papillary muscle dysfunction• Pericarditis and cardiac tamponade

Assessment and diagnostic findings

• The diagnosis of MI is generally based on the presenting symptoms, the ECG, and laboratory test results (e.g serial cardiac biomarke valve)

Patient history

• The patient history has two parts: the description of the presenting symptoms and the history of previous illness and family history of the cardiovascular disease.

Electrocardiogram or ECG

• The ECG provides information that assists in diagnosing acute MI.• It should be obtained within 10 minutes from the patient a reports chest pain

Echocardiogram

Laboratory tests

• Laboratory tests called “CARDIAC BIOMARKERS” are used to diagnose AMI.• Creatine kinase –MB or CK-MB• myoglobin• Troponin T or I

Medical management

• The goal of medical management is to 1. Minmize myocardial damage 2. Preserve myocardial function and prevent complications*Minimizing myocardial damage is also reducing myocardial oxygen demand and increasing oxygen supply.

Pharmacologic therapy

• The patient with suspected MI given• Aspirin• Morphine sulphate• Beta blockers

Thrombolytics

• Thrombolytics are usually administered IV, although some may also be given directly into the coronary artery in cardiac catheterization.• The purpose of thrombolytics is to dissolve and lyse thrombus in a coronary artery allowing blood to flow through the coronary artery again (reperfusion), minimising the size of the infraction and preserving ventricular function.

Conti...

• Thrombolytics should not be used if the patient is bleeding or has a bleeding disorders.• To be effective,thrombolytics must be administered as early as possible after the onset of symptoms that indicate an acute MI, generally within 3 to 6 hours.

Contraindications of thrombolytic therapy

• Previous hemorrhagic stroke• Known intracranial tumour• Active internal bleeding• Severe uncontrolled hypertension• Recent head injury• current use of anticoagulants

Analgesics

• Morphine sulfate administered in IV boules to reduce pain and anxiety• The cardiovascular response to morphine is monitored carefully particularly BP and respiratory rate.

Angiotensin-converting enzyme inhibitors (ACE inhibitors)

Emergent percutaneous coronary intervention

• CABG• PTCA

Cardiac rehabilitation

• Cardiac rehabilitation is a comprehensive long term program that involves periodic evaluation,prescribed exercise and education and counseling about cardiac risk factors modification.

Indications of cardiac rehabilitation

• Myocardial infarction• Post CABG • Angina pectoris• Percutaneous coronary intervention• Heart transplant• Coronary artery disease

Aras of cardiac rehabilitation

• Smoking cessation• Lipid management• Weight control• BP control• Improve exercise tolerance• Symptoms control• Psychological well-being /strss management

Nursing management for a patient with acute MI • Achieving a balance between myocardial oxygen supply and

demand• This are achieved via oxygen administration and medication

(Nitroglycerin)• Prevention of complications• Continuous monitoring of cardiac functions• Continuous ECG monitoring• Hemodynamic monitoring• Monitor and record intake and urine output

Conti.

• Closely monitor and prevent complications associated with MI particularly dysrhythmia and cardiigenic shock• Provide emotional and psychological support • Explain and provide adequate information and knowledge about disease cond and treatment process

Risk factors modification

• Daily fat intake less than 309 % of total calories• Maintenance of serum cholesterol level• Maintain LDL levels less than 70 mg/dl• Stop smoking and reduce daily salt intake• Control Hypertension and diabetes• Increase physical activity and reduce weight

Nursing diagnosis

• Ineffective cardiac tissue perfusion related to reduced coronary blood flow from coronary thrombus and atherosclerotic plaque• Risk for imbalnved fluid• Death of anxiety• Deficient knowledge about post-MI and self care