Myocardial Infarction (MI)

 The death or destruction of the myocardial cells from inadequate oxygenation often
cause by a sudden complete blockage of a coronary artery; characterized by localized
formation of necrosis (tissue destruction) with subsequent healing by scar formation
and fibrosis.

 Complete or nearly complete occlusion of the coronary artery ( due to rupture of

atherosclerotic plaque →thrombus or embolism; vasospasm; ↓oxygen supply; or ↑
demand oxygen) →profound imbalance between oxygen supply & demand → ischemia
→ infarction (cell death)

Risk Factors
Modifiable
 Infarctions may occur for a variety of reasons, but coronary thrombosis of a coronary
artery narrowed with plaque is the most common cause.
 Other causes include spasms of the coronary arteries; blockage of the coronary arteries
by embolism of thrombi, fatty plaques, air, or calcium; and disparity between
myocardial oxygen demand and coronary arterial supply.
 Multiple risk factors have been identified for coronary artery disease and MI.
 Modifiable risk factors include cigarette smoking, which causes arterial vasoconstriction
and increases plaque formation. A diet high in saturated fats, cholesterol, sugar, salt,
and total calories increases the risk for MIs. Elevated serum cholesterol and low-density
lipoprotein levels increase the chance for atherosclerosis. Hypertension and obesity
increase the workload of the heart, and diabetes mellitus decreases the circulation to
the heart muscle.
 Hostility and stress may also increase sympathetic nervous system activity and pose risk.
 A sedentary lifestyle diminishes collateral circulation and decreases the strength of the
cardiac muscle.
 Medications can also prevent risks.
 Oral contraceptives may enhance thrombus formation, cocaine use can cause coronary
artery spasm, and anabolic steroid use can accelerate atherosclerosis.
Non-Modifiable
 Some factors—such as age, family history, and gender—cannot be modified.
 Aging increases the atherosclerotic process, family history may increase the risk by both
genetic and environmental influences, and males are more prone to MIs than are
premenopausal women.
 Premenopausal women have the benefit of protective estrogens and a lower
hematocrit, although heart disease is on the rise in this population, possibly because of
an increased rate of smoking in women. Once women become postmenopausal, their
risk for MI increases, as it also does for men over age 50

Clinical Manifestation of MI

 Inc. frequency, severity or duration of angina

 Cardial symptoms of MI: persistent, crushing substernal pain or pressure
possibly radiating to the left arm,jaw, neck and sholder blades: for women;
fatigue and back pain
 In elderly patients or those with diabetes, pain possibly absent in others pain
possibly mild and confused with indigestion
 Feeling of impending doom, fatigue nausea vomiting and shortness of breath
 Extreme anxiety and restlessness
 Dyspnea, diaphoresis
 Tachycardia, hypertension; bradycardia and hyptension in inferior MI
Medications
 Analgesic
 For relief pain. This is a priority
 Morphine, sulphate, Lidocaine or Nitroglycerine are administered intravenously
 Thrombolytic Therapy
 To disintegrate blood clot by activating the fibrinolytic processes.
 Streptokinase, urokinase and tissue plasminogen activator are currently used
 Administration of thrombolytic is most crucial between 3 to 6hours after the
initial infarction has occurred
 Detect for occult bleeding during and after thrombolytic therapy
 Assess neurologic status changes which may indicate G.I bleeding or cardiac
tamponade
 Anticoagulant and antiplatelet medications are administered after thrombolytic
theraphy to maintain arterial patency
 Infarct Other Medications: Beta-adrenergic blocking agents; diazepam (Valium)
Treatment
 Goals
- Prevention of further tissue injury and limitation of infarct size
- Maximize myocardial tissue perfusion and reduce myocardial tissue demands
 Supplemental oxygen by nasal cannula. This increases myocardial oxygen supply. Nasal
Cannula does not intensify feeling of suffocation in the client with Mi
 Cardiac monitoring to detect occurrence of dysrhythmias.
 Percutaneous transluminal coronary angioplasty (PTCA) may be done to reopen an
occluded artery
 Diet: low- cholesterol, low- salt diet is prescribed
 Activity- Bed rest is usually prescribed for 24 to 48 hours to decrease oxygen demand.
Progressive ambulation is implemented as soon as possible, unless complications
occurred.
Nursing Interventions
Promoting Oxygenation and Tissue Perfusion
 Instruct the patient to avoid overfatigue; stop activity immediately in the presence of
chest pain, dyspnea, lightheadedness of faintness
 Oxygen theraphy by cannula for the first 24 to 48 hours or longer if pain, hypotension,
dysnea or dysrhythmias persist. Monitor VS changes, indicative of complications
 Position the client in semi-fowler to allow greater diaphragm expansion, thereby lung
expansion and better carbon dioxide- oxygen exchange Promoting Adequate Cardiac
Output.
 Administer pharmacotherapy as prescribed
 Promote rest and minimize unnecessary disturbances
Promoting Comfort
 Relieve pain. Administer morphine sulphate as ordered. This is decrease sympathetic
stimulation , which increase myocardial oxygen demand. In addition, this will prevent
shock which may result from severe pain. Providing rest
 The client is usually placed on bed rest with commode privileges for 24 to 48 hours
 Administer diazepam(vallium) as ordered
 Explain that the purpose of CCU is for continuous monitoring and safety during the early
recovery period

Provide psychosocial support to the client and his family. Calmness and competency are
extremely reassuring.
 Promoting Activity
 Gradual increase in activity is encourage. After the first 24 to 48 hours, the client may
be allowed to sit on a chair for increasing periods of time and begins ambulation on the
4th or 5th day.
 Monitor for signs of dysrhythmias, chest pain, and changes in Vs during activity
Promoting Nutrition and elimination
 Provide small frequent feedings
 Provide low- calorie, low cholesterol, low-sodium diet
 Avoid stimulant
 Avoid taking very hot or very cold. Vasovagal stimulation may occur: This may lead to
bradycardia arrest
 Use of bedpan and straining at stool should be avoided. Valsalva Maneuver causes
changes in blood pressure and heart rate, which may trigger ischemia, dysrhythmias,
pulmonary embolism or cardiac arrest
 Use bedside commode
 Administer stool softener as ordered e.g. sodium docussate ( Colace)

Discharge and Home Healthcare Guidelines

 Be sure the patient understands all the medications, including the dosage, route, action,
and adverse effects. Instruct the patient to keep the nitroglycerin bottle sealed and away
from heat.
 The medication may lose its potency after the bottle has been opened for 6 months. If the
patient does not feel a sensation when the tablet is put under the tongue or does not get a
headache, the pills may have lost their potency.
 Explain the need to treat recurrent chest pain or MI discomfort with sublingual nitroglycerin
every 5 minutes for three doses. If the pain persists for 20 minutes, teach the patient to
seek medical attention. If the patient has severe pain or becomes short of breath with chest
pain, teach the patient to take nitroglycerin and seek medical attention right away. Explore
mechanisms to implement diet control, an exercise program, and smoking cessation if
appropriate.