ACTIVITY NO.

1: MYOCARDIAL INFARCTION

INTRODUCTION

A heart attack, or myocardial infarction (MI), is permanent damage to the heart muscle.
"Myo" means muscle, "cardial" refers to the heart, and "infarction" means death of tissue due to
lack of blood supply. It happens when one or more of your coronary arteries suddenly becomes
blocked, stopping the flow of blood to the heart muscle and damaging it, causing a heart attack.
Without adequate blood flow, your heart muscle can’t get the nutrients and oxygen it needs to
function. Symptoms include chest pain or discomfort, heartburn, nausea, sweating and more.
Women’s symptoms may be different.

CAUSES AND RISK FACTORS:

Causes of MI primarily stems from the vascular system which includes the following:

- Vasospasm. This is the sudden constriction or narrowing of the coronary artery.

- Decreased oxygen supply. The decrease in oxygen supply occurs from acute blood
loss, anemia, or low blood pressure.

- Increased demand for oxygen. A rapid heart rate, thyrotoxicosis, or ingestion of

cocaine causes an increase in the demand for oxygen.

Some of the causative/risk factors of myocardial infarction include smoking, large amounts of
fatty food consumption, lack of exercise and drug use. Smoking causes MI by decreasing oxygen
to the heart, increasing blood pressure and heart rate, increasing blood clotting and damaging to
cells that line coronary arteries and other blood vessels.
PATHOPHYSIOLOGY (DIAGRAM FORM)

LABORATORY

Ideally, your doctor should screen you during regular physical exams for risk factors that can
lead to a heart attack.

If you're in an emergency setting for symptoms of a heart attack, you'll be asked about your
symptoms and have your blood pressure, pulse and temperature checked. You'll be connected to
a heart monitor and have tests to see if you're having a heart attack.

Tests to diagnose a heart attack include:

Electrocardiogram (ECG). This first test done to diagnose a heart attack records electrical signals
as they travel through your heart. Sticky patches (electrodes) are attached to your chest and
limbs.

Blood tests. Certain heart proteins slowly leak into your blood after heart damage from a heart
attack. Emergency room doctors will take samples of your blood to check for these proteins, or
enzymes.

Additional tests
If you've had or are having a heart attack, doctors will take immediate steps to treat your
condition. You might also have these additional tests.

Chest X-ray. An X-ray image of your chest allows your doctor to check the size of your heart
and its blood vessels and to look for fluid in your lungs.

Echocardiogram. Sound waves (ultrasound) create images of the moving heart. Your doctor can
use this test to see how your heart's chambers and valves are pumping blood through your heart.
An echocardiogram can help identify whether an area of your heart has been damaged.

Coronary catheterization (angiogram). A liquid dye is injected into the arteries of your heart
through a long, thin tube (catheter) that's fed through an artery, usually in your leg or groin, to
the arteries in your heart. The dye makes the arteries visible on X-ray, revealing areas of
blockage.

Cardiac CT or MRI. These tests create images of your heart and chest. Cardiac CT scans use X-
rays. Cardiac MRI uses a magnetic field and radio waves to create images of your heart. For both
tests, you lie on a table that slides inside a long tubelike machine. Each can be used to diagnose
heart problems, including the extent of damage from heart attacks.

MEDICAL MANAGEMENT

The goals of medical management are to minimize myocardial damage, preserve

myocardial function, and prevent complications.

Pharmacologic Therapy:

- Morphine administered in IV boluses is used for MI to reduce pain and anxiety.

- ACE Inhibitors. ACE inhibitors prevent the conversion of angiotensin I to angiotensin

II to decrease blood pressure and for the kidneys to secrete sodium and fluid,
decreasing the oxygen demand of the heart.

- Thrombolytics. Thrombolytics dissolve the thrombus in the coronary artery,allowing

blood to flow through the coronary artery again, minimizing the size of the infarction
and preserving ventricular function.

Emergent Percutaneous Coronary Intervention:

The procedure is used to open the occluded coronary artery and promote reperfusion to
the area that has been deprived of oxygen. PCI may also be indicated in patients with unstable
angina and NSTEMI for patients who are at high risk due to persistent ischemia.
NURSING MANAGEMENT

Nursing interventions should be anchored on the goals in the nursing care plan.

- Administer oxygen along with medication therapy to assist with relief of symptoms.

- Encourage bed rest with the back rest elevated to help decrease chest discomfort and
dyspnea.

- Encourage changing of positions frequently to help keep fluid from pooling in the
bases of the lungs.

- Check skin temperature and peripheral pulses frequently to monitor tissue perfusion.

- Provide information in an honest and supportive manner.

- Monitor the patient closely for changes in cardiac rate and rhythm, heart sounds,
blood pressure, chest pain, respiratory status, urinary output, changes in skin color,
and laboratory values.

COMPLICATIONS

DARTH VADER

-Death

-Arrthymia

- Rupture (free venticular wall, septum or papillary muscles)

- Tanponade

- Heart failure

- valve disease

- aneurysm of ventricla

- dressler's syndrom

- embolism (mural thrombus)

- recurrence/mitral regurgitation