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Myocardial infarction (MI)

Introduction
 Myocardial infarction is an emergency and life threatening condition and also known as heart attack.
 Myocardial infarction is an irreversible damage and necrosis of myocardial tissue due to prolonged ischemia
and hypoxia.

Definition
 Myocardial infarction (MI) is defined as a permanent destruction and necrosis of myocardial tissue Due to
insufficient blood supply of myocardial tissue.
 Male have higher risk.
 MI occurs when myocardial tissues are abruptly and severely deprived of oxygen due to atherosclerosis and
occlusion of an artery.

Types of MI
1. According to infarction -

 Trans mural infarction

 Subendocardial infarction

1. According to ECG

 ST elevation MI

 Non ST elevation MI

1. A/C to anatomy

 Anterior wall MI

 Posterior wall MI
 Anterior septal wall MI
 Lateral wall MI
 Posterior septal wall MI
 Interior wall MI.

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Cause
 Coronary artery thrombosis ( most common cause )
 Coronary artery embolism
 Coronary artery plaque formation
 Vasospasm
 Coronary artery atherosclerosis
 Cocaine abuse.

Risk Factors
 Atherosclerosis
 Hypertension
 Drug abuse
 Alcohol, stress
 Obesity
 Smoking
 Diabetes
 Age, Gender
 Chronic kidney Disease
 Physical in activity
 Sedentary lifestyle
 Family history.

Pathophysiology
Etiology / cause / risk factor
↓
Abrupt blood supply to myocardial tissue and cell
↓
Insufficient oxygen supply according to demand
↓
Necrosis and ischemia of tissue
↓
Myocardial cell death
↓
Irritation myocardial nerve fibre
↓
Anatomical and physiological changes of heart
↓
Ischemic chest pain.

Clinical Manifestation

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 Sever, crushing, unbearable chest pain.

 Pain may be radiated to the neck, jaw, left arm or back.
 Dysrhythmias
 Tachycardia
 Bradycardia
 Hypertension
 Dyspnoea
 GI disturbance
 Increased sweating
 Shortness of breath
 Cyanosis
 Cold extremities
 Anxiety
 Nausea, vomiting
 Dizziness
 Palpitation
 Sleeplessness, fatigue.

Diagnostic Examination
 History collection and physical examination.
 Chest x ray and MRI.
 Angiography
 ECHO - Assess anatomy
 ECG - check heart performance

 ST - segment elevated
 T - wave inversion
 "Q" wave abnormal.

 Positron emission tomography (PET - scan).

 Thallium scan - assess necrotic tissue.
 Cardiac marker assessment (myoglobin, troponin, CPK - MB test).
 CBC.

Management
Pharmacological
 Morphine sulphate ( drug of choice )
 Nitro-glycerine
 Anticoagulants
 Vasodilators
 Thrombolytic agents
 Antihypertensive drugs
 Antiemetic
 Antiplatelet

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 Heparin
 Oxygen administer.

Non pharmacological
 Lifestyle modification
 Smoking cessation
 Salt restriction
 Exercise and yoga ( Range of motion )
 Dietary modification
 Avoid alcohol intake
 Health education
 Maintain bed rest.

Surgical Management
 Percutaneous Trans luminal coronary angioplasty (PTCA).
 Coronary artery bypass grafting (CABG).
 Median Sternotomy (open heart surgery).

MI Complication
 Dysrhythmias
 Congestive cardiac failure
 Cardiogenic shock
 Pulmonary edema
 Dressler syndrome
 Deep vein thrombosis
 Pericarditis
 Thrombophlebitis.

Nursing Management
 Nurses assess the patient's general condition and intensity of chest pain.
 Provide semi Fowler position.
 Provide oxygen therapy.
 Maintain balance between oxygen supply and demand.
 Regularly monitor cardiac function.
 The Administrator prescribed medication (morphine sulphate).
 Examine the ECG findings continuously.
 Assess patient MI complications.
 Encourage bed rest and reduce stress.

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 Provide health education and emotional support.

 Educate about follow up care.

Key Points
1. Necrosis of myocardial tissue in case of - Myocardial infarction.

1. Most common cause of MI - Coronary artery thrombosis.

1. Duration of chest pain in myocardial infarction - More than 30 minute.

1. Common manifestation of MI - Chest pain.

2. "Q" wave abnormality in ECG, indicate - Permanent changes.

1. Common complication of MI - Dysrhythmia.

1. Common position During MI - Semi Fowler position.

1. Drug of choice of MI - Morphine sulphate.

1. ECG finding in MI patient - ST segment elevated.

1. Which coronary affect in lateral wall MI - Left coronary artery.

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