Myocardial infarction

Srijana Mahato
Lecturer, OBG
 Myocardial infarction
Myocardial infarction (MI), is used synonymously
with coronary occlusion and heart attack, yet MI is
the most preferred term as myocardial ischemia
causes acute coronary syndrome that can result in
myocardial death.
In an MI an area of the myocardium is
permanently destroyed because plaque rupture
and subsequent thrombus formation result in
complete occlusion of the artery.
 Statistics and epidemiology
• Each year in the United state, nearly 1 million
people have acute MIs.
• One fourth of the people with the disease die
of MI
• Half of the people who die with acute MI
never reach the hospital
 CAUSESE OF MI
• 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.
 Clinical Manifestations
• Chest pain: This is the cardinal symptom of MI.
Persistent and crushing substernal pain that
may radiate to the left arm, jaw, neck or
shoulder blades. Pain is usually described as
heavy squeezing or crushing and may persist
for 12 hours or more.
• Shortness of breath: because of increased
oxygen demand and a decrease in the supply
of oxygen shortness of breath occurs.
• Indigestion: indigestion is present as a result of
the stimulation of the sympathetic nervous
system.
• Tachycardia and tachypnea: to compensate for
the decreased oxygen supply, the heart rate and
respiratory rate speed up.
• Catecholamine responses: the patient may
experience such as coolness in extremities,
perspiration, anxiety and restlessness.
• Fever: unusually occurs at the onset of MI, but
a low grade temperature elevation may
develop during the next few days.
 Prevention
• A healthy lifestyle could help prevent the
development of MI.
• Exercise: exercising at least thrice a week could
help lower cholesterol levels that cause
vasoconstriction of the blood vessels.
• Balanced diet: fruits, vegetables, meat and fish
should be incorporated in the patient’s daily
diet to ensure that he or she gets the right
amount of nutrients he or she needs.
• Smoking cessation: nicotine causes
vasoconstriction which can increase the
pressure of the blood and result in MI.
 Assessment and Diagnostic Findings

• Patient history: the patient history includes

the description of the presenting symptoms,
the history of previous cardiac and other
illness and the family history of heart diseases.
• ECG: ST elevation signifying ischemia, peaked
upright or inverted T wave indicating injury,
development of Q waves signifying prolonged
ischemia or necrosis.
ECG changes during MI
• Cardiac enzymes and isoenzymes: CPK- MB
(isoenzyme in cardiac muscle): elevated within
4-8 hr, peaks in 12-20 hr, returns to normal in
48-72 hr.
• LDH: elevates within 8-24hr, peaks within 72-
144 hr, and may take as long as 14 days to
return to normal. An LDH greater than LDH
helps confirm/ diagnose MI if not detected in
acute phase
• Troponins: Troponin I and troponin T: level are
elevated at 4-6 hr, peak at 14- 18 hr and return to
baseline over 6-7 days. These enzymes have
increased specificity for necrosis and are therefore
useful in diagnosing postoperative MI.
• Myoglobin: a heme protein of small molecular
weight that is more rapidly released from damaged
muscle tissue with elevation within 2 hr after an
acute MI and peak levels occurring in 3-15 hr
• Electrolytes: imbalances of sodium and potassium can alter conduction and
compromise contractility
• WBC: leukocytosis (10,000-20,000) usually appears on the second day after MI
because of the inflammatory process
• ESR: rises on second or third day after MI, indicating inflammatory response.
• Chemistry profiles: may be abnormal, depending on acute/chronic abnormal
organ function/perfusion
• ABGs/ pulse oximetry. May indicate hypoxia or acute/chronic lung disease
processes
• Lipids (total lipids, HDL,LDL, total cholesterol, triglycerides, phospholipids).
Elevations may reflect atreiosclerosis as cause for coronary narrowing or spasm
• Chest X-ray: may be normal or show an enlarged cardiac shadow
suggestive of HF or ventricular aneurysm
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