NURSING MANGEMENT CLIENT

WITH MYOCARDIAL INFARCTION

(MI) HEART ATTACK
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.
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• 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