CASE PRESENTATION ON

MYOCARDIAL INFARCTION
(MI)
PRESENTED BY:

CENIZA, VINCENT EARL

MUAMMIL-HALIL, YLAIZA

MONREAL, KAREN JOY S.

 ANATOMY AND PHYSIOLOGY

Cardiovascular System

The human heart is an organ that pumps blood

throughout the body via the circulatory system, supplying
oxygen and nutrients to the tissues and removing carbon
dioxide and other wastes.

The heart has four chambers the right atrium which

receives blood from the veins and pumps it to the right
ventricle. The right ventricle receives blood from the right
atrium and pumps it to the lungs, where it is loaded with
oxygen.
 The left atrium receives oxygenated blood from the
lungs and pumps it to the left ventricle and the left
ventricle (the strongest chamber) pumps oxygen-rich
blood to the rest of the body. It is also made up of four
valves: the tricuspid, pulmonary, mitral and aortic
valves.
The heart is located between the lungs in the middle
of the chest, behind and slightly to the left of the
breastbone (sternum).  A sac known as the
pericardium surrounds the heart. The outer layer of the
pericardium surrounds the roots of the heart’s major
blood vessels and is attached by ligaments to your
spinal column, diaphragm, and other parts of the body.
ANATOMY AND PHYSIOLOGY

• The coronary arteries run along the surface

of the heart and provide oxygen-rich blood to
the heart muscle.

• The coronary arteries supply the heart with

nutrients. They branch off from the aorta into
the left and right coronary artery.
• Left Coronary Arteries:

Left anterior descending artery: supplies right and left

ventricle and septum. This is the most common site
for blockages.

Left circumflex: supplies the left atrium and ventricle

• Right Coronary Arteries:

Right coronary artery: supplies the right atrium and v

entricle

Right marginal artery: supplies the right ventricle and

septum
PATHOPHYSIOLOGY OF MYOCARDIAL
INFARCTION
CASE SCENARIO

A 57 year old man presented to the ER of General Hospital complaining of almost 1h of ‘crushing’
chest pain radiating to the neck and shoulders. He narrates that "Maayos naman po ako kanina, pero
after namin kumain ng dinner bigla nalang nanikip dibdib ko, tapos medyo nahihilo, then after ilang
minutes nahihirapan nako huminga ". The past medical history included a diagnosis of hypertension 8
years ago. The family history included the sudden death of his father aged 55 years (cause unknown).
It was also known that his mother was hypertensive, his elder brother had angina and that his paternal
grandmother had type 2 diabetes mellitus. He was married with two sons and worked as a bus driver.
He was a regular smoker (20 per day) and consumed approximately 16 units of alcohol per week.
Upon assessment Vital signs shows BP-150/100 mmHg, RR-26 breaths/min, PR- 96 beats/min, Temp.-
37.6°C and O2sat of 93%. DIAGNOSIS: possible MYOCARDIAL INFARCTION(heart attack).
DEFINITION:

• Myocardial Infarction is defined as a diseased condition

which is caused by reduced blood flow in a coronary
artery due to atherosclerosis & occlusion of an artery by
an embolus or thrombus.

• Myocardial Infarction or Heart attack is the irreversible

damage of the myocardial tissue caused by prolonged
ischemia & hypoxia.
• It is a life-threatening condition characterized by death
of myocardial tissue in regions of the heart with abrupt
interruption of coronary blood supply.
ETIOLOGY:

• The blockage is caused by a buildup of

plaque in the arteries
(atherosclerosis). Plaque is made up of
deposits, cholesterol, and other
substances. When a plaque breaks
(ruptures), a blood clot quickly forms.
The blood clot is the actual cause of the
heart attack.
RISK FACTORS:

Modifiable Risk Factors: Non-modifiable Risk factors:

-Smoking -Age
-Physical Activity -Gender
-Obesity -Heredity/ Family History
-Diabetes mellitus (DM)
-Hypertension
-Psychosocial stress
-Hypersholesterolemia
SIGNS AND SYMPTOMS:

• Chest pain (intense, heavy)

• Radiating chest pain that goes to left arm, jaw, back
• Unrelieved by nitroglycerin or rest (chest pain)
• Sweating (cold)
• Hard to breathe (shortness of breath) Increased heart rate, blood
pressure or irregular heart rate
• Nausea with vomiting
• Going to be anxious and scared  
DIAGNOSTIC PROCEDURES:

• Electrocardiogram (ECG or EKG)

• Blood tests
• Chest X-ray
• Echocardiogram
• Coronary catheterization (angiogram)
• Cardiac CT or MRI
MEDICAL MANAGEMENTS:

The goal of medical management are to minimize myocardial damage, preserve myocardial function and prevent complication
Medications: Initial treatment
Medications Surgical and other Procedure
• Aspirin -Coronary Angioplasty and
• Thrombolytics or fibrinolytics Stenting
• Nitroglycerin -Coronary artery bypass

• Morphine surgery (CABG)

• Beta blockers
• ACE Inhibitors
• Statins
NURSING MANAGEMENT:

• Provide Oxygen at 2L/min.

• Administer medications
• Minimize patient anxiety
• Provide adequate rest periods
• Minimize metabolic demands
• Assist in treatment modalities such as PTCA and CABG
• Monitor for complications of MI
• Provide client and family education
 FOCUS OF ASSESSMENT

The physical examination of the cardiovascular system involves the interpretation of vital signs, inspection, palpation and auscultation of heart sounds.
Objective Assessment
Vital signs taken as follows:
• Temperature: 37.6*C
• Blood pressure: 150/100 mmHg
• Pulse Rate: 96 beats/min.
• Respiratory rate: 26 breaths/min.
• O2 Sat.: 93%
Inspection
Patient skin is pale but warm to touch and also the lips are dry. Absence of jugular vein distention and sensation and movement of fingers and toes are
intact
Palpation
Apical pulse felt over midclavicular fifth intercostal space, pulses is present and equal bilaterally, absence of edema in both extremities, capillary refill is
normal less than 2 seconds
Auscultation
Upon auscultating the heart sounds S1 and S2 is in regular rhythm, no extra sounds heard. No carotid bruit sound heard during auscultation.
Subjective assessment
According to patient he experienced pain for about 1hr, particularly in the chest area that eventually radiates to his neck and
shoulders. He described pain as tightness and squeezing pain as he wasn’t be able to breathe normally.

Medical History
Patient is diagnosed with hypertension 8 years ago.

Medication
Patient is taking a drug for his hypertension condition such as Enalapril and also according to him; sometimes he takes ginger tea at
least 3 times a week to control his blood pressure.

Cardiac History
Patient have family history of hypertension from his mother also his paternal grandmother has DM type2 and his elder brother had
angina, he also stated that his father died for unknown reason.
Patient is physical active as he is a bus driver, he was able exercise his arms and upper extremities.
Patient doesn’t experienced sleeping difficulty, his usual bed time @ 9pm.
DRUG STUDY
 DRUG MECHANISM OF
ACTION
Generic name: Chemical effect:
Aspirin Acetylsalicylic acid (ASA)
  blocks prostaglandin
Brand name: synthesis. It is non-
Ecotrin, Bayer, selective for COX-1 and
Aspergum, Aspirtab COX-2 enzymes 9,10,11.
  Inhibition of COX-1 results
Dosage: 1-tab 80mg in the inhibition of platelet
  aggregation for about 7-10
Frequency: OD days (average platelet
  lifespan). The acetyl group
Route: Per Orem of acetylsalicylic acid binds
  with a serine residue of the
Classification of cyclooxygenase-1 (COX-1)
pharmacologic class: enzyme, leading to
nonsteroidal anti- irreversible inhibition. This
inflammatory drugs prevents the production of
(NSAIDs) pain-causing
  prostaglandins.
Therapeutic class:  
Nonopioid analgesic, Therapeutic effect: Mild to
antipyretic, moderate pain caused by
antiplatelet inflammation such as
rheumatoid arthritis. Fever
reduction. Prevention of
strokes, myocardial
infarction (MI), and other
thromboembolic disorders.
INDICATION CONTRAINDICATION ADVERSE AND SIDE NUSING
EFFECT RESPONSIBILITES
 Fever  Do not use if sensitive to other NSAIDs or Adverse effect: Hearing loss,  Routinely monitor the
reduction. salicylates. Can cause renal or liver tinnitus, ototoxicity Nausea, effectiveness of aspirin
Prevention impairment. Excessive bleeding may occur if vomiting, abdominal pain, by assessing pain levels
of strokes, used with another anticoagulant. Do not use in heartburn GI bleeding or and fever reduction.
myocardial the third trimester of pregnancy or when ulceration Thrombocytopenia,  Monitor for signs of
infarction breastfeeding. hemolytic anemia, Liver toxicity: diplopia, EKG
(MI), and toxicity ↓ sodium, potassium, changes, seizures,
other and glucose Wheezing, hallucinations,
thromboem pulmonary edema with hyperthermia, oliguria,
bolic toxicity Rash, urticaria, acute renal failure,
disorders. bruising. irritability, restlessness,
  tremor, confusion,
  lethargy, and
anaphylaxis. The elderly
is at a greater risk for
toxicity.
 Closely monitor
hemoglobin, hematocrit,
INR, and renal function
when prescribed long-
term therapy.
 Activated charcoal can be
administered for aspirin
poisoning.
 
 DRUG MECHANISM OF
ACTION
Generic name: Chemical effect:
Metoprolol Metoprolol is a
  cardioselective beta-1-
Brand name: adrenergic receptor
Lopressor inhibitor that competitively
  blocks beta1-receptors with
Dosage: 1-tab 50mg minimal or no effects on
  beta-2 receptors at oral
Frequency: BID doses of less than 100 mg
  in adults. It decreases
Route: Per Orem cardiac output by negative
  inotropic and chronotropic
Classification of effects.
pharmacologic class:  
Beta-adrenergic blocking   syndromes, including angina
agent Therapeutic effect: to treat
  angina, heart failure,
Therapeutic class: Anti- myocardial infarction, atrial
hypertensive fibrillation/flutter, and
hypertension
INDICATION
 To treat angina, heart failure,
myocardial infarction, atrial
fibrillation/flutter, and
hypertension
CONTRAINDICATION
 Metoprolol is
contraindicated in patients
with sick sinus syndrome,
second or third-degree heart
block (in the absence of
pacemaker), decompensated
heart failure, hypotension,
and documented
hypersensitivity to the drug
or components. Also, caution
is necessary for patients with
a history of noncompliance
as the abrupt cessation of the
drug can lead to withdrawal
and myocardial infarction.
Patients who have ingested
cocaine or methamphetamine
have traditionally had a
contraindication to the use of
selective beta-blocker such
as metoprolol.
ADVERSE/SIDE EFFECT
Adverse effect:
heart failure exacerbation,
fatigue, depression, bradycardia
or heart block, hypotension,
bronchospasm, cold extremities,
dizziness, decreased libido,
diarrhea, tinnitus, decreased
exercise tolerance, glucose
intolerance, and may mask
hypoglycemia
 
 
 
 
 Advise patient to notify
 Advise patient to carry
NURSING
RESPONSIBILITY
 Instruct patient to take
medication as directed, at
the same time each day,
even if feeling well; do not
skip or double up on
missed doses. Take missed
doses as soon as possible
up to 8 hr before next
dose. Abrupt withdrawal
may precipitate life-
threatening arrhythmias,
hypertension, or
myocardial ischemia.
 Teach patient and family
how to check pulse daily
and BP biweekly and to
report significant changes
to health care professional.
health care professional if
slow pulse, difficulty
breathing, wheezing, cold
hands and feet, dizziness,
light-headedness,
confusion, depression,
rash, fever, sore throat,
unusual bleeding, or
bruising occurs.
identification describing
disease process and
medication regimen at all
times.
 NURSING CARE PLAN#3
Assessment Diagnosis Planning Implementation Evaluation
Subjective cues: Fear/ Anxiety Goal of Care or Goal Met!
related to
The patient narrate
threat to or
Outcome: -Identify and acknowledge patient’s perception of
threat and situation. Encourage expressions of, and do
-Allow the patient to verbalize
his feelings, thought and The patient able to
that “Maayos naman After 1hr of nursing
change in not deny feelings of, anger, grief, sadness, fear. concern towards his condition. recognize his
po ako kanina, pero intervention the feeling, verbalize
health status. R- Coping with the pain and emotional trauma of an
after namin kumain patient will able to MI is difficult. Patient may fear death and/or be reduction of anxiety
ng dinner bigla Recognize his anxious about immediate environment. and fear and
nalang nanikip dibdib feelings. Verbalize demonstrated
ko, tapos medyo -Note presence of hostility, withdrawal, and or denial -Noted and document any positive view.
reduction of
nahihilo, then after (inappropriate affect or refusal to comply with presence of hostility,
anxiety/fear, and to medical regimen). withdrawal and or denial. Vital Signs:
ilang minutes demonstrate positive BP-120/80mmHg
R- the impact of denial has been ambiguous; however,
nahihirapan nako view. studies show some correlation between degree RR-18breaths/min
huminga ". or expression of anger or hostility and an increased PR-75beats/min
risk for MI. Temp.-37.4°C
O2sat of 97%.
Objective cues: -Answer all questions factually. Provide consistent -Answered all the patient
Vital signs: information; repeat as indicated. questions honestly and
BP-150/100 mmHg R- Accurate information about the situation reduces factually.
RR-26 breaths/min fear, strengthens nurse-patient relationship, and assists
PR- 96 beats/min patient and to deal realistically with situation.
Temp.-37.6°C -Encourage patient and to communicate with one -Conducted an open forum
O2sat of 93%. another, sharing questions and concerns together with other patient who
R- Sharing information elicits support and comfort has experience MI and allow
and can relieve tension of unexpressed worries. one another to communicate
and ask questions, share their
experience and concerns.
-Encourage independence, self-care, and decision -Allow the patient to
making within accepted treatment plan. participate in treatment
R- Increased independence from staff promotes self- and healing process. Let
confidence and reduces feelings of abandonment the patient take bath in his
that can accompany transfer from coronary unit own, change clothes in his
and/or discharge from hospital own and etc.

-Administer anti anxiety and hypnotics as indicated: -Gave anti anxiety and

 alprazolam (Xanax), diazepam (Valium), lorazepam hypnotics drug as
(Ativan), flurazepam (Dalmane). prescribe by the physician.
R-Promotes relaxation and rest and reduces feelings
of anxiety.
Reference:
https://www.mayoclinic.org/diseases-conditions/heart-attack/diagnosis-treatment/drc-20373112?fbclid=IwAR1-WpbIukeWY6hk-
Fu92gTVjdnT9n1K61AscTFOIckwBvhmD_HyNp_wbgI

https://www.jpsr.pharmainfo.in/Documents/Volumes/vol4Issue01/jpsr%2004120102.pdf?fbclid=IwAR2e8BtzgTaySsLWe5CjIRFH
-J2oci9cV_cOvflWp7DgB3rUzfbPd7gmXzE

https://nurseslabs.com/7-myocardial-infarction-heart-attack-nursing-care-plans/3/