MYOCARDIA

L
INFARCTION
Abdulmalik herban 381014101
Abduallah saeed 411005968
Amjad Eid 411007221
Ayesh mansour 411006192
Faisal Tariq 411001827
Mohammed Asiri 411001201
Mohammed Hamadan 411000091
Hassan suliman 411000098
Nawaf Ahmed 411007732
 Contents of this
template
I.Introductiona.
II. Patient/Case Presentation
a. Short definition of the case
b. Background of the study a.Primary and secondary assessment
- rationale for choosing the case
- statistics (incidence and prevalence of the case(
IV. Pathophysiology

a. book-based (schematic diagram/ concept mapping)

III. Anatomy and Physiology
b. client-based (schematic diagram/ concept mapping)
- (Include images)

IV. Medical Management & Interventions

V. Nursing Interventions
a. Medications
Nursing Care Plan (NCP of 3 prioritized problems)
b. Medical-Surgical interventions
c. Diagnostic and Laboratory Tests

VI. Conclusion & Recommendation .VII. Reference’s

 Introduction

A 46 years old man came the emergency room in King Fahad hospital with a chest
pain and difficulty breathing, the pain was central and move to the left arm. After
assessment from the doctors it sems that he has a myocardial infarction and this
condition is a life threating condition that happen when blood flow to the heart
muscle is abruptly cut of, leads to tissue damage and usually it is a result of
blockage in one or more of the coronary arteries
Cardiovascular disease is the number one cause of death around the world and in Saudi Arabia according to CDC. (2)
Between May 2015 and January 2017, 2233 patients with ACS (mean age was 56 [standard deviation
= 13] years; 55.6% were Saudi citizens, 85.7% were men, and 65.9% had STEMI). Coronary artery disease risk
factors were high; 52.7% had diabetes mellitus and 51.2% had hypertension.
 II. Patient/Case
:Presentation
PRIMARY SURVEY

Nature of Illness (NOI) – Medical Patients(MI)

1. Responsiveness
 Is the patient Alert? - Yes
 Respond to Verbal stimuli - Yes
- The patient is alert, oriented to time, place,
 Respond to Pain stimuli person, and situation
 Is the patient Unresponsive -No

2. Airway : Assess and open the airway  

 Is the airway open? The airway is open without using an adjuncts .
 What adjuncts used to keep it
open?
 II. Patient/Case
:Presentation
PRIMARY SURVEY

Nature of Illness (NOI) – Medical Patients(MI)

3. Assess breathing (LLF)  
 Rate 32BPM
 Rhythm Irrugler
 Quality Shallow
 Symmetry of chest movement Chest rise and fall are symmetry and equally
 Usage of accessory muscles No use of Usage of accessory muscles
 Auscultate lungs for presence of The patient have normal breath
bilateral breath sounds sounds(vesicular)
 O2 supply simple face-mask at an oxygen flow of 8 L/min
 Rate  
 Method
4. Circulation No bleeding
 Check for major bleeding
Less then 2 seconds
 Check for perfusion- Capillary refill Pink
o Skin color Skin is warm (36.7C)
o Skin Temperature  
 Pulse (both carotid and radial pulses) Strong
o Quality
Regular
o Rhythm
 II. Patient/Case
:Presentation
SECONDARY SURVEY

Nature of Illness (NOI) – Medical Patients(MI)

a. TRAUMA PATIENT
SAMPLE HISTORY: history/ mechanism of injury
 Allergies Uknown
 Medications Amlor 5mg (Amlodipine)

 Past medical & surgical history None

 Last oral intake 10:00pm last night
 Events leading to illness or injury Patient did not take his medications for a week .
 II. Patient/Case
:Presentation
SECONDARY SURVEY Nature of Illness (NOI) – Medical Patients(MI)

HEAD TO TOE ASSESSMENT

a. HEAD -Lips normal color, without lesions. Teeth present, poor dental hygiene.
  -Gingiva and mucous membranes pink without bleeding, lesions, and
 Mouth inflammation.
  -Tongue normal size and papillation, midline protrusion also tonsils not
  enlarged.
  -Soft and hard Palates and gag reflex is intact.

 Nose Without deformity, external tenderness and discharge

 Facial area -Sensation is intact over the face. No facial asymmetry, muscles of facial
expression intact.
-No scars and injuries
 Scalp Normal cephalic without scalp lesions and injury.
 Ears Without deformity, external tenderness and discharge.
Hearing intact bilaterally by rough testing.
b. NECK Trachea midline.
Position of trachea
 
 
 Jugular veins Jugular venous distension is normal
 II. Patient/Case
:Presentation
SECONDARY SURVEY Nature of Illness (NOI) – Medical Patients(MI)

 Palpates cervical spine No tenderness, masses and deformity.

: tenderness/ pain or deformity
c. CHEST  
 Inspects -No signs of trauma
 
 Palpates The chest wall is intact with no tenderness , masse
 Auscultate Vesicular breath sounds throughout peripheral lung fields.
d. ABDOMEN/PELVIS: Inspects , Abdomen is soft ,symmetric, and non-tender without
palpates auscultate -abdomen distention
 Abdomen Umbilicus is midline without herniation
Bowel sounds are present and normal active in all four
quadrants
No masses splenomegaly, hepatomegaly are noted
-3
lifestyle

Food

Exericse Unhealthy
((overweight)
does not play sports

Non smoker
 Family -4
History

His grandfather have DM - HTN

Medical-5
:History

A- Past History ( hypertensive )

B- Present History ( myocardial infarction )

 III. Anatomy and
Physiology

The heart itself is made up of 4 chambers, 2 atria and 2 ventricles. De-oxygenated blood returns to
the right side of the heart via the venous circulation. It is pumped into the right ventricle and then
to the lungs where carbon dioxide is released and oxygen is absorbed. The oxygenated blood then
travels back to the left side of the heart into the left atria, then into the left ventricle from where it
is pumped into the aorta and arterial circulation
 Our statistics

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The atrio-ventricular septum completely separates the 2
sides of the heart. Unless there is a septal defect, the 2
sides of the heart never directly communicate. Blood
travels from right side to left side via the lungs only.
However, the chambers themselves work together. The 2
atria contract simultaneously, and the 2 ventricles
contract simultaneously. Brief discussion of the anatomy
and physiology of the organ/s involved in the case
 IV.
Pathophysiology

Myocardial infarction is defined as myocardial necrosis in a clinical setting consistent with myocardial ischemia .
These conditions can be satisfied by a rise of cardiac biomarkers (preferably cardiac troponin [cTn]) above the 99th
percentile of the upper reference limit (URL) plus at least one of the following: Symptoms of ischemia
ECG changes indicative of new ischemia (significant ST/T changes or left bundle branch block)
Development of pathologic Q waves
Imaging evidence of new loss of myocardium or new regional wall motion abnormality
Angiography or autopsy evidence of intracoronary thrombus
Slightly different criteria are used to diagnose MI during and after percutaneous coronary intervention or
.coronary artery bypass grafting, and as the cause of sudden death
 IV.
Pathophysiology
01 03
Spontaneous MI caused by
ischemia due to a primary Related to sudden unexpected
coronary event (eg, -plaque cardiac death
rupture, erosion, or fissuring;
coronary dissection)
Etiology and
circumstances
04
02
Ischemia due to increased oxygen Associated with percutaneous
demand (eg, hypertension), or coronary intervention (signs
decreased supply (eg, coronary and symptoms of myocardial
artery spasm or embolism, infarction with cTn values > 5 ×
arrhythmia, hypotension) 99th percentile URL
Infarct location

MI affects predominantly the left ventricle (LV), but damage may extend into the right
ventricle (RV) or the atria.

Right ventricular infarction usually results from obstruction of the right coronary or a
dominant left circumflex artery; it is characterized by high RV filling pressure, often with
severe tricuspid regurgitation and reduced cardiac output

An inferoposterior infarction causes some degree of RV dysfunction in about half of

patients and causes hemodynamic abnormality in 10 to 15%. RV dysfunction should be
considered in any patient who has inferoposterior infarction and elevated jugular venous
pressure with hypotension or shock. RV infarction complicating LV infarction
significantly increases mortality risk.

Anterior infarcts tend to be larger and result in a worse prognosis than inferoposterior
infarcts. They are usually due to left coronary artery obstruction, especially in the
anterior descending artery; inferoposterior infarcts reflect right coronary or dominant
left circumflex artery obstruction.

Infarct extent

Infarction may be:

-Transmural
-Nontransmural
Transmural infarcts involve the whole thickness of myocardium from
epicardium to endocardium and are usually characterized by abnormal Q
waves on ECG.

Nontransmural (including subendocardial) infarcts do not extend through

the ventricular wall and cause only ST-segment and T-wave (ST-T)
abnormalities. Subendocardial infarcts usually involve the inner one third
of myocardium, where wall tension is highest and myocardial blood flow
is most vulnerable to circulatory changes. These infarcts may follow
prolonged hypotension.

Because the transmural depth of necrosis cannot be precisely determined

clinically, infarcts are usually classified as STEMI or NSTEMI by the presence
or absence of ST-segment elevation or Q waves on the ECG. Volume of
myocardium destroyed can be roughly estimated by the extent and duration
of CK elevation or by peak levels of more commonly measured cardiac
troponins.
IV. Medical Management &
Interventions
Medications Description Dose and rote
Aspirin To reduce the 325 mg oral
blood clots.

Omeprazole To prevent the 40mg oral

heartburn.

Nitrostat To reduce the 0.6mg sublingual

workload of the heart by decreasing
of the blood pressure .

O2 For the shortness 3 L/m by nasal

of breath and O2 saturation cannula
DRUG NAME MECHANISM OF ACTION CONTRAINDICATI SIDE EFFECTS NURSING
AND ONS RESPONSIBILITI
INDICATION ES
GENERIC NAME: MECHANISM OF ACTION: – inadequate 1– Back, leg, or 1 – instruct the
It is a proton pump inhibitor vitamin B12. stomach pain. client report any
Omeprazole it inhibits the parietal cell H+ – Liver problems. 2– bleeding or side effect of the
/K+ ATP pump, the final step – Subacute crusting sores on drug such as: skin
:BRAND NAME of acid production. cutaneous lupus the lips. problems or GI
Omeprazole suppresses erythematosus. 3 – blister effect.
Prilosec the gastric basal and – Systemic lupus 4– continuing
stimulates acid secretion. erythematosus. ulcer or sores in 2- Advise the client
CLASSIFICATION – an autoimmune the mouth. to avoid alcohol
: INDICATION: disease. 5 – difficult, and food that may
Proton pump 1– is indicated for short – low amount of burning, or cause an increase
inhibitors term treatment of active magnesium in the painful urination. in the GI irritation.
duodenal ulcer or active blood. 6 – itching, skin
DOSAGE: benign gastric ulcer in Osteoporosis rash.
40mg adults. a type of kidney 7 – muscle 3- monitor the
2– is indicated for the inflammation called aches or urinalysis for
ROUTE: treatment of heartburn and interstitial nephritis cramps. hematuria and
Oral other symptoms associated proteinuria
FREQUENCY: with gastroesophageal reflux
OD disease.
DRUG NAME MECHANISM OF ACTION CONTRAINDICATI SIDE EFFECTS NURSING
AND ONS RESPONSIBILITI
INDICATION ES
GENERIC NAME: MECHANISM OF ACTION: – Aspirin is Abdominal or Assess for an allergy to
.NSAIDs or acetylsalicylic
aspirin and other non-steroid anti- contraindicated stomach pain, Assess for pain by having
Aspirin inflammatory drugs (NSAIDs) inhibit in patients cramping, or the patient rate on a scale
with salicylate of 1-10, and describe
the activity of the enzyme now .burning characteristics, duration,
:BRAND NAME called cyclooxygenase (COX) which hypersensitivity black, tarry .and frequency
leads to the formation of or NSAID .stools If given as an antipyretic,
hypersensitivity .assess temperature
Aggrenox prostaglandins (PGs) that cause bloody or cloudy Assess for pregnancy or
. Aspirin is also
inflammation, swelling, pain and .urine lactation. Aspirin is a
CLASSIFICATION contraindicated category C/D risk
fever. change in meaning there is
in patients with
: INDICATION: .consciousness evidence of fetal harm
the syndrome of but the benefit may
Anti platelets Aspirin is used to reduce fever chest pain or
and relieve mild to moderate asthma, rhinitis, outweigh the risk as
and nasal
.discomfort determined by a
pain from conditions such as
polyps; aspirin
convulsions, .healthcare professional
muscle aches, toothaches, Assess for recent
DOSAGE: common cold, and may cause severe or varicella vaccination.
325mg headaches. It may also be severe urticaria, .continuing Aspirin should not be
administered within 6
used to reduce pain and angioedema, or decreased weeks of a live varicella
ROUTE: swelling in conditions such as bronchospasm in frequency or vaccine due to the risk of
Oral arthritis. Aspirin is known as a amount of urine .Reye’s syndrome
these patients
FREQUENCY: salicylate and a nonsteroidal
anti-inflammatory drug (NSAID)
OD
 The diagnostic test and laboratory
:tests

CBC

complete blood count to evaluate the overall health and detect a

wide range of disorders, it is done to this patient to determine
the thrombolytic agents and to check the heart enzymes
(troponin).
ECG

ST segment elevation in the anterior leads (V3 and V4) at the J point and sometimes
in the septal or lateral leads, depending on the extent of the MI. This ST segment
elevation is concave downward and frequently overwhelms the T wave.
Echocardiogram (Echo)

is a test that uses high frequency sound waves

(ultrasound) to make pictures of your heart.
 Lap test
21/1/2023 Describe Results and range

Platelet count Secrete procoagulants (clotting factors) to promote

10^3 blood clotting. -Secrete vasoconstrictors which constrict Normal 150-450
blood vessels, causing vascular spasms in broken blood
vessels. Result 500

CK type of protein. The muscle cells in the body pt result is 2249 and the normal is 39-308 U/L
need CK to function.

Troponins (Its protein released from the heart when the da pt result is 0. 39 and the normal is 0 to 0.04
mage is present from myocardial infarction) ng/ml

Magnesium regulate diverse biochemical reactions in the pt result is 0.92 and the normal is 0.74 -0.99
body, including protein synthesis, muscle and mmol/L
nerve function, blood glucose control, and blood
pressure regulation.

Potassium It helps heartbeat stay regular, also helps move pt result is 4.2 and the normal is 3.5-5.1 mmol/L
nutrients into cells and waste products out of
cells.
V. Nursing
:Interventions
 V. Nursing
:Interventions

prioritized problems 3
1 Acute Pain
2 Activity Intolerance
3 Fear/Anxiety
 V. Nursing
:Interventions
2 Activity intolerance related to Imbalance between myocardial oxygen supply and demand

Demonstrate measurable/progressive increase in tolerance for activity with heart rate/rhythm and BP within
patient’s normal limits and skin warm, pink, dry

1 Encourage rest initially. Thereafter, limit activity on basis of pain and/or adverse cardiac response. Provide
nonstress diversional activities.

2 Instruct patient to avoid increasing abdominal pressure (straining during defecation).

3 Explain pattern of graded increase of activity level: getting up to commode or sitting in chair,
progressive ambulation, and resting after meals.
 VI. Conclusion &
:Recommendation

The case reports on 46 saudi male nonsmoker, he don’t do exercise and eating unhealthy food after the
admission to the hospital because of the chest pain and shortness of breath in the morning the doctor ordered (
CBC- ECG- ECHO) and then determined that the patient have a myocardial infarction and the intervention
begins and the patient condition started to be better using medications and observations in day 21/1/2023 the
patient discharged.

The myocardial infarction disease is a common because of the bad life styles so we can prevent it or decrees
the number of cases by orienting our families and friend about the low physical activity because that is one of
the main reasons of MI among other reasons such as smoking or obesity, if every person changed his sanitary
life style with a healthy life style that will not just keep you away from MI that will prevent other conditions
such as DM or Obesity.
 Reference’s

/https://heartresearch.org.uk/heart-attack -1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716383/ -2
https://www.nottingham.ac.uk/nursing/practice/resources/cardiology/function/anatomy.php -3
https://www.mayoclinic.org/diseases-conditions/ventricular-septal-defect/symptoms-causes/syc-20353495 -4
https://www.cdc.gov/ncbddd/heartdefects/ventricularseptaldefect.html -5
https://www.msdmanuals.com -6
/professional/cardiovascular-disorders/coronary-artery-disease/acute-myocardial-infarction-mi
https://www.jacc.org/doi/10.1016/j.jacc.2022.05.012 -7
https://www.sciencedirect.com/science/article/pii/S221181601200155X -8
THANK YOU