o MYOCARDIAL INFARCTION (HEART ATTACK) Acute myocardial infarction (MI) is defined as the death or necrosis of myocardial cells due

e to occlusion in the coronary artery by a thrombus that result to the insufficient or cease of blood flow. Commonly known as heart attack Incidence:
Philippines 2,377,987incidence rate 86,241,697 estimated pop.

o CLINICAL SIGNS AND SYMPTOMS Chest pain Shortness of breath (dyspnea) Nausea and vomiting Palpitations Sweating (diaphoresis) Syncope (dizziness) Fatigue

o LABORATORY FINDINGS ELECTROCARDIOGRAM / ECG The main aim of the ECG is to determine the presence of ischemia or coronary injury because it is sensitive to detecting ischemia and infarction and there are certain ECG changes that will indicate the presence of disease. Laboratory findings

 CARDIAC MARKERS / ENZYMES These are proteins from cardiac tissue released into the blood stream when damage to the heart muscle occurs. Creatine Kinase-MB is a biomarker that is highly sensitive and specific for to the heart. When infarction occurs, MB2 which is the tissue form of creatine kinase is initially released in small amounts so that CK-MB remains within normal limits. Even so, the ratio between MB and MB2 will differ which helps in making a diagnosis. Myoglobin is a protein found in both skeletal and cardiac muscle and also happens to bind to oxygen. It is a sensitive indicator of muscle injury and its rise can help determine the infarct size and although it is not specific for cardiac muscle, it helps in the diagnosis of MI. Troponin T & I These are regulatory muscle proteins released by damaged myocardial cells and are more specific for MI than MB-CK. They increase plasma levels a few hours after an infarction occurs. Lactate Dehydrogenase This is another protein which becomes elevated with the occurance of a myocardial injury. It increases a few days after the onset of symptoms and lasts up to 10 days. It is less commonly used nowadays. ECG- the ST segment is ELEVATED. T wave inversion, presence of Q wave Myocardial enzymes- elevated CK-MB, LDH and Troponin levels CBC- may show elevated WBC count Test after the acute stage- Exercise tolerance test, thallium scans, cardiac catheterization Nursing Interventions Provide Oxygen at 2 lpm, Semi-fowlers Administer medications o Morphine to relieve pain nitrates, thrombolytics, aspirin and anticoagulants o Stool softener and hypolipidemics Minimize patient anxiety Provide information as to procedures and drug therapy o Provide adequate rest periods Minimize metabolic demands o Provide soft diet

o Provide a low-sodium, low cholesterol and low fat diet Minimize anxiety o Reassure client and provide information as needed o . Assist in treatment modalities such as PTCA and CABG o 8. Monitor for complications of MI- especially dysrhythmias, since ventricular tachycardia can happen in the first few hours after MI o 9. Provide client teaching PROGNOSIS o The expected outcome varies with the amount and location of damaged tissue. The outcome is worse if there is damage to the electrical conduction system. Approximately one-third of cases are fatal. If the person is alive 2 hours after an attack, the probable outcome for survival is good, but may include complications. Uncomplicated cases may recover fully; heart attacks are not necessarily disabling. Usually the person can gradually resume normal activity and lifestyle. CONCLUSION o Myocardial infarction is a life-threatening disease that requires immediate and effective treatment as mentioned previously. For some people it can be a life changing experience as it makes people realize how important it is to live a heart healthy lifestyle. The ongoing research for new ways to treat myocardial infarction and the new ways of detecting it before the onset of symptoms can help minimize the number of deaths with of course the cooperation of the patient in terms of them changing their lifestyle and reducing the number of modifiable risk factors.