MYOCARDIAL INFARCTION

BASE LINE DATA

Name : Mr.Venkatesh Age : 59yrs Sex : Male Ip no :1169288 D.O.A : 13.07.2010 Ward : CCU Diagnosis : Myocardial Infarction Date of care stat : 14.07.10 Date of care end : 18.07.10

Chief complaints:- patient came with the history of chest pain and breathlessness since 1 day and pedal edema present over both legs. PHOI:- patient is conscious and oriented and he is on room ventilation maintaining saturation upto 92%. Past medical history:- patient known history of HTN since 3yrs and he is on medication like Tab Betaloc 25mg 1-0-1/2 tab.Aten 50mg 1-0-0.

Surgical history:- there is no evidence of past and present surgical history. Family history:-there is no family history of CAD, MI and any cardiac disease and also any other communicable diseases.

Physical examination:CVS-ECG shows that ST segment elevation present, bradhycardia HR-42b/m. Respiratory system:-crepitation present in left lower lung region. Musculo skeletal system:- pedal edema present over both legs.

Investigation:-Elevated CPK(177IU/mt), Troponin positive, FBS-144mg/dl, Triglycerides268mg/dl,HDL-86mg/dl

ECG-ST elevation present in 2nd lead. Echo cardiogram-Anterior wall myocardial infarction. Coronary artery disease. X-ray Homogenous opacity in left lower zone, pleural effusion.

Inj . Magnex 1gm iv BD Tab . Imdur 30mg 1-0-1 Tab . Lasix 40mg 1-1-0 Tab . Ramipril 2.5mg 1-0-1 Tab . Atorva 10mg 0-0-1 Tab . Deplatt 75mg 0-1-0

DEFINITION

Myocardial infarction is life threatening condition it is also called as heart attack and characterized by death of myocardial cells from inadequate oxygenation often cost by a sudden and complete blockage of coronary artery.

ETIOLOGY

Book picture Atherosclerosis Occlusion of an artery by embolus or thrombi. Coronary artery spasm Decreased oxygen supply due to blood loss, anemia, low BP. Increased demand of oxygen rapid heart rate, ingestion of coccin

Patient picture Coronary artery disease.

RISK FACTORS

1.

2.
3. 4.

Book picture NON MODIFIABLE FACTORS Hereditary Age over 40 years Sex more in males Race blacks

Patient picture Age -57yrs Sex - male

MODIFIABLE FACTORS
1.

2.
3.

4.
5. 6.

Book picture Environment Elevated serum cholesterol Hypertension Cigarette smoking Diabetes

Patient picture Environment Elevated s.cholestrol HDL 86mg/dl, Triglyceride 286mg/dl. HTN BP 180/100mm of hg.

CONTRIBUTING FACTORS
1.

2.
3.

Obesity Lack of exercise Stress

PATHOAHYSIOLOGY

Changes in the condition of plaque in the coronary artery Activation of platelets Formation of thrombus Ischemia of tissue in the region supplied by the artery Myocardial cell death Altered repolarization of the myocardium Releases of enzymes Myocardial irritability Decreased contractility Decreased left ventricular failure Decreased cardiac output

CLINICAL FEATURES

BOOK PICTURE CVS:Chest pain Palpitation Increased jugular vien distention Cardiogenic shock ST segment and T wave changes ECG shows tachycardia,bradycardia &dysrhythmia. Heart failure.

PATIENT PICTURE Chest pain Palpitation ST segment changes elevated in 2nd lead ECG shows bradycardia. BP- 180/100mm of hg.

RESPIRATORY SYSTEM
1.

2.
3. 4. 5.

6.

Book picture Shortness of breath Dyspnoea Tachypnea Crackles caused by pulmonary congestion Pulmonary edema

Patient picture Dyspnoea Crackle present in left lower lobe of the lung.

 1. 2.

BOOK PICTURE GI SYSTEM Nausea Vomiting GENITO URINARY SYSTEM

1.

PATIENT PICTURE Absent

Decreased urine output 20ml/hr

Decreased urine output

 1. 2.

Book picture SKIN Cool, clammy skin Pale appearance NEUROLOGICAL SYSTEM Anxiety Decreased cerebral oxygenation Cardiogenic shock Headache, visual disturbance PHYSIOLOGICAL Fear anxiety

Patient picture Pedal edema present

1. 2.

Headache Anxiety

3. 4.

Fear Anxiety

DIAGNOSTIC EVALUATION

BOOK PICTURE History collection physical examination Electrocardiogram Echocardiogram Laboratory testes CKMB, TROPONINE, MYOGLOBIN. MRI

PATIENT PICTURE History collection Physical examination ECG Echo cardiogram Labs CKMB,TROPONIN X-ray

MEDICAL MANEGEMENT

1.
2.

GOALS Prevention of further attack Rehabilitation and education of the client

ACUTE MANAGEMENT
1.

2.
3. 4. 5.

6.
7.

Immediate admission to the hospital with in ICU Pain control administer morphine Oxygen administration Continuous ECG monitoring Administer anti-dysrhythmias Anticoagulant are given to decrease the risk of embolism Thrombholytic therapy

MEDICAL MANAGEMENT
Thrombolytic therapy:-thrombolytic are medication when are usually administered intravenously, although some may be given directly into the coronary artery in cath lab. The purpose of thrombolytic is to dissolves the lyses the thrombus in a coronary artery Allowing the blood flow through the coronary artery Minimize the size of the the infarction Preserving the ventricular function Thrombolytic must be administered as early as possible after the onset of the symptoms Eg;-streptokinase, urokinase, tissu plasminogen activator

continued

Angiotensin converting enzyme inhibitor;-Eg;Ramipril Emergent percutaneous coronary intervention;Suspected MI may refer to percutaneous coronary intervention. It may be used open the occluded coronary artery. It will helps to treat the underlying atherosclerosis lesion and also promote reperfusion to the area that has been deprived by oxygen.

Analgesics;-the analgesic of choice is Morphine sulphate administered through IV. Morphin reduces the pain and anxiety,and also relaxes bronchioles to enhance oxygenation.

COMPLICATION
1.

2.
3. 4. 5. 6. 7.

Bleeding Allergic reaction Stroke Dysrrhythmic Cardiogenic shock Heart failure pericarditis

NURSING DIAGNOSIS
1. 2. 3. 4.

5. 6. 7.

Pain related to MI with reduced blood flow. Decreased cardiac output related to MI Impaired gas exchange related to decreased cardiac output. Activity intolerance r/t imbalance between the oxygen supply Fear and anxiety r/t hospitalization and death Risk for heart failure r/t disease process. Deficit knowledge r/t disease condition and treatment.

Reference
Medical and surgical nursing Joyce .M.Black Medical and surgical nursing Brunner and Suddarths Nursing drug referance - Mosby