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JT U32 (KUP)
Unit Kecemasan & Trauma
Hospital Kudat
MYOCARDIAL INFARCTION
LEARNING OBJECTIVES :
Define myocardial infarction (MI)
List etiology of myocardial infarction
Name the clinical manifestation of myocardial
infarction.
Explain types of medication used in MI
Able to identify 2 nursing problems and plan
the nursing process for these problems.
Explain the preventive measure that should be
taken.
MYOCARDIAL INFARCTION
Myocardial Infarction
Also known as heart attack
Definition :
Death of heart muscle (myocardium) from the
sudden blockage of a coronary artery by blood
clot.
Onset maybe sudden or gradual & progression
to completion takes 3 6 hours.
MYOCARDIAL INFARCTION
PATHOPHYSIOLOGY :
The coronary arteries are responsible for the
delivery of oxygen-containing blood to the muscle.
When they become severely blocked, they
restrict the flow of oxygen to the heart causing
injury to the heart muscle. This results in MI
ETIOLOGY
Atherosclerosis
Smoking
High BP
Elevated cholesterol
DM
Male
Family history of heart disease
CLINICAL MANIFESTATIONS
Chest pain
Severe, diffuse substernal pain crushing &
squeezing.
Not relieved by rest / sublingual GTN, needs narcotics
eg Morphine.
May radiate to arms (common left), shoulder, neck,
back, jaw.
Continues > 15 mins.
Produce anxiety, fear HR, BP, RR.
Diaphoresis, cool clammy, pallor.
CLINICAL MANIFESTATION..(cont)
Hypertension / hypotension.
Bradycardia / tachycardia.
Palpitation, anxiety, dyspnea.
Disorientation, confusion, restlessness.
Fainting, weakness.
Nausea, vomiting.
Atypical symptoms epigastric / abdominal distress,
SOB, dull aching.
DIAGNOSTIC EVALUATION
ECG CHANGES
NORMAL ECG
NORMAL ECG
MYOCARDIAL INFARCTION
MANAGEMENT
Aim of therapy :
Protection of ischemic & injured heart tissue to preserve
muscle function.
Reduce infarct size.
Prevent death.
Included :
O2 therapy.
Pain control.
Pharmacologic therapy.
Percutaneous Transluminal Coronary Angioplasty (PTCA).
Surgery.
OXYGEN THERAPY
To improve oxygenation
to ischemic heart muscle.
PAIN CONTROL
Pain increase catecholamine release increase
workload on heart muscle increase O2 demand.
Opiate (Morphine) to relieve pain, to improve cardiac
hemodynamics, to provide anxiety relief.
Vasodilator (Nitroglycerin / GTN) sublingual, IV,
paste. Promotes venous & arterial relaxation.
Myocardial O2 demand reduced with pain relief.
Persistent chest pain IV nitroglycerin.
PHARMACOLOGICAL THERAPY
Thrombolytic agents tissue plasminogen activator,
streptokinase, reteplase dissolve obstructing
thrombus reestablish blood flow to coronary vessels.
Aspirin to prevent platelet activation.
Anticoagulant therapy may combine with thrombolytic
therapy.
Beta-adrenergic blocking agents improve O2 supply &
demand by sympathetic stimulation to heart.
Calcium channel blockers HR, BP & dilating
coronary vessels O2 demand.
Morphine
Oxygen
Nitroglycerine
Aspirin
PTCA
Mechanical opening of coronary vessel.
Can be used - combine with thrombolytic therapy.
SURGERY
Surgical revascularization.
Coronary artery bypass graft (CABG) performed within
6 hrs of infarction.
Benefit definite treatment of stenosis.
COMPLICATION
Rhythm disturbances.
Heart failure congestive heart failure (CHF),
cardiogenic shock.
Cardiac rupture.
Ventricular thrombus.
Thromboemboli.
Ventricular aneurysm.
Cardiac temponade.
Psychiatric problems depression.
NURSING ASSESSMENT
Information regarding chest pain :
Nature & intensity
Onset & duration
Location & radiation
Aggravating factors
Associated symptoms SOB, diaphoresis, vomiting etc.
Health status, current medication, allergies.
Information cardiac risk factors.
RATIONALE
Position in semi-Fowlers
position.
Administer O2 nasal
cannula @ 4L/min.
To myocardial
oxygenation.
To reduce pain by
venous return to heart.
Morphine decrease pts
sensation of pain.
RATIONALE
Monitor BP closely.
RATIONALE
RATIONALE
Administer IV fluid as
ordered.
RATIONALE
RATIONALE
Administer vasopressor;
titrate to BP response.
Controversial may
systemic vascular resistance
cardiac work.
RATIONALE
Help to anxiety due to
threatening environment.
RATIONALE
Administer diazepam.
THANK YOU!