SlideShare a Scribd company logo
1 of 43
Download to read offline
MYOCARDIAL INFARCTION
1
Learning Outcomes
At the end of the lecture, student will be able to:
 Define acute myocardial infarction (AMI).
 State the etiology of AMI.
 Explain the pathophysiology of AMI
 State the clinical manifestations of AMI.
 State the diagnostic tests that helps to confirmed the
AMI.
2
Cont. Learning Outcomes
At the end of the lecture, student will be able to:
 Explain the treatment and management for AMI.
 Explain the nursing management for patient with
AMI.
 Provide health teaching on preventive measures to
patients prior to discharge.
3
The Heart
4
Coronary Arteries
5
Artery Wall
Acute Myocardial Infarction (AMI)
 Also called a heart attack.
 Defines as myocardial cell death due to
prolonged ischemia.
(Malaysian Heart Assoc, 2019).
 Myocardial injury is myocardial cell death due to
non ischemic causes.
7
Cont..
 AMI is diagnosed by the rise and/fall in cardiac
troponins with at lease one value > 99 percentile
with accompanied with at lease one of the following:
 clinical history consistent with chest pain of
ischemic origin
 ECG changes
 imaging evidence of new loss of variable
myocardium
 identification of an intracoronary (IC) thrombus
by angioplasty
(Malaysian Heart Assoc, 2019).
8
Cont.
 The main cause of AMI ---> sudden blockage
in the coronary artery ---> due to formation of
blood clot (thrombus) ---> causing irreversible
damage (necrosis) to the heart muscle.
9
Types of AMI
10
11
Pathophysiology
12
Atherosclerosis Arterial Spasm
Atherosclerosis + Plaque
breaks + Thrombus
Gradual
Obstruction
Sudden Reversible
Obstruction
Sudden Irreversible
Occlusion
ISCHEMIA
Hypoxia
Reduced O2 demands Angina
Thrombolysis
Permanent Thrombolysis
Unstable Angina
Necrosis MI
Pathogenesis of MI
13
 Myocardial necrosis begins within 20-30 minutes, mostly
starting at the sub-endocardial region (less perfuse, high
intramural pressure.
 Infarct reaches its full size within 3-6 hrs; during this
period, lysis of the thrombus by streptokinase or tPA
(tissue plasminogen activator), may limit the size of the
infarct.
Etiology & Risk Factors
 Most heart attack results from atherosclerosis
 Family history CAD
 Hypercholesterolemia
 ↑LDL ↓HDL
 ↑BP
 Obesity
14
Cont.
 Limited physical activity
 Cigarette smoking
 Excessive alcohol intake
 Metabolic disorders
 Diet high in saturated fat, cholesterol &
calories
15
Clinical Manifestations
16
Different Location of Pain
17
Cont.
 Fever
 Nausea & vomiting ---> results from
vasovagus reflexes.
 Crackles sound, peripheral edema & hepatic
enlargement ---> indicates cardiac failure.
 Cardiac vascular manifestations:
 elevated BP and HR
 BP may drop as decreased co and urinary output.
18
Diagnostic Tests
 Clinical history consistent chest pain of ischemic
origin.
 Serum Troponin I or T
 Serum CK-MB (cretinine kinase-myocardial band)
 12-lead ECG (ST-T wave elevated by greater than
1 mm or > in two continuous leads ---> MI)
19
Cont.
 Echocardiogram
 Serum potassium, magnesium & calcium
(imbalances & acidosis may cause change in
conduction & contractile).
20
ECG Changes
21
5. MYOCARDIAL INFARCTION.ppt
Pre-Hospital Management
 Patient with suspected ST segment elevation
MI (STEMI), should be given soluble or
chewable 300 mg aspirin and 300 mg
clopidogrel.
 These patient should be rapidly transported to
the hospital for early initiation of reperfusion
strategies.
 DO NOT BRING TO A CLINIC
23
Treatment & Management
The goals of medical management are to:
 minimize myocardial damage, preserve myocardial
function and prevent complications lethal
dysrhythmias and cardiogenic shock:
1) Reperfusion – use of the percutaneous coronary
intervention (PCI) or thrombolytic medications.
2) Reduce myocardial oxygen demand & increase
oxygen supply with medications, oxygen therapy
& bed rest.
3) Coronary artery bypass or minimally invasive direct
coronary bypass (MIDCAB)
24
Cont..
Pharmacological Therapy
 Nitrates (nitroglycerin) to increase oxygen supply
 Anticoagulants (aspirin, heparin)
 Analgesics (morphine sulfate)
 Angiotensin-converting enzyme inhibitors
 Beta blocker initially & a prescription to continue its
use after hospital discharge
 Thrombolytics (tPA, Activase) and reteplase (rPA,
TNKase) ---> must be administered after the onset of
symptoms, generally within 3-6hours
25
26
27
Contraindication for Thrombolytic
Therapy
 Active Bleeding
 Known bleeding disorder
 History of hemorrhagic stroke
 Recent major surgery or trauma
 Uncontrolled hypertension, CVA
 Pregnancy
Potential Complications
 Acute pulmonary edema
 Heart failure
 Cardiogenic shock
 Dysrhythmias
 Cardiac arrest
 Pericardial effusion
 Cardiac tamponade
29
Complications Post STEMI
 Important complications following STEMI:
 Arrhythmias
 Heart failure due to extensive myocardial damage or
mechanical complications.
 Chest pain post STEMI may be due to:
 reinfarction / recurrent MI
 post infarct angina
 pericarditis
 non cardiac causes such as gastritis (epigastric pain)
30
Nursing Management
 Obtain baseline data on current status for
comparison with ongoing status include:
 history of chest pain or discomfort,
 dyspnea,
 palpitations,
 unusual fatigue,
 faintness (syncope) or
 diaphoresis.
31
Cont..
1. Perform a complete physical assessment
---> for detecting complications & any change in
status. The examination include:
 Assess level of consciousness
 Evaluate chest pain (most important clinical
finding).
 Assess heart sound to detect an early sign of
impending LVF.
 Measure BP to determine response to pain &
treatment.
32
Cont..
 Note narrowed pulse pressure after MI, suggesting
ineffective ventricular contraction.
 Assess bowel movement. Serve laxative to prevent
straining.
 Observe urinary output and check for edema; an
early sign of cardiogenic shock in hypotension with
oliguria.
 Examine IV lines and sites frequently.
2. Maintain CRIB
3. Assist in ADLs
33
Nursing Diagnoses
1) Ineffective cardiac tissue perfusion related to
reduced coronary blood flow.
2) Risk for imbalanced fluid volume.
3) Risk for ineffective peripheral tissue perfusion
related to decreased cardiac output from left
ventricular dysfunction.
4) Death anxiety.
5) Deficient knowledge about post acute coronary
syndrome self-care.
34
Nursing Interventions
Relieve sign & symptoms of ischemia.
 Administer oxygen to reduce pain associated with
low levels of circulating oxygen.
 Assess vital signs frequently to detect
hemodynamic changes.
 Position patient of Fowler’s position or put on
cardiac bed to decrease chest discomfort and
dyspnea.
35
Cont…
Improving Respiratory Function
 Assess respiratory function to detect an early
signs of complications.
 Monitor fluid volume status to prevent
overloading the heart and lungs.
 Encourage patient to perform deep breathing
exercise and change position often to prevent
pooling fluid in lungs bases.
36
Cont…
 Promoting Adequate Tissue Perfusion
 Maintain patient on bed rest
 rest to reduce myocardial oxygen consumption.
 Check skin temperature and peripheral pulses
frequently
 determine adequate tissue perfusion.
37
Cont…
 Reduce Anxiety
 Develop a therapeutic relationship with patient.
 Allow patient to express feelings.
 Provide information to the patient and family in an
honest and supportive manner.
 Ensure a quiet environment, prevent interruptions that
disturb sleep.
 Use a caring and appropriate touch, relaxation
technique, and use humor.
 Provide spiritual support consistent with patient’s
beliefs.
 Provide divertional therapy.
38
Health Teaching
 Compliance with prescribed medication.
 Adhere to the prescribed cardiac rehabilitation
regimen.
 Assist patient with scheduling & keeping follow up
appointments for monitoring, laboratory test, ECG
and general health screening.
 Advise family member to assist patient in adhere to
restrictions dietary advice.
 Instruct patient to monitor for sign of complications
and seek for medical attention immediately.
39
Cont.
 Advice patient to change life styles:
 Stop smoking and alcohol intake
 Regular exercise as advised at lease 3 times a
week (cardio-exercise).
 Diet modifications
 Stress management
 Maintain ideal body weight
40
References
 Amsterdam EA, Wenger NK, Brindis RG, et al. (2014).
AHA/ACC guideline for the management of patients with
non–ST-elevation acute coronary syndromes. J Am Coll
Cardiol. 2014;64(24):e139- 228. [PMID:25260718]
 Basavanthappa. B.T. (2015). Medical Surgical Nursing (3rd ed.).
New Delhi: Jaypee.
 Black, J. M., & Hawks, J. H. (2011). Medical Surgical Nursing.
(8th ed.). St. Louis, UK: Saunders.
 Ignatavicius, D. D., & Workman, M. L. (2016). Medical-Surgical
Nursing: Patient-Centered Collaboration Care. (8th ed.).
Singapore: Elsevier.
 https://www.malaysianheart.org/files/5cb6bf193304e.pdf
41
Any Questions?
42
5. MYOCARDIAL INFARCTION.ppt

More Related Content

What's hot

Angina pectoris : causes, symptoms, diagnosis and treatment
Angina pectoris : causes, symptoms, diagnosis and treatmentAngina pectoris : causes, symptoms, diagnosis and treatment
Angina pectoris : causes, symptoms, diagnosis and treatmentLazoi Lifecare Private Limited
 
Congestive Heart Failure
Congestive Heart FailureCongestive Heart Failure
Congestive Heart FailureBaljinder Singh
 
Myocardial infarction
Myocardial infarction Myocardial infarction
Myocardial infarction vani
 
Cardiomyopathy slideshare Dilated cardiomyopathy Hypertrophic cardiomyopathy ...
Cardiomyopathy slideshare Dilated cardiomyopathy Hypertrophic cardiomyopathy ...Cardiomyopathy slideshare Dilated cardiomyopathy Hypertrophic cardiomyopathy ...
Cardiomyopathy slideshare Dilated cardiomyopathy Hypertrophic cardiomyopathy ...Fortis Hospitals Limited
 
Anti-hypertensive drugs for Nursing Students
Anti-hypertensive drugs for Nursing StudentsAnti-hypertensive drugs for Nursing Students
Anti-hypertensive drugs for Nursing StudentsKalaivanisathishr
 
Pathophysiology of angina and atheroslerosis
Pathophysiology of angina and atheroslerosisPathophysiology of angina and atheroslerosis
Pathophysiology of angina and atheroslerosisKoppala RVS Chaitanya
 
Coronary artery disease (CAD)
Coronary artery disease (CAD)Coronary artery disease (CAD)
Coronary artery disease (CAD)DeepiKaur2
 
Lec 3 management of acute pulmonary oedema for mohs
Lec 3 management of acute pulmonary oedema for mohsLec 3 management of acute pulmonary oedema for mohs
Lec 3 management of acute pulmonary oedema for mohsEhealthMoHS
 
Angina Pectoris.PPT
Angina Pectoris.PPTAngina Pectoris.PPT
Angina Pectoris.PPTManikandan T
 

What's hot (20)

Cardiomyopathy ppt
Cardiomyopathy pptCardiomyopathy ppt
Cardiomyopathy ppt
 
Angina pectoris : causes, symptoms, diagnosis and treatment
Angina pectoris : causes, symptoms, diagnosis and treatmentAngina pectoris : causes, symptoms, diagnosis and treatment
Angina pectoris : causes, symptoms, diagnosis and treatment
 
Myocardial infarction
Myocardial infarctionMyocardial infarction
Myocardial infarction
 
Pericarditis
PericarditisPericarditis
Pericarditis
 
Congestive Heart Failure
Congestive Heart FailureCongestive Heart Failure
Congestive Heart Failure
 
Cardiac tamponade
Cardiac tamponadeCardiac tamponade
Cardiac tamponade
 
Cardiac tamponade
Cardiac tamponadeCardiac tamponade
Cardiac tamponade
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Myocardial infarction
Myocardial infarction Myocardial infarction
Myocardial infarction
 
Myocarditis
MyocarditisMyocarditis
Myocarditis
 
Congestive heart failure
Congestive heart failureCongestive heart failure
Congestive heart failure
 
Cardiomyopathy slideshare Dilated cardiomyopathy Hypertrophic cardiomyopathy ...
Cardiomyopathy slideshare Dilated cardiomyopathy Hypertrophic cardiomyopathy ...Cardiomyopathy slideshare Dilated cardiomyopathy Hypertrophic cardiomyopathy ...
Cardiomyopathy slideshare Dilated cardiomyopathy Hypertrophic cardiomyopathy ...
 
Anti-hypertensive drugs for Nursing Students
Anti-hypertensive drugs for Nursing StudentsAnti-hypertensive drugs for Nursing Students
Anti-hypertensive drugs for Nursing Students
 
Coronary heart disease
Coronary heart diseaseCoronary heart disease
Coronary heart disease
 
Pathophysiology of angina and atheroslerosis
Pathophysiology of angina and atheroslerosisPathophysiology of angina and atheroslerosis
Pathophysiology of angina and atheroslerosis
 
Coronary artery disease (CAD)
Coronary artery disease (CAD)Coronary artery disease (CAD)
Coronary artery disease (CAD)
 
Aneurysm
AneurysmAneurysm
Aneurysm
 
Lec 3 management of acute pulmonary oedema for mohs
Lec 3 management of acute pulmonary oedema for mohsLec 3 management of acute pulmonary oedema for mohs
Lec 3 management of acute pulmonary oedema for mohs
 
Angina Pectoris.PPT
Angina Pectoris.PPTAngina Pectoris.PPT
Angina Pectoris.PPT
 
Cardiomyopathy
CardiomyopathyCardiomyopathy
Cardiomyopathy
 

Similar to 5. MYOCARDIAL INFARCTION.ppt

MUCLecture_2022_12319533. Medical surgical nursing pptx
MUCLecture_2022_12319533. Medical surgical nursing pptxMUCLecture_2022_12319533. Medical surgical nursing pptx
MUCLecture_2022_12319533. Medical surgical nursing pptxssuser47b89a
 
Lesson plan on myocardial infarction
Lesson plan on myocardial infarctionLesson plan on myocardial infarction
Lesson plan on myocardial infarctionkalyan kumar
 
Cardiogenic shock
Cardiogenic shock Cardiogenic shock
Cardiogenic shock ANILKUMAR BR
 
CARDIAC EMERGENCY
CARDIAC EMERGENCYCARDIAC EMERGENCY
CARDIAC EMERGENCYShalu Udhay
 
Myocardial Infraction -cardiac system disorder .pptx
Myocardial Infraction -cardiac system disorder .pptxMyocardial Infraction -cardiac system disorder .pptx
Myocardial Infraction -cardiac system disorder .pptxshiwani88
 
Anaesthetic Management of a Patient with Ischaemic Heart Disease
Anaesthetic Management of a Patient with Ischaemic Heart DiseaseAnaesthetic Management of a Patient with Ischaemic Heart Disease
Anaesthetic Management of a Patient with Ischaemic Heart DiseaseZareer Tafadar
 
Management of Ischemic heart diseases
Management of Ischemic heart diseasesManagement of Ischemic heart diseases
Management of Ischemic heart diseasesSameh Abdel-ghany
 
Advanced Pathophysiology
Advanced PathophysiologyAdvanced Pathophysiology
Advanced PathophysiologyJack Frost
 
Acute myocardial infarction
Acute myocardial infarctionAcute myocardial infarction
Acute myocardial infarctionhatch_jane
 
Myocardial infarction and hridaya rog
Myocardial infarction and hridaya rogMyocardial infarction and hridaya rog
Myocardial infarction and hridaya roggauravgautam125
 
Myocardial infarction
Myocardial infarction Myocardial infarction
Myocardial infarction Aizaz919930
 
Acute coronary syndrome
Acute coronary syndromeAcute coronary syndrome
Acute coronary syndromeShaalina Nair
 
Chest pain Case Presentation with management
Chest pain Case Presentation with managementChest pain Case Presentation with management
Chest pain Case Presentation with managementMuqtasidkhan
 
Shock - the life threatening condition
Shock - the life threatening conditionShock - the life threatening condition
Shock - the life threatening conditionNehaNupur8
 
Cardiogenic shock and IABP.pptx
Cardiogenic shock and IABP.pptxCardiogenic shock and IABP.pptx
Cardiogenic shock and IABP.pptxPRIYANKA BHATI
 
Heart failure – an update [autosaved]
Heart failure – an update [autosaved]Heart failure – an update [autosaved]
Heart failure – an update [autosaved]SMSRAZA
 

Similar to 5. MYOCARDIAL INFARCTION.ppt (20)

MUCLecture_2022_12319533. Medical surgical nursing pptx
MUCLecture_2022_12319533. Medical surgical nursing pptxMUCLecture_2022_12319533. Medical surgical nursing pptx
MUCLecture_2022_12319533. Medical surgical nursing pptx
 
Lesson plan on myocardial infarction
Lesson plan on myocardial infarctionLesson plan on myocardial infarction
Lesson plan on myocardial infarction
 
Cardiogenic shock
Cardiogenic shock Cardiogenic shock
Cardiogenic shock
 
CARDIAC EMERGENCY
CARDIAC EMERGENCYCARDIAC EMERGENCY
CARDIAC EMERGENCY
 
Acs presentation final
Acs presentation finalAcs presentation final
Acs presentation final
 
Myocardial Infraction -cardiac system disorder .pptx
Myocardial Infraction -cardiac system disorder .pptxMyocardial Infraction -cardiac system disorder .pptx
Myocardial Infraction -cardiac system disorder .pptx
 
Anaesthetic Management of a Patient with Ischaemic Heart Disease
Anaesthetic Management of a Patient with Ischaemic Heart DiseaseAnaesthetic Management of a Patient with Ischaemic Heart Disease
Anaesthetic Management of a Patient with Ischaemic Heart Disease
 
Management of Ischemic heart diseases
Management of Ischemic heart diseasesManagement of Ischemic heart diseases
Management of Ischemic heart diseases
 
Advanced Pathophysiology
Advanced PathophysiologyAdvanced Pathophysiology
Advanced Pathophysiology
 
Acute myocardial infarction
Acute myocardial infarctionAcute myocardial infarction
Acute myocardial infarction
 
7 ihd (2)
7 ihd (2)7 ihd (2)
7 ihd (2)
 
Myocardial infarction and hridaya rog
Myocardial infarction and hridaya rogMyocardial infarction and hridaya rog
Myocardial infarction and hridaya rog
 
Mi(2)
Mi(2)Mi(2)
Mi(2)
 
Myocardial infarction
Myocardial infarction Myocardial infarction
Myocardial infarction
 
Pathophysiology
PathophysiologyPathophysiology
Pathophysiology
 
Acute coronary syndrome
Acute coronary syndromeAcute coronary syndrome
Acute coronary syndrome
 
Chest pain Case Presentation with management
Chest pain Case Presentation with managementChest pain Case Presentation with management
Chest pain Case Presentation with management
 
Shock - the life threatening condition
Shock - the life threatening conditionShock - the life threatening condition
Shock - the life threatening condition
 
Cardiogenic shock and IABP.pptx
Cardiogenic shock and IABP.pptxCardiogenic shock and IABP.pptx
Cardiogenic shock and IABP.pptx
 
Heart failure – an update [autosaved]
Heart failure – an update [autosaved]Heart failure – an update [autosaved]
Heart failure – an update [autosaved]
 

Recently uploaded

Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxkitati1
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxsumanchaulagain3
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxLikeways
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).kishan singh tomar
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 

Recently uploaded (20)

Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptx
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptx
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 

5. MYOCARDIAL INFARCTION.ppt

  • 2. Learning Outcomes At the end of the lecture, student will be able to:  Define acute myocardial infarction (AMI).  State the etiology of AMI.  Explain the pathophysiology of AMI  State the clinical manifestations of AMI.  State the diagnostic tests that helps to confirmed the AMI. 2
  • 3. Cont. Learning Outcomes At the end of the lecture, student will be able to:  Explain the treatment and management for AMI.  Explain the nursing management for patient with AMI.  Provide health teaching on preventive measures to patients prior to discharge. 3
  • 7. Acute Myocardial Infarction (AMI)  Also called a heart attack.  Defines as myocardial cell death due to prolonged ischemia. (Malaysian Heart Assoc, 2019).  Myocardial injury is myocardial cell death due to non ischemic causes. 7
  • 8. Cont..  AMI is diagnosed by the rise and/fall in cardiac troponins with at lease one value > 99 percentile with accompanied with at lease one of the following:  clinical history consistent with chest pain of ischemic origin  ECG changes  imaging evidence of new loss of variable myocardium  identification of an intracoronary (IC) thrombus by angioplasty (Malaysian Heart Assoc, 2019). 8
  • 9. Cont.  The main cause of AMI ---> sudden blockage in the coronary artery ---> due to formation of blood clot (thrombus) ---> causing irreversible damage (necrosis) to the heart muscle. 9
  • 11. 11
  • 12. Pathophysiology 12 Atherosclerosis Arterial Spasm Atherosclerosis + Plaque breaks + Thrombus Gradual Obstruction Sudden Reversible Obstruction Sudden Irreversible Occlusion ISCHEMIA Hypoxia Reduced O2 demands Angina Thrombolysis Permanent Thrombolysis Unstable Angina Necrosis MI
  • 13. Pathogenesis of MI 13  Myocardial necrosis begins within 20-30 minutes, mostly starting at the sub-endocardial region (less perfuse, high intramural pressure.  Infarct reaches its full size within 3-6 hrs; during this period, lysis of the thrombus by streptokinase or tPA (tissue plasminogen activator), may limit the size of the infarct.
  • 14. Etiology & Risk Factors  Most heart attack results from atherosclerosis  Family history CAD  Hypercholesterolemia  ↑LDL ↓HDL  ↑BP  Obesity 14
  • 15. Cont.  Limited physical activity  Cigarette smoking  Excessive alcohol intake  Metabolic disorders  Diet high in saturated fat, cholesterol & calories 15
  • 18. Cont.  Fever  Nausea & vomiting ---> results from vasovagus reflexes.  Crackles sound, peripheral edema & hepatic enlargement ---> indicates cardiac failure.  Cardiac vascular manifestations:  elevated BP and HR  BP may drop as decreased co and urinary output. 18
  • 19. Diagnostic Tests  Clinical history consistent chest pain of ischemic origin.  Serum Troponin I or T  Serum CK-MB (cretinine kinase-myocardial band)  12-lead ECG (ST-T wave elevated by greater than 1 mm or > in two continuous leads ---> MI) 19
  • 20. Cont.  Echocardiogram  Serum potassium, magnesium & calcium (imbalances & acidosis may cause change in conduction & contractile). 20
  • 23. Pre-Hospital Management  Patient with suspected ST segment elevation MI (STEMI), should be given soluble or chewable 300 mg aspirin and 300 mg clopidogrel.  These patient should be rapidly transported to the hospital for early initiation of reperfusion strategies.  DO NOT BRING TO A CLINIC 23
  • 24. Treatment & Management The goals of medical management are to:  minimize myocardial damage, preserve myocardial function and prevent complications lethal dysrhythmias and cardiogenic shock: 1) Reperfusion – use of the percutaneous coronary intervention (PCI) or thrombolytic medications. 2) Reduce myocardial oxygen demand & increase oxygen supply with medications, oxygen therapy & bed rest. 3) Coronary artery bypass or minimally invasive direct coronary bypass (MIDCAB) 24
  • 25. Cont.. Pharmacological Therapy  Nitrates (nitroglycerin) to increase oxygen supply  Anticoagulants (aspirin, heparin)  Analgesics (morphine sulfate)  Angiotensin-converting enzyme inhibitors  Beta blocker initially & a prescription to continue its use after hospital discharge  Thrombolytics (tPA, Activase) and reteplase (rPA, TNKase) ---> must be administered after the onset of symptoms, generally within 3-6hours 25
  • 26. 26
  • 27. 27
  • 28. Contraindication for Thrombolytic Therapy  Active Bleeding  Known bleeding disorder  History of hemorrhagic stroke  Recent major surgery or trauma  Uncontrolled hypertension, CVA  Pregnancy
  • 29. Potential Complications  Acute pulmonary edema  Heart failure  Cardiogenic shock  Dysrhythmias  Cardiac arrest  Pericardial effusion  Cardiac tamponade 29
  • 30. Complications Post STEMI  Important complications following STEMI:  Arrhythmias  Heart failure due to extensive myocardial damage or mechanical complications.  Chest pain post STEMI may be due to:  reinfarction / recurrent MI  post infarct angina  pericarditis  non cardiac causes such as gastritis (epigastric pain) 30
  • 31. Nursing Management  Obtain baseline data on current status for comparison with ongoing status include:  history of chest pain or discomfort,  dyspnea,  palpitations,  unusual fatigue,  faintness (syncope) or  diaphoresis. 31
  • 32. Cont.. 1. Perform a complete physical assessment ---> for detecting complications & any change in status. The examination include:  Assess level of consciousness  Evaluate chest pain (most important clinical finding).  Assess heart sound to detect an early sign of impending LVF.  Measure BP to determine response to pain & treatment. 32
  • 33. Cont..  Note narrowed pulse pressure after MI, suggesting ineffective ventricular contraction.  Assess bowel movement. Serve laxative to prevent straining.  Observe urinary output and check for edema; an early sign of cardiogenic shock in hypotension with oliguria.  Examine IV lines and sites frequently. 2. Maintain CRIB 3. Assist in ADLs 33
  • 34. Nursing Diagnoses 1) Ineffective cardiac tissue perfusion related to reduced coronary blood flow. 2) Risk for imbalanced fluid volume. 3) Risk for ineffective peripheral tissue perfusion related to decreased cardiac output from left ventricular dysfunction. 4) Death anxiety. 5) Deficient knowledge about post acute coronary syndrome self-care. 34
  • 35. Nursing Interventions Relieve sign & symptoms of ischemia.  Administer oxygen to reduce pain associated with low levels of circulating oxygen.  Assess vital signs frequently to detect hemodynamic changes.  Position patient of Fowler’s position or put on cardiac bed to decrease chest discomfort and dyspnea. 35
  • 36. Cont… Improving Respiratory Function  Assess respiratory function to detect an early signs of complications.  Monitor fluid volume status to prevent overloading the heart and lungs.  Encourage patient to perform deep breathing exercise and change position often to prevent pooling fluid in lungs bases. 36
  • 37. Cont…  Promoting Adequate Tissue Perfusion  Maintain patient on bed rest  rest to reduce myocardial oxygen consumption.  Check skin temperature and peripheral pulses frequently  determine adequate tissue perfusion. 37
  • 38. Cont…  Reduce Anxiety  Develop a therapeutic relationship with patient.  Allow patient to express feelings.  Provide information to the patient and family in an honest and supportive manner.  Ensure a quiet environment, prevent interruptions that disturb sleep.  Use a caring and appropriate touch, relaxation technique, and use humor.  Provide spiritual support consistent with patient’s beliefs.  Provide divertional therapy. 38
  • 39. Health Teaching  Compliance with prescribed medication.  Adhere to the prescribed cardiac rehabilitation regimen.  Assist patient with scheduling & keeping follow up appointments for monitoring, laboratory test, ECG and general health screening.  Advise family member to assist patient in adhere to restrictions dietary advice.  Instruct patient to monitor for sign of complications and seek for medical attention immediately. 39
  • 40. Cont.  Advice patient to change life styles:  Stop smoking and alcohol intake  Regular exercise as advised at lease 3 times a week (cardio-exercise).  Diet modifications  Stress management  Maintain ideal body weight 40
  • 41. References  Amsterdam EA, Wenger NK, Brindis RG, et al. (2014). AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes. J Am Coll Cardiol. 2014;64(24):e139- 228. [PMID:25260718]  Basavanthappa. B.T. (2015). Medical Surgical Nursing (3rd ed.). New Delhi: Jaypee.  Black, J. M., & Hawks, J. H. (2011). Medical Surgical Nursing. (8th ed.). St. Louis, UK: Saunders.  Ignatavicius, D. D., & Workman, M. L. (2016). Medical-Surgical Nursing: Patient-Centered Collaboration Care. (8th ed.). Singapore: Elsevier.  https://www.malaysianheart.org/files/5cb6bf193304e.pdf 41

Editor's Notes

  1. Early management of STEMI is directed at: Pain relief – analgesic & oxygen therapy Establishing early reperfusion – use of Percutaneous Coronary Intervention (PCI) or thrombolytic medications Treatment of complications