EASY AND EFFECTIVE PRESENTATION ABOUT HEART ATTACK /MI.

1. BY :- MANISHA KUMARI
IGIMS COLLEGE PATNA -14

2.  INTRODUCTION
 DEFINITION
 EPIDEMIOLOGY
 TYPES/LOCATION
 CLASSIFICATION
 RISK FACTORS
 PATHOPHYSIOLOGY
 CLINICAL MANIFESTATION
 DIAGNOSTIC TESTS
 MANAGEMENTS
 PROGNOSIS
 HEALTH EDUCATION
 BIBLIOGRAPHY

3.  HH
ANATOMY OF HEART
PHYSIOLOGY OF HEART

4.  HEART IS A MUSCULAR ORGAN .
 LOCATED IN THORACIC CAVITY ,
POSTERIOR TO STERNUM , SUPREIOR TO
DIAPHRAGM , BETWEEN THE LUNGS .
 HEART HAS 3 LAYERS - PERICARDIUM ,
ENDOCARDIUM , MYOCARDIUM .
 4 CHAMBERS - 2 ATRIUM , 2 VENTRICLES .
 4 VALVES - MITRAL , AORTIC , TRICUSPID ,
PULMONARY

5.  HEART PUMPS BLOOD THROUGHOUT THE BODY VIA
THE CIRCULATORY SYSTEM , SUPPLYING OXYGEN
AND NUTRIENTS TO THE TISSUES AND REMOVING
CARBON DIOXIDE AND OTHER WASTES .
 HEART CONTAINS ELECTRICAL ‘PACEMAKER’ CELLS
, WHICH CAUSE IT TO CONTRACT - PRODUCING
HEARTBEAT .
 THE FUNCTION OF RIGHT HEART IS TO COLLECT
DE-OXYGENATED BLOOD FROM BODY AND PUMP IT
INTO RIGHT VENTRICLE .
 THE FUNCTION OF LEFT VENTRICLE IS TO
OXYGENATION OF BLOOD AND PUMP IT IN ALL
OVER BODY PARTS .

7.  MYOCARDIAL INFARCTION REFERS TO THE
PROCESS BY WHICH AREAS OF MYOCARDIAL
CELLS IN THE HEART ARE PERMANENTLY
DESTROYED .
 ACUTE MI IS MOST COMMON SERIOUS DISEASE
IN THE SOCIETY WHICH LEADS TO HIGH
MORTALITY AND MORBIDITY OF THE SOCIETY .
 IT IS THE IRREVERSIBLE DEATH OF THE HEART
MUSCLE SECONDARY TO PROLONGED LACK OF
OXYGEN SUPPLY .
 CHEST PAIN OR DISCOMFORT TRAVEL INTO THE
SHOULDER , ARM , BACK , NECK , OR JAW – MAIN
SYMPTOMS SEEN IN MI.

8.  MYOCARDIAL INFARCTION IS A DISEASED
CONDITION WHICH IS CAUSED BY REDUCED
BLOOD FLOW IN A CORONARY ARTERY DUE
TO ATHEROSCLEROSIS AND OCCLUSION OF
AN ARTERY BY AN EMBOLUS OR
THROMBUS.

10.  EVERY YEAR ABOUT 7,35000 AMERICAN HAVE A
HEART ATTACK , OF THESE 5,25000 ARE A
FIRST HEART ATTACK AND 2,10000 HAPPEN IN
PEOPLE WHO HAVE ALREADY HAD A HEART
ATTACK .
 IN 2010 , APPROX. 1 IN 6 PEOPLE DIED OF MI .
 EVERY 34 SECONDS , 1 HAS CORONARY EVENT.
 EVERY 1 MINUTE 23 SECONDS , AN AMERICAN
WILL DIE OF ONE .
 INCIDENCE OF MI IN INDIA IS 64.37/1000
PEOPLE IN MEN AGED 29 – 69 YEARS .

13. 1 . ACCORDING TO ANATOMIC REGION OF
LEFT VENTRICLE INVOLVED :
 ANTERIOR
 POSTERIOR
 LATERAL
 SEPTAL
 CIRCUMFERENTIAL
 COMBINATION- ANTEROLATERAL ,
POSTEROLATERAL, ANTEROSEPTAL

14. 2 . ACCORDING TO DEGREE OF THICKNESS
OF VENTRICULAR WALL INVOLVED :
 TRANSMURAL ( FULL THICKNESS )
 LAMINAR ( SUBENDOCARDIAL ) .
3 . ACCORDING TO AGE OF INFARCTS :
 NEWLY FORMED ( ACUTE , RECENT , FRESH )
 ADVANCED INFRACTS (OLD , HEALED ,
ORGANISED )

15. 1. NON – MODIFIABLE RF :
AGE -SEEN MAINLY IN MORE THAN 40 YEARS
SEX - 3 TIMES MORE IN MEN THAN WOMEN .
FAMILY HISTORY - INHERITED FROM PARENTS TO
CHILDREN.

16. 2 . MODIFIABLE RF :
STRESS OBESITY SMOKING
DIABETES
MELLITUS
HYPERTEN
SION
PHYSICAL
INACTIVITY
HIGH BLOOD LIPID LEVEL

22.  CHEST PAIN
 DYSPNOEA
 FATIGUE
 INCREASED SWEATING
 WEAKNESS
 NAUSEA
 VOMITING
 LIGHT HEADACHE
 PALPITATION
 ANXIETY
 SLEEPLESSNESS
 ARRHYTHMIAS

24.  1. HISTORY COLLECTION :-
 2. ECG :- ASSISTS IN DIAGNOSING ACUTE MI.
THE CLASSIC ECG CHANGES ARE ;
1. ST SEGMENT ELEVATION
2. T WAVE INVERSION
3. ABNORMAL Q WAVE

26. 3 . ANGIOGRAPHY :-
ANGIOGRAPHY IS AN IMAGING TEST THAT
USES X - RAY AND SPECIAL CONTRAST
DYE TO VIEW BLOOD VESSELS AND TO
STUDY NARROW , BLOCKED , ENLARGED ,
MALFORMED ARTERIES OR VEINS .

28.  4. CHEST X – RAY :-
IT IS USEFUL ADDITIONAL INDEX OF THE
SEVERITY OF HEART FAILURE IN MI .
PULMONARY CONGESTION OR CARDIAC
ENLARGEMENT ARE THE INDICATOR OF
HEART FAILURE

29.  5 . BLOOD TESTS :-
CERTAIN HEART PROTEIN SLOWLY LEAK INTO
BLOOD AFTER HEART DAMAGE FROM MI .
Eg… 1 . CK - CREATINE KINASE
2. TROPONIN – I $ T
3. MYOGLOBIN etc.
BOTH TROPONIN I & T LEVEL ELEVATED WITHIN 2
-4 hrs AFTER INFRACTION AND PEAK AT 48 hrs
AND STAY ELEVATED FOR 7 -10 DAYS.
CK –MB LEVEL ELEVATED 2-4 hrs AFTER INFARCTION
AND PEAK AT 48 hrs AND RETURNS NORMAL
MORE QUICKLY - SO IT IS USED TO DIAGNOSE
REINFARCTION.

30. 6 . ECHOCARDIOGRAM : -
AN ACCURATE NON – INVASIVE TESTS THAT
ENABLES DETECTION OF EVIDENCE OF
MYOCARDIAL DYSFUNCTION CAUSED BY
ISCHEMIA OR NECROSIS .
EVALUATION OF WALL MOTION WHILE A
PATIENT IS EXPERIENCING CHEST PAIN CAN
BE USEFUL WHEN THE ECG IS
NONDIAGNOSTIC .

32. 7. CT SCAN :-
 COMPUTED TOMOGRAPHY
 PAINLESS IMAGING TEST THAT USES X –
RAYS TO TAKE MANY DETAILED PICTURES
OF HEART AND ITS BLOOD VESSELS .
 IT PRODUCES HIGH QUALITY PICTURES OF
THE BEATING HEART AND CAN DETECT
CALCIUM OR BLOCKAGE IN THE CORONARY
ARTERIES

33. 8. NUCLEAR STRESS IMAGING :-
AN IMAGING METHOD THAT USES
RADIOACTIVE MATERIAL TO SHOW HOW
WELL BLOOD FLOWS INTO THE HEART
MUSCLE , BOTH AT REST AND DURING
ACTIVITY .
 POSITIVE IN 75 -90 % OF PATIENTS OF
SIGNIFICANT CORONARY DISORDERS .
 FALSE POSITIVE TEST MAY SEEN IN
WOMEN DUE TO BREAST TISSUES .

39. 1 . MEDICAL MANAGEMENT :- DRUG
THERAPY
2. SURGICAL MANAGEMENT
3. NURSING MANAGEMENT

40. 1. MORPHINE
2. OXYGEN
3. NITRATES
4. ASPIRIN
5. REPERFUSION
6. CLOPIDOGREL
7. HEPARIN
8. BETA - BLOCKERS
9. ANTICOGULANTS
10. STATIN
11. ANGIOTENSIN 2 INHIBITORS
12. CORRECTION OF RISK FACTORS

41. A. INTRA – AORTIC BALOON PUMP

42. B. PERCUTANEOUS CORONARY
INTERVENTION / ANGIOPLASTY

43. C. TRANSMYOCARDIAL LASER
REVASCULARIZATION :

44. D. CORONARY ARTERY BY – PASS ( CABG )
:

45. E . MINIMAL INVASIVE DIRECT CORONARY
ART ERY BYPASS (
MIDCAB ) :-

46.  1 . ASSESSMENT
 ASSESS THE PATIENT’S COMPLAINTS ABOUT
FATIGUE , WEAKNESS , MALAISE
 ASSESS THE PRESENCE OF PAIN IN CHEST ,
NECK , HAND AND FINGERS
 ASSESS ALL THE DIAGNOSTIC FINDINGS .
 ASSESS THE RESPIRATORY DISTRESS AND
NEED FOR VENTILATORY SUPPORT .

47.  ACUTE PAIN r/t MYOCARDIAL ISCHEMIA
RESULTING FROM CORONARY ARTERY
OCCLUSION WITH LOSS / RESTRICTION OF
BLOOD FLOW TO AN AREA OF THE
MYOCARDIUM AND NECROSIS OF THE
MYOCARDIUM .
 ACTIVITY INTOLERANCE r/t CARDIAC
DYSFUNCTION CHANGES IN OXYGEN SUPPLY
AND CONSUMPTION AS EVIDENCED BY
SHORTNESS OF BREATH .
 DEFICIENT KNOWLEDGE r/t NEW DIAGNOSIS
AND LACK OF UNDERSTANDING OF MEDICAL
CONDITION .

48.  INITIAL EVALUATION AND STABILIZATION .
 RELIEF OF ISCHEMIC CHEST DISCOMFORT.
 EFFICIENT RISK STRATIFICATION.
 FOCUSED CARDIAC CARE.
 EARLY RESTORATION OF BLOOD FLOW TO
THE INFARCT-RELATED ARTERY TO
PREVENT INFARCT EXPANSION .
 INCREASE MYOCARDIAL OXYGGEN
DELIVERY.
 PREVENTATION OF DEATH OTHER
COMPLICATION .

49.  MONITOR AND DOCUMENT CHARACTERISTIC OF
PAIN.
 OBTAIN FULL DESCRIPTION OF PAIN FRON PATIENT
IMCLUDING LOCATION, INTENSITY, DURATION AND
RADIATION .
 REVIEW HISTORY OF PREVIOUS ANGINA, ANGINAL
EQUIVALENT, OR MI PAIN.
 INSTRUCT PATIENT TO REPORT PAIN IMMEDIATELY.
 PROVIDE QUIET ENVIRONMENT, CALM ACTIVITIES
AND COMFORT MEASURES .
 INSTRUCT PT. TO DO DEEP AND SLOW BREATHING.
 CHECK VITAL SIGNS BEFORE AND AFTER NARCOTIC
MEDICATION.
 ADMINISTER SUPPLEMENTAL OXYGEN, IF NEEDED.

50.  MI ARE A SERIOUS EVENTS , APPROXIMATELY
25% OF PATIENTS DIE FROM THE INITIAL
EVENTS i.e THEY MAY DIE BEFORE REACHING
HOSPITAL , OR IN THE FIRST DAY OR SO
 OF THE REST , 25% WILL DIE WITHIN THE NEXT
TWO YEARS , USUALLY DUE TO RECURRENT MI
OR COMPLICATIONS .
 ABOUT 50 % OF THE INITIAL SURVIVORS ARE
ALIVE AFTER 10 YEARS .

52. 1 1gffSN. DURING HOSPITAL STAY ON DISCHARGE
TAKE MEDICINESS AS
PRESCRIBED.
SAME
TELL DOCTORS ABOUT
CURRENT PROBLEMS
TELL PATIENTS ABOUT FOLLOW
– UP .
KEEP HYGIENE DURING
HOSPITAL STAY .
REDUCE THE RISK FACTORS
OF MI .
1.
2.
3.
STRICT BED REST 24-48
hrs ON 100% OXYGEN .
PREPARE IMMEDIATE GENERAL
MANAGEMENT.
4
.

53.  DIET
 RESTRICTING SALT
 REDUCING WT.
 EXERCISE
 QUITTING ALCOHOL
 QUITTING SMOKING
 REDUCE STRESS.

55.  SMELTZR C. SUZANNE (2004 ) , “BRUNNER
AND SUDDARTH’S TEXTBOOK OF MEDICAL
AND SURGICAL NURSING “ LIPPINCOLT
PUBLICATIONS PHILDELPHIA .
 WAUGH ANX. (2007) ROSS AND WILSON
ANATOMY AND PHYSIOLOGY IN HEALTH
AND ILLNESS ; 9 th ED . CHRUCHILL
PUBLICATIONS , LIVINGSTONE .
 GOOGLE @ SLIDESHARE #Dr. RAMESH
KRISHNAN