3. INTRODUCTION
Acute myocardial infarction is the medical name for a
heart attack. A heart attack is a life-threatening condition
that occurs when blood flow to the heart muscle is
abruptly cut off, causing tissue damage. This is usually
the result of a blockage in one or more of the coronary
arteries. A blockage can develop due to a build up of
plaque, a substance mostly made of fat, cholesterol, and
cellular waste products.
4. Definition
MI is defined as 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. MI or
heart attack is the irreversible damage of myocardial tissue
caused by prolonged ischemia and hypoxia.
5.
6. MI is defined as death of a segment of heart
muscle which follows interruption of its blood
supply.
MI refers to the process by which myocardial
tissue is destroyed in region of the heart that are
deprived of an adequate blood supply because of a
reduced coronary blood flow.
8. TYPE-1 Spontaneous MI
Type-2: MI secondary to an ischemic imbalance
Type-3: MI resulting in death when Biomarker
values are unavailable
Types-4: MI related to percutaneous coronary
intervention.
Type-5: MI related to CABG.
11. 1.Zone of
Necrosis
• Death of the heart muscle caused by
extensive and complete oxygen
deprivation, irreversible damage.
1.Zone of
Injury
• Region of the muscle surrounding
the area of necrosis, inflamed and
injury, but still visible if adequate
oxygenation can be restored.
1.Zone of
Ischemia
• Region of the heart
muscle surrounding
the area if injury,
which is ischemic and
viable and endangered
unless extension of
the infarction occurs.
22. C- Chest pain
R- Radiating pain chest, left arm, jaw, back
U- Unrelieved pain by rest or nitro-glycerine
S- Sweating
H-Hard to breath
I- Increased or irregular heart rate, increased BP, Indigestion
N- Nausea and Vomiting
G- Going to anxious
Painful condition with tightness, pressure or squeezing pain
in chest – 75% patients experience.
24. HISTORY
Patient with MI describe a heaviness, squeezing, choking or
something sensation.
Patients often describe the sensation as “something sitting on
my chest”.
The substernal pain can radiate to the neck, left arm, back, or
jaw.
Associated finding on history include nausea and vomiting,
especially for the patient with an inferior wall MI.
PHYSICAL EXAMINATION
25. ECG: An ECG can be used to detect pattens of ischemia,
injury and infraction.
ECG changes
ST segment elevation
T wave inversion
Appearance of wide deep Q waves
26. CARDIAC MARKERS
CK-MB appears in the serum in 6 to 12 hours, peaks between
12 to 28 hours, and return to normal level in about 72 to 96
hours. Serial sampling are performed every 4 to 6 hours for the
first 24 to 24 hours after the onset of symptoms.
Creatine Kinase Isoforms CK-MB1 is the isoforms found in
the plasma, and CK-MB2 is found in the tissues. In the patient
with an MI, the CK-MB2 level rises, resulting in a CK-MB2 to
CK-MB1 ratio greater than one.
27. Myoglobin is an oxygen binding protein found in skeletal
and cardiac muscle. Myoglobin’s release from ischemic
muscle occurs earlier than the release of CK. The
myoglobin level can elevate within 1 to 2 hours of acute
MI and peaks within 3 to 15 hours. Because myoglobin
present in skeletal muscle, an elevated myoglobin level is
not specific for the diagnosis of MI.
Troponin (troponin T and Troponin I) Troponin I level
rise in about 3 hours, peak at 14 to 18 hours and remain
elevated for 5 to 7 days. Troponin T level rise in 3 to 5
hours and remain elevated for 10 to 14 days.
35. Percutaneous Transluminal Coronary Angioplasty (PTCA)
Percutaneous coronary angiography is minimal invasive procedure
blocked coronary arteries.
PURPOSE
The purpose of PTCA is to improve blood flow within a coronary
artery by compressing and cracking the atheroma.
36. PROCEDURE
Hollow the catheter sheaths are inserted, usually in the
femoral artery, providing a conduit for the other catheters.
The catheters are threaded through the femoral artery, up
through the aorta and into the coronary arteries.
Angioplasty is performed using infected radiopaque
contrast agent to identify the location and extent of
blockage.
A billion tipped catheter is passed through the sheath and
position over lesion.
After insertion, the catheter is inflated with high pressure
of several second and then deflated.
The pressure compresses and then cracks the atheroma.
37. CORONARY ARTERY STENT
A stent is a metal mesh placed in the coronary arteries that supply blood
to the heart to keep the arteries open in the treatment of coronary heart
disease. A stent reduce chest pain and improve the survivability in the
event of an acute myocardial infarction. Some stent are coated with
medications such as paclitaxel, which minimize the for plaque formation
of thrombus or scar tissue within the stent.
ATHERECTOMY
Atherectomy is an invasive interventional procedure that involves the
removal of the atheroma or plaque from a coronary artery by cutting,
shaving or grinding. It may be used in conjunction PTCA. Directional
atherectomy involves the use of catheter that remove the lesions and its
fragments.
38. POST PROCEDURE CARE
The nurses have to obtain a comprehensive report that include,
medication during the procedure, stent placed and their location, time of
last heparin dose. No of sticks required to place the sheath.
Assessment of the sheath site for any bleeding
Check the vital sign, site assessment and pedal pulse checks every 5
minutes until the sheath is removed.
Elevate the head of the bed at 30 degree. If bleeding occur or any
presence of hematoma then lie the patient flat.
Sterile gloves and mask to be worn during procedure.
Fluid therapy during the procedure.
39. CORONARY ARTERY REVASCULARIZATION
CABG is a surgical procedure in which a blood vessel is grafted to an
occluded coronary artery so blood can flow beyond the occlusion.
A blood vessel commonly used for CABG is the greater saphenous
vein. Cephalic and basilica veins are also used. The vein is move from
the leg and grafted to ascending aorta and to coronary artery distal to
the lesion. Arterial graft are preferred over veins for CABG because
they do not develop atherosclerosis changes as quickly and remain
potent longer.
40. INDICATIONS
Alleviation of angina that cannot be control with medications or
PCO.
Treatment of left main coronary artery stenosis or multi vessel
CAD.
Prevention and treatment of MI, dysrhythmias or heart failure.
Treatment for complication from an unsuccessful PCI
44. One of the most important aspects of care of the patient with MI is
the assessment.
• Assess for chest pain not relieved by rest or medications.
• Monitor vital signs, especially the blood pressure and pulse rate.
• Assess for presence of shortness of breath, dyspnea, tachypnea,
and crackles.
• Assess for nausea and vomiting.
• Assess for decreased urinary output.
• Assess for the history of illnesses.
• Perform a precise and complete physical assessment to detect
complications and changes in the patient’s status.
• Assess IV sites frequently
45. NURSING DIAGNOSIS
Acute pain related to myocardial ischemia and decreased
myocardial oxygen supply.
Decreased cardiac output related to decreased cardiac
contractility.
Activity intolerance related to fatigue secondary to
insufficient oxygenation as evidenced by shortness of
breath, weakness.
Anxiety related to chest pain, fear of death, threatening
environment.
Knowledge deficit related to disease process, medications,
home activities.
46. CARDIAC REHABILITATION
Cardiac rehabilitation does not change your past, but it can help you improve your
heart’s future.
Cardiac rehabilitation is a medically supervised program designed to improve your
cardiovascular health if you have experienced heart attack, heart failure, angioplasty or
heart surgery. Cardiac rehabilitation has three equally important parts:
Exercise counselling and training: Exercise gets your heart pumping and entire
cardiovascular system working. Patient will learn how to get the body moving in ways
that promote heart heath.
Education for heart-healthy living: A key element of cardiac rehab is educating:-
How can you manage your risk factors? Quit smoking? Make heart- healthy nutrition
choices?
Counselling to reduce stress: Stress hurts yours heart. This part of cardiac rehab helps
you identify and tackle everyday sources of stress.
47. PHASES OF CARDIAC REHABILITATION
Phase I in hospital (3-5 days)
Phase II post discharge (2-6 weeks)
Phase III outpatient programme (6-12 weeks)
Phase IV long term maintenance in community
48. In Phase I: Acute MI, CABG, unstable heart failure.
First 24-48 hours- breathing exercises.
Simple arm and leg ROM exercises
Limited self-care activities
Over the next 2-3 days- sit out of bed
Take short walks.
Shower
49. In Phase II: By discharge patient should know sign and
symptoms of excessive exertion and rate level of exertion.
Home exercise programme for first 6 weeks, mostly
walking.
Contact and telephonic follow-ups with rehabilitation
services
In Phase III: Patient should be seen by physician or
cardiologist before exercising. Patient safety during
exercising very important. Assessment of heart rate and
BP at rest and during exercising, etc.
In Phase IV: Patient must be able to manage himself
regarding exercise. Community based instruction.
50. BIBLIOGRAPHY
Brunner & Suddarth’s, “textbook of medical surgical nursing” 11th edition, published by
lippincort, page no. 1602-1617.
Lemone Priscilla “medical surgical nursing” 4th edition, published by pearson, page no. 600-620.
Ansari Javed “a textbook of medical surgical nursing-1” PV published, page no. 869-883.
http://www.scribed.com
http://en.m.wikipedia.com
http://nurseslabs.com
http://www.healthxchange.sg.com
https://www.healthline.com/health/acute-myocardial-infarction#risk-factors
https://nurseslabs.com/myocardial-infarction/
