1. TOPIC: MYOCARDIAL INFARCTION
Presenters: Amos Mapesa & Millicent Wanjiku
B.S.c.N K.U students
KENYATTATA NATIONAL HOSPITAL C.M.E ROOM

2. OBJECTIVES
1.Define MI
2.Describe Pathophysiology of MI
3.State Classical S & S of MI
4. Diagnosis of M.I
5.Highlight Complications of MI
6.Describe management of MI

3. DEFINATION
M.I is myocardium necrosis due to occlusion of C.A.
Necrosis result from poor oxygen supply.
C.A has two branches from aorta
1. Right coronary artery
2. Left coronary artery-Least occluded
-Supply 40% myocardium & bundle of

4. Pathophysiology of M.I
Genesis is Low density Lipoprotein(L.D.L)
Causes atherosclerosis of C.A-CX non STEMI(r/xlytics)
This cxs platelet aggregation
Thromboxane activated
Friction of blood cxs clot formation
Clot occlude C.A-STEMI(P.C.I)

5. Ct
Size of Infarction Depend on:
 size of vessels-LCA
 collateral circulation available
 status of fibrinolytic system
 Vascular tone
 Metabolic demand of myocardium
 Time of intervention

6. CLASSICAL S & S of M.I
1. Sudden chest pain.
2. Substanal Pain radiating to jaw, neck& left arm.
3. Pain is unrelieved with rest.
4. Heaviness on the chest
5. Labored breathing
6. Vomiting because Pain cxs Vagal stimulation

7. DIAGNOSIS
ECG
1. T-wave inversion
2. ST-segment elevation-R/X-Thrombolisis or PCI
BLOOD TEST
1. Levels of Troponin
2.Creatinine kinase- CK MB
3.Myoglobin- not definitive (skeletal muscles has)

8. COMPLICATIONS
Vascular complication
Recurrent ischemia & Recurrent infarction
Mechanical complication
Diastolic dysfxn &Systolic dysfxn
Congestive heart failure & Aneurism formation
Thromboembolic Complication
DVT
Pulmonary embolism

9. N/DX
 Acute pain r/t to oxygen supply & demand imbalance
 Anxiety r/t to chest pain or fear of death
 Reduced CO r/t to impaired contractility
 Activity intolerance r/t to insufficient oxygenation to
 perform daily Living activities.

10. MANAGEMENT
 FOLLOW A,B,C,D,E,F,G,H,I
1.A-AIRWAY
CHECK 4 PATENCY
CLEAR IF SECREATIONS ARE CONFIRMED, POSITION
2.BREATHING
OXYGEN- BY NASAL PRONGS-4 mls/MIN
Ensure SPO2 of 95% and above

11. 3. C-CIRCULATION
 ECG- 12 LEAD-ST ELEVATION
 I.V LINES FOR MEDICATION
 BLOOD SAMPLES-TROPONIN,CK-MB2,MYOGLOBIN
 CARDIAC MONITORING

12. 4. D-DRUGS
 O- OXYGEN-4mls/minutes.
 B-BETA BLOCKERS-reduce oxygen demand
 ACEI-VASOPRESSOR & LOWER BP- captopril
 MORPHINE-Opiod for chest pain. 1mg
 ASPIRIN-prevent platelet aggregation.
 STATINS(atorvastatin)-lower LDL cholesterol levels
 IV HEPARIN
 NITROGLYCERINE-1st line, Gives NO, a C.A vasopressor
check BP &RR before starting

13. INTENSIVE CARE
 IV Nitroglycerine
 Daily Aspirin
 IV Beta blocker within initial hours
 Calcium channel blocker- if B-Blocker is c/indicated
 Heparin 4 pt on thrombolytic therapy with ateplace

14. 8. H- HOSPITAL DISPOSAL
STABLE SEND TO CARDIOLOGIST
9. I- INFORM ON THE M.I. CONDITION
PATIENT
RELATIVES
CARDIOLOGIST
SIGNIFICANT OTHERS

15. 5. E-environment control & exposure
CHECK FOR OTHER CONDITIONS
QUICK P.E
6. F- FOLLEYS & FINGERS
7.G- GENERAL COMFORT OF PATIENT
POSITION
NOISE FREE

16.  IN SUMMARY- THE OBJECTIVES
QUESTIONS
THANK YOU!
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