A blockage of blood flow to the heart muscle. A heart attack is a medical emergency. A heart attack usually occurs when a blood clot blocks blood flow to the heart. Without blood, tissue loses oxygen and dies. Symptoms include tightness or pain in the chest, neck, back or arms, as well as fatigue, lightheadedness, abnormal heartbeat and anxiety. Women are more likely to have atypical symptoms than men. Treatment ranges from lifestyle changes and cardiac rehabilitation to medication, stents and bypass surgery.

1. OBJECTIVES:
 GENERALOBJECTIVES:
At the end of the class students will be able to gain adequate knowledge about Myocardial infarction
and will be able to apply this in the clinical setting for better improvement in quality care.
 SPECIFIC OBJECTIVES
The students will be able to
1. define Myocardial infarction
2. discuss Incidence of Myocardial infarction
3. elaborate Risk factors of Myocardial infarction
4. explain Pathophysiology of Myocardial infarction
5. enlist the clinical features of Myocardial infarction
6. explain diagnostic procedures of Myocardial infarction
7. enlist complications for Myocardial infarction
8. describe collaborative management of Myocardial infarction

2. Duration Objectives Content
Teacher
activity
Student
activity
Evaluation
5 min
5 min
To introduce the
topic
Define
myocardial
infarction
Introduction: Myocardial infarction (MI) or acute
myocardial infarction (AMI), commonly known as
a heart attack, results from the partial interruption
of blood supply to a part of the heart, causing
heart cells to die. This is most commonly due to
occlusion (blockage) of a coronary
artery following the rupture of a vulnerable
atherosclerotic plaque, which is an unstable
collection of lipids (cholesterol and fatty acids)
and white blood cells (especially macrophages) in
the wall of an artery
Definition: Myocardialinfarction (MI) or acute
myocardial infarction (AMI), commonly known
as a heart attack, results from the partial
interruption of blood supply to a part of the heart
muscle, causing the heart cells to be damaged or
die.
Discussion
Lecture
Discussion
Listening
Listening
Writing
What is
Myocardial
infarction ?

3. 2 min
5 min
Discuss
Incidence of
myocardial
infarction
Elaborate Risk
factors of
myocardial
infarction
Approximately one million Americans suffer a
heart attack each year. Four hundred thousand of
them die as a result of their heart attack.
Non modifiable risk factors for atherosclerosis
include the following:
 Age
 Sex
 Family history of premature coronary heart
disease
 Male-pattern baldness
Modifiable risk factors for atherosclerosis
include the following:
 Smoking or other tobacco use
 Diabetes mellitus
 Hypertension
 Hypercholesterolemia and
hypertriglyceridemia, including inherited
lipoprotein disorders
 Dyslipidemia
 Obesity
Lecture
method
Listening
Writing
What is the
incidence of
Myocardial
infarction ?
What are the
Risk factors of
MI ?

4. 8 min Explain
pathophysiology
of myocardial
infarction
 Sedentary lifestyle and/or lack of exercise
 Psychosocial stress
 Poor oral hygiene
 Type A personality
Elevated homocysteine levels and the presence of
peripheral vascular disease are also risk factors for
atherosclerosis
Acute myocardial infarction refers to two subtypes
of acute coronary syndrome, namely non-ST-
elevated myocardial infarction and ST-elevated
myocardial infarction, which are most frequently
(but not always) a manifestation of coronary
artery disease.
The most common triggering event is the
disruption of an atherosclerotic plaque in an
epicardial coronary artery, which leads to a
clotting cascade, sometimes resulting in total
occlusion of the artery.
Atherosclerosis is the gradual build up
of cholesterol and fibrous tissue in plaques in the
wall of arteries (in this case, the coronary arteries),
typically over decades.
Lecture
cum
discussion
Listening
and taking
notes
What is the
pathophysiology
of myocardial
infarction ?

5. Blood stream column irregularities visible on
angiography reflect artery lumen narrowing as a
result of decades of advancing atherosclerosis.
Plaques can become unstable, rupture, and
additionally promote a thrombus (blood clot) that
occludes the artery; this can occur in minutes.
When a severe enough plaque rupture occurs in
the coronary vasculature, it leads to myocardial
infarction (necrosis of downstream myocardium).
If impaired blood flow to the heart lasts long
enough, it triggers a process called the ischemic
cascade; the heart cells in the territory of the
occluded coronary artery die (chiefly
through necrosis) and do not grow back.
A collagen scar forms in its place, indicate that
another form of cell death called apoptosis also
plays a role in the process of tissue damage
subsequent to myocardial infarction.

6. 5 min Enlist clinical
features of
Myocardial
infarction
Patients with typical myocardial Infarction may
have the following prodromal symptoms in the
days preceding the event (although typical STEMI
may occur suddenly, without warning):
 Fatigue
 Chest discomfort
 Malaise
Typical chest pain in acute myocardial infarction
has the following characteristics:
Intense and unremitting for 30-60 minutes
 Retro sternal and often radiates up to the
neck, shoulder, and jaw and down to the
ulnar aspect of the left arm
 Usually described as a sub sternal pressure
sensation that also may be characterized as
squeezing, aching, burning, or even sharp
 In some patients, the symptom is epigastric,
with a feeling of indigestion or of fullness
and gas
The patient’s vital signs may demonstrate the
following in myocardial infarction:
Lecture
method
Listening
Writing
What are the
clinical features
of myocardial
infarction ?

7. 5 min Explain
diagnostic
findings for MI
 The pulse may be irregular because of
ventricular ectopy, an accelerated
idioventricular rhythm, ventricular tachycardia,
atrial fibrillation or flutter, or other supra
ventricular arrhythmias; brady arrhythmias
may be present
 The respiratory rate may be increased in
response to pulmonary congestion or anxiety
 Coughing, wheezing, and the production of
frothy sputum may occur
 Fever is usually present within 24-48 hours,
with the temperature curve generally parallel to
the time course of elevations of creatine kinase
(CK) levels in the blood. Body temperature
may occasionally exceed 102°F.
History collection, physical examination
Cardiac biomarkers/enzymes:
 Troponin levels: Troponin is a contractile
protein that normally is not found in serum; it
is released only when myocardial necrosis
occurs
 Creatine kinase (CK) levels: CK-MB levels
increase within 3-12 hours of the onset of chest
Lecture
cum
discussion
Listening What are the
diagnostic
findings for MI?

8. 5 min Enlist
complications of
myocardial
infarction
pain, reach peak values within 24 hours, and
return to baseline after 48-72 hours
 Myoglobin levels: Myoglobin is released more
rapidly from infarcted myocardium than is
troponin; urine myoglobin levels rise within 1-
4 hours from the onset of chest pain
 Complete blood count
 Chemistry profile
 Lipid profile
 C-reactive protein and other inflammation
markers
Electrocardiography
Cardiac imaging
For individuals with highly probable or confirmed
ACS, a coronary angiogram can be used to
definitively diagnose or rule out coronary artery
disease
Complications may occur immediately following
the heart attack (in the acute phase), or may need
time to develop (a chronic problem).
 Acute complications may include heart
failure if the damaged heart is no longer
able to adequately pump blood around the
body;
Lecture Listening What are the
complications of
myocardial
infarction ?

9. 10 min Describe
collaborative
management of
MI
 Aneurysm or rupture of the myocardium;
 Mitral regurgitation, in particular if the
infarction causes dysfunction of the
papillary muscle; and
 Arrhythmias, such as ventricular
fibrillation, ventricular tachycardia, atrial
fibrillation and heart block.
Longer-term complications include,
 Heart failure,
 Atrial fibrillation, and the
 Increased risk of a second myocardial
infarction.
Pre hospital care
For patients with chest pain, pre hospital care
includes the following:
Intravenous access, supplemental oxygen, pulse
oximetry
Immediate administration of aspirin en route
Nitro-glycerine for active chest pain, given
sublingually or by spray
Telemetry and pre hospital ECG, if available
Emergencydepartmentand inpatientcare
Initial stabilization of patients with suspected
myocardial infarction and ongoing acute chest
pain should include administration of sublingual
What is
management of
MI?

10. nitroglycerin if patients have no contraindications
to it.
The American Heart Association (AHA)
recommends the initiation of beta blockers to all
patients with STEMI (unless beta blockers are
contraindicated).
If STEMI is present, the decision must be made
quickly as to whether the patient should be treated
with thrombolysis or with primary percutaneous
coronary intervention (PCI).
An MI requires immediate medical attention.
Treatment attempts to salvage as much
myocardium as possible and to prevent further
complications. Oxygen aspirin, and nitro-
glycerine may be administered.
Morphine was classically used if Nitroglycerin
was not effective.
Nursing management:
 Assess patient condition
 Monitor vital signs and ECG carefully
 Administer analgesics as ordered.
 Organize patient care and activities to allow
periods of uninterrupted rest.

11.  Provide a clear liquid
diet until nausea subsides.
 Provide stool softener to prevent straining
during defecation.
 Assist with range of motion exercises.
 Provide emotional support, and help reduce
stress and anxiety.
 Assess and record the patient’s severity,
location, type, and duration of pain.
 Check his blood pressure after giving
nitroglycerin, especially during first dose.
 Thoroughly explain the medication and
treatment regimen.
 Review dietary restriction with the patient.
 Advise the patient about appropriate responses
to new or recurrent symptoms.
 Stress the need to stop smoking.
Nursing Diagnosis forMyocardialInfarction
1. Decreased Cardiac Output related to:
changes in the frequency of heart rhythm.
2. Impaired Tissue Perfusion related to: decrease
in cardiac output.

12. 3. Ineffective Airway Clearance related to:
accumulation of secretions.
4. Ineffective Breathing Pattern related to:
lung development is not optimal.
5. Impaired Gas Exchange related to:
pulmonary oedema.
6. Acute Pain relate to: Increase in lactic acid.
7. Fluid Volume Excess related to: retention of
sodium and water.
8. Imbalanced Nutrition, Less Than Body
Requirements related to: Inadequate intake.
9. Activity Intolerance relate to:
imbalance between myocardial oxygen supply and
needs.
10. Self-Care Deficit related to: physical
weakness.

13. Summary and conclusion:
Myocardial infarction, commonly known as a
heart attack, is the irreversible necrosis of heart
muscle secondary to prolonged ischemia. This
usually results from an imbalance in oxygen
supply and demand, which is most often caused by
plaque rupture with thrombus formation in a
coronary vessel, resulting in an acute reduction of
blood supply to a portion of the myocardium.

14. Bibliography:
Book references:
Medical and surgical nursing, Joyce.M.Black;
volume-2; 7th edition; page no:-1543-1546
Medical and surgical nursing; Brunner siddarth;
volume-2; 12th edition; page no:-1629-1637.
Medical and surgical nursing; Lewis; volume-1; 7th
edition; page no:-659-664.