A 49-year-old male presented with chest pain, heaviness, and shortness of breath. He has a history of smoking, diabetes, and hypertension. An ECG showed ST elevation indicating an anteroseptal myocardial infarction. He was diagnosed with a myocardial infarction involving the area between the left and right ventricles. His condition was poor so he was prepared for primary percutaneous coronary intervention to open the blocked artery within half an hour.

1. CASE PRESENTATION ON
MYOCARDIAL
INFARCTION

2. PATIENT PROFILE
Name : Shakeel Ahmed
Age/Sex: 49 years/Male
Education: Illiterate
Religion: Muslim
Marital status: Married
Date of admission: 2019-11-07
IP.NO: 1702100357
Diagnosis: Myocardial Infarction ( anteroseptal)

3. Case Summary
A 49 years old Male patient presented in emergency
department with complain of chest pain ( radiate to back
and left arm), chest heaviness and shortness of breath. The
pain began 2 hours ago and more severe after half an hour
of taking food.
Patient has chronic smoker with past medical history of
diabetes mellitus and hypertension non- compliance to
medicine for the past 15 years.
In ECG ST elevation show in lead V1+V2+V3+ V4.
Medical diagnosed anterioroseptal wall MI. patient general
condition was poor.
plan was patient prepare for primary PCI ( percutaneous
coronary Intervention) and shifted in cath lab within half an
hour.

4. DEFINATION
Myocardial infraction is a heart problem where partialor complete
occlusiononeor more of thecoronaryarterydue toan atheroma,
thrombus orembolismresultingincelldeath ( infarct)of theheart
muscles.
In this case tissue damage is around the anteroseptal wall , the
area between the left and right ventricles.
Arthur S. Schneider

5. Pathophysiology

6. Risk factors
• The main cause of mayocardial infarction is atherscleosis
(90%).
• Smoking
• Diabetes mellitus
• Hypertension
• High-cholestrol diet
• Family history of heart disease
• Obesity
• Stress or anger
• Sex (Male > Female)
• Age (Male 45 and Female 55 years)

7. Sign & Symptoms
• Angina most important sign of mayocardial infarction
(Stable angina) => chest pain on exertion.
(Unstable Angina) => chest pain at rest.
• Severe Chest pain in substernal area, radiate to back, left
arm, neck, jaw and shoulder.
• Shortness of breath
• Hypertension
• Tachycardia
• Perspiration
• Nausea and vomiting
• Fatigue and dizziness

8.  Present illness
Mr. Shakeel Ahmed was apparently well 1 hour back , then he
sudden developed the central chest pain radiating to the left arm and
back. He had an episode of vomiting non projectile in nature, no
any blood composition. He also developed the history of shortness
of breathe.
 Past history
History of diabetes mellitus and hypertension from 15 years
 Family history
History of father having ischemic heart disease.
 Personal history
Smoker, smoke 12 sticks per day from 15 years.
History Collection

9. Physical Assessment
 Neurological system
 Level of consciousness (Oriented to
time, place, person.
 Slurred speech
 Deeping of snoring sound
 Cardiovascular system
 Chest pain ( COLDERA )
 Heart rate (tachycardia or
bradycardia)
 Abnormal heart sound S3 ( sign of
ventricle failure ).
 Heart murmur
 Blood pressure ( vasodilation,
decrease B.P )
 Peripheral pulses ( blood flow to
extremities).
 Respiratory system
 Tachypnea or bradypnea
 Shortness of breath
 Wheezing or Crackles
 Gastrointestinal system
 Tenderness
 Bowel sound ( hyper or hypo
active ).
 Genitourinary
 Decrease urine output ( sign of
shock)
 Urine COCA

10. Investigation
 CBC => (Complete blood picture)
HB=14.2mg/DL, WBC= 13.4/L, PLT= 225000/L
 UCE => (urea, creatinine, electrolytes)
UREA= 36mg/dl, CREAT, 0.9mg/dl, NA= 133mEq/dl, K=
4.4mEq/dl, CL= 104mEq/dl
 PT/INR=> ( Prothrombin time)
PT COUNT= 10.5sec, INR 1.1
 TOPONIN I=> 35
ECG changes=> ST- elevation V1+V2+V3+V4

11. MEDICAL MANAGMENT
 ECG monitoring
 Sedatives ( Nalbuphine 5-10mg intravenous).
 Oxygen theraphy
 Beta blockers ( propanolol , esmolol, labetolol)
 Antiplatelete therapy :- aspirin 75mg, clopidegrel 75-300 mg
 Anticoagulants ( heparin 5000 units intravenous)
 Thrombolytic therapy (streptokinase)
Apply MONA protocol
• M= morphine
• O = oxygen
• N = nitrates
• A = aspirin

12. NURSING MANAGMENT
1. Assess the level of pain (COLDERA).
2. Given comfortable position to the patient to reduce chest pain or
dyspnea.
3. Administered oxygen to reduce Pain associated with low level of
circulating oxygen.
4. Attached cardiac monitor and monitor vital sign every 2.3 seconds.
5. Maintain double I.V line and follow MONA protocol as per doctor
advice.
6. Assess the level of consciousness.
7. Assess heart sound S3 Can be early sign of ventricular failure assess
lung sound as sound as frequent interval, crackles sound is early sign
of ventricular failure.
8. Assess heart and rhythm, dysarrthmias May indicate Not enough
oxygen to the myocardium.
9. Observe blood pressure and prevent patient from hypotension.
10. Observe urinary output and check for edema is an early sign of
carcinogenic shock (Hypotension with oliguria).
11. Observe and prevent patient from complication.
12. Prepared patient within half hour and shifted in catch lab for PPCI.

13. NURSING DIAGNOSIS
1. Acute pain related to tissue ischemia as evidenced by patient
reporting of chest pain, facial grimacing.
2. Decreased cardiac output related to changes in myocardial
contractility.
3. Impaired gas exchanges related to interruption of blood flow to
pulmonary alveoli.
4. Imbalanced nutrition less than the body requirements related to
inadequate intake, anorexia.
5. Activity intolerance related to imbalance between myocardial
oxygen supply and needs
6. Anxiety related to hospitalization and fear of death
7. Risk of ineffective tissue perfusion related to reduction of blood
flow

14. COMPLICATION
• Dysarrthmias
• Cardiogenic shock
• Pericarditis
• Ventricular aneurysm
• Congestive heart failure
• Mayocardial rupture

15. REFRENCES
 Kluwer, W. (2012). In pathophysiology made incredibly
visual (pp. 21-22). J. Christopher Burghardt.
 schneider, A. S. (2009). pathophysiology.
 www.webhealthcentre.com/Diseasecondition/heart.aspx
 https://www.vardiosmart.org/heart-
conditions/guidlines/sihd