The document discusses myocardial infarction (MI), defining it as a severe decrease in oxygen supply to the heart, leading to tissue necrosis. It details the causes, clinical classifications, pathophysiology, manifestations, diagnostic evaluations, and treatments for MI, including both medical and surgical options. Additionally, it lists nursing diagnoses related to the management of patients experiencing MI.

1. MYOCARDIAL INFARCTION
Presented by : Heena Shastri
Msc nursing

2. Objectives
 To Define The Myocardial Infarction .
 To Explain The Causes Of Myocardial Infarction .
 To Explain the Clinical classification of Myocardial Infarction
 To Explain The Pathophysiology Of Myocardial Infarction .
 To List Out The Clinical Manifestation Of Myocardial Infarction .
 To Explain The Diagnostic Evaluation Of Myocardial Infarction .
 To List Out The Medical Treatment Of Myocardial Infarction .
 To Explain The Surgical Treatment Of Myocardial Infarction .
 To List Out The Nursing Diagnosis Of Myocardial Infarction .

3. Infarction
 Obstruction of the blood supply to an organ or
region of tissue, typically by a thrombus causing
local death of the tissue

4. Definition
 MI refers to a dynamic process by which one or more
regions of the heart experience a severe and
prolonged decrease in oxygen supply because of
insufficient coronary blood flow; subsequently,
necrosis or to the myocardial tissue occurs.

5. Causes
Vasospasm and constriction of coronary
artery.
Decreased blood flow and less oxygen
supply to myocardium.
Psychological stress
 Acute severe infections such as pneumonia can
trigger myocardial infarction

6. Clinical classification
 Type 1- Spontaneous myocardial infarction related to
ischemia caused by primary coronary events, such as plaque
formation are fissuring or ruptures
 Type 2 – MI secondary to ischemia from an imbalance
between oxygen demand and supply, such as coronary spasm.
 Type 3 – Sudden, unexpected cardiac death before blood
samples for biomarkers could be drawn or before their
appearance in the circulation.
 Type 4- MI associated with primary percutaneous coronary
intervention.
 Type 5 – MI associated with coronary artery bypass graft

7. Pathophysiology
Due to etiological factors
Arterial spasm
Sudden irreversible obstruction
Ischemia
Hypoxia
Angina
Necrosis (Gradually )
MI

8. Clinical manifestation
 Chest pain
 Severe, steady substernal pain
 Not relieved by rest or sublingual vasodilator therapy, but requires
opioids
 May radiate to the arms (usually the left), shoulders, neck, back, and/or
jaw
 Continues for more than 15 minutes
 May produce anxiety and fear, resulting in an increase in heart rate, BP,
and respiratory rate
 Hypertension or hypotension
 severe anxiety, breathing difficulty
 Disorientation, confusion, restlessness
 weakness
 Nausea, vomiting

10. Diagnostic evaluation
 Patient history
 ECG
 Angiography
 Elevated white blood cell (WBC) count and
sedimentation rate due to the inflammatory process
involved in heart muscle cell damage

11. Medical management
Oxygen therapy
Analgesic therapy
 Morphine is used to relieve pain, to improve cardiac homodynamic
by reducing preload and after load, and to provide anxiety relief.
Vasodilator therapy- nitric oxide
 NTG promotes venous and arterial relaxation and prevent coronary
artery spasm
Calcium channel blockers-amlodipine , felodipine
 Improve the balance between oxygen supply and demand by
decreasing hearts rate, blood pressure and dilating coronary vessels.
Anticoagulant therapy
 Heparin is useful as an adjunct to thrombolytic therapy.

12. Surgical management
 CABG
 Percutaneous Transluminal Coronary Angioplasty
(PTCA)
 Coronary stent
 Atherectomy
 Is a minimally invasive endovascular surgery
technique for removing atherosclerosis from blood
vessels within the body

13. Nursing diagnosis
 Acute chest pain related to imbalance between oxygen supply and
demand secondary to reduced coronary blood flow.
 Decreased cardiac output related to impaired contractility.
 Anxiety related to chest pain, fear of death, threatening
environment.
 Activity intolerance related to an imbalance between oxygen supply
and demand
 Impaired gas exchange related to ineffective breathing pattern.
 Risk for Ineffective coping related to threats to self-esteem,
disruption of sleep-rest pattern, lack of significant support system
and loss of control.
 Disturbed sleep pattern related to pain and stressful environment.
 Knowledge deficiency related to treatment modalities as evidenced
by frequently asking question.

14. Thank you