This is a topic of MSN 1 from the unit of cardiovascular system myocardial infraction contents:- definition, classification etiology and risk factor pathophysiology clinical menifestation diagnostic evaluation medical management surgical management nursing management health educaton other topic i have share are pacemaker etc.

1. MYOCADIAL INFARCTION
Department of medical surgical nursing
Department of medical surgical
nursing
SRMM college of nursing
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2. LEARNING OBJECTIVES
At the end of the class students will be able to:-
 Define MI.
 Enumerate the causes of MI.
 Explain about the pathophysiology of MI.
 Enlist the clinical manifestations of MI.
 Enumerate the diagnostic evaluation of MI.
 Explain the management of MI.
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3. DEFINITION:-
“Acute myocardial infarction also heart attack,
coronary occlusion, or simply a “ coronary”, is a
life-threatening condition characterized by the
formation of localized necrotic area within the
myocardium”.
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4. • Myocardial infarction is a life- threatening
condition characterized by the formation of
localized necrotic areas within the
myocardium.
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5. Classification
1. ST elevation MI (STEMI) – complete
blockage
2.Non-ST elevation MI (NSTEMI) – partial
blockage
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6. ETIOLOGY AND RISK
Internal factors :-
Include plaque characteristics such as the
• consistency of the core
• thickness of the fibrous cap as will condition to which it
is exposed, such as coagulation status and degree of
arterial vasoconstriction
• . High serum cholestrerol
• triglyceride, LDL
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7. External factors :-
External condition that affect client strenuous
physical activity and severe emotional stress,
such as a anger, symptomatic activity that in
turn increases hemodynamic stress that may
led to plaque rupture at the some time,
systematic activity increases myocardial
oxygen demand.
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8. Risk factor-
• Blood pressure,
• Diabetes,
• Obesity,
• Age >45years,
• Smoking,
• Family history,
• ,Lack of physical activity,
• Drugs (cocaine),
• Preeclampsia and eclampsia 8

9. pathophysiology
• Due to etiological factors  Reduced blood
and oxygen supply  Low ATP and High
lactic acid Acidosis Reduced left ventricle
contraction Reduced myocardial
perfusionRaise in myocardial oxygen
demandNecrosis of tissue Myocardial
infarction
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10. CLINICAL MANIFASTATIONS :-
1) Chest pain
• Severe, diffuse steady substernal pain of
crushing squeezing in nature.
• Not relieved by rest or sublingual vasodilator
therapy, but requires opioids.
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11. Ct---CLINICAL MANIFASTATIONS :-
• May radiate to the arms, shoulder, neck, back and
jaw
• Continues for more than 15 minutes.
2) May produce anxiety and fear, resulting increase
in heart rate, blood pressure, and respiratory rate,
3) Cool, clammy skin, facial pallor.
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12. Ct---CLINICAL MANIFASTATIONS
4) Hypertension or hypotension
5) Bradycardia or tachycardia.
6) Premature vantricular and atrial beats.
7) Palpitation, confusion, restlessness.
8) Disorientation, severe anxiety, dyspnea.
9) Nausea ,vomiting.
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13. 10)Atypical symptoms :- epigastric or
abdominal distress, dull aching or tingling
sensations, shortness of breath, extreme
fatigue.
DIAGNOSTIC EVALUATION:-
1)ECG Changes:-
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14. DIAGNOSTIC EVALUATION:-
• Generally occur within 2 to12 hours and but may
take 72 to 96 hours
Necrotic injured and ischemic tissue alters
vantricular depolarization and repolarization
2) Laboratory tests / serum cardiac markers
.
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15. • Cardiac troponin,
• Myoglobin,
• Creatinine Kinase-MB,
• Lactate dehydrogenase (LDH),
• Aspartate Aminotransferase (AST),
• Leukocytosis:
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16. • Imaging studies:
• a)Positron Emission Tomography (PET)
• b) Magnetic Resonance Imaging (MRI)
• c) Echocardiography
• d) Transesophageal Echocardiography:
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17. • Complications
• Dysrhythmias,
• Heart failure,
• Cardiogenic shock,
• Papillary muscle dysfunction,
• Ventricular aneurysm,
• Pericarditis,
• Dressler syndrome
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18. 18

19. MEDCIAL MANAGEMENT:-
GOAL:-
 Initiating prompt care.
 Delivering successful treatment for the acute attack
and prompt reperfusion of the myocardial.
 Reducing pain .
 Preventing complications and heart failure.
 Administer loading dose: 1. ecosprin 300mg, 2.
clopitab 300mg, atorvastin 80 mg.
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20. • STEMI
• Door to drug time within 30 minutes-
thrombolytic agents such as streptokinase
• Door to balloon time of 90 minutes-with
percutaneous coronary interventions (PCI) &
stenting
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21. • NSTEMI:
• Fibrinolytic therapy: Aspirin, Low
molecular weight heparin (LMWH),
Glycoprotein IIb/IIIa inhibitors like
abciximab
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22. DRUGS:
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23. DRUG:-
• Antiplatelet aggregrating agent -
(Acetylsalicylic acid)
• Indirect thrombin inhibitors - (Heparin)
• Glycoprotein receptor antagonists
(Abciximab)
• Thrombolytic agents - (Reteplase)
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24. • Surgical management
• 1. Coronary artery bypass graft surgery
(CABG):
• 2. Minimal invasive direct coronary artery
bypass:
• 3. Transmyocardial laser revascularization:
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25. NURSING MANAGEMENT:-
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26. Assessment
NURSING DIAGNOSIS:-
• Pain related to myocardial ischemia.
• Altered tissue perfusion related to thrombus in
coronary artery.
• Risk for injury related to cogulopathies associated
with thrombolytic therapy.
• 4)Anxiety and fear related to hospital admission and
fear to death.
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27. • Nursing management:
• Recognize and treat,
• Administer thrombolytic therapy,
• Maintain a therapeutic environment,
• Identify psychological impact of MI on patient
and family,
• Educate the patient in life style changes
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28. Health education:
• Life style modifications:
1.Avoid any activity that produces chest pain,
extreme dyspnea or undue fatigue
2.Avoid extremes of heat and cold
3.Loose weight as indicated, initially 10%
4.Stop smoking and use of tobacco
5.Stop consumption of alcohol
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29. • Diet:
1.Consume diet low in sodium and saturated fats
and cholestrol
2.Avoid large meals
3.Avoid physical activity immediately after a
meal
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30. • Teaching patient self care:
1.Adhere to medical regimen, especially in
taking medications
2.Notify if shortness of breath, fainting, slow or
rapid heartbeat, swelling of feet and ankles
occur.
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31. • Continued care:
1.Maintain BP and blood glucose levels under
control
2.Pursue activities that reduce and relieve stress
3.Walk daily increasing the distance and time
gradually
4.Monitor pulse rate during physical activities
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32. SUMMARY
In this class we discussed the :-
 Definition of MI.
 Causes of MI.
 Pathophysiology of MI.
 Clinical manifestations of MI.
 Diagnostic evaluation of MI.
 Management of MI.
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33. BIBLIOGRAPHY
• Black, J.M. & Hawks, J.H. (2009). Medical-
Surgical Nursing: Clinical Management for
Positive Outcomes (8th ed.). Philadelphia:
Elsevier/Saunders.
• Ignatavicius, D.D. & Workman, M.L. (2010).
Medical-Surgical Nursing: Patient-Centered
Collaborative Care (6th ed.). Philadelphia:
Elsevier/Saunders.
• Lewis, S.M., Dirkse, S.R., Heitkemper, M.M., &
Bucher, L. (2010). Medical-Surgical Nursing:
Assessment and Management of Clinical
Problems (7th ed.). St. Louis: Mosby.
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