A myocardial infarction (MI), or heart attack, occurs when blood flow to the heart is reduced or blocked, damaging the heart muscle. It is usually caused by a buildup of plaque in the coronary arteries that ruptures, forming a blood clot. Risk factors include older age, smoking, high cholesterol, diabetes, high blood pressure, obesity, and lack of exercise. Treatment depends on whether it is an ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI), but generally involves unblocking arteries, reducing clots and ischemia, and modifying risk factors to prevent future heart attacks. Nursing care focuses on relieving symptoms, preventing further damage, maintaining perfusion and function, educating the

1. MI
Presented By:
Mr. Pradeepsingh B
Asst. Professor
HOD OF Medical - Surgical Nursing

2. Definition
• A myocardial infarction (MI), commonly known as a heart attack,
occurs when blood flow decreases or stops to the coronary artery of
the heart, causing damage to the heart muscle.
• A myocardial infarction occurs when an atherosclerotic plaque slowly
builds up in the inner lining of a coronary artery and then suddenly
ruptures, causing catastrophic thrombus formation, totally occluding
the artery and preventing blood flow downstream

4. Causes/risk factors
• older age
• coronary artery disease high blood cholesterol
• heart failure and excessive alcohol intake.
• cardiogenic shock saturated fat
• high blood pressure Family history of ischemic heart disease
• Smoking low socioeconomic status.
• diabetes mellitus Women who use combined oral contraceptive
pills
• lack of exercise
• obesity
• poor diet

5. CAD

6. • In 2015, CAD affected 110 million people and resulted in 8.9 million
deaths.It makes up 15.6% of all deaths, making it the most common
cause of death globally.

8. Clinical features
• Chest pain may be accompanied by sweating.
• nausea or vomiting
• fainting
• shortness of breath, weakness, and fatigue
• palpitations, back pain,
• Women with heart attacks also had more indigestion, dizziness,
loss of appetite, and loss of consciousness.[38] Shortness of
breath is a common.

9. • breathlessness arising either from low oxygen in the blood
• pulmonary edema
• Other less common symptoms include weakness, light-
headedness, palpitations, and abnormalities in heart
rate or blood pressure.

10. Diagnostic Evaluation
• Criteria:
• A myocardial infarction, according to current consensus, is
defined by elevated cardiac biomarkers with a rising or falling
trend and at least one of the following:
• Symptoms relating to ischemia
• Changes on an electrocardiogram (ECG), such as ST
segment changes, new left bundle branch block, or
pathologic Q waves
• Changes in the motion of the heart wall on imaging.
• Demonstration of a thrombus on angiogram or at autopsy.

11. Types:
• AMI: Acute MI
• CMI: Chronic MI
• IWMI: Infireior wall MI
• PMI: Postririor MI
• ALMI: Antriolateral MI
• A myocardial infarction is usually clinically classified as an
• ST-elevation MI (STEMI) or a non-ST elevation MI (NSTEMI).

12. • Cardiac biomarkers:Troponins I & T
• CK-MB: CK-MB is not as specific as troponins for acute
myocardial injury, and may be elevated with past cardiac
surgery, inflammation or electrical cardioversion; it rises within
4–8 hours and returns to normal within 2–3 days.
• Myoglobin
• Electrocardiogram:Electrocardiograms (ECGs) are a series of
leads placed on a person's chest that measure electrical activity
associated with contraction of the heart muscle.The taking of an
ECG is an important part of the workup of an AMI,and ECGs
are often not just taken once but may be repeated over minutes
to hours, or in response to changes in signs or symptoms.

13. • In addition to a rise in biomarkers, a rise in the ST segment,
changes in the shape or flipping of T waves, new Q waves, or a
new left bundle branch block can be used to diagnose an AMI.
• In addition, ST elevation can be used to diagnose an ST
segment myocardial infarction (STEMI).

16. Imaging
• Tests such as chest X-rays can be used to explore and exclude
alternate causes of a person's symptoms.
• Tests such as stress echocardiography and myocardial
perfusion imaging can confirm a diagnosis when a person's
history
• Echocardiography, an ultrasound scan of the heart, is able to
visualize the heart, its size, shape, and any abnormal motion of
the heart walls as they beat that may indicate a myocardial
infarction.

17. Angiogram
• Primary percutaneous coronary intervention (PCI) is the
treatment of choice for STEMI if it can be performed in a timely
manner, ideally within 90–120 minutes of contact with a medical
provider. Some recommend it is also done in NSTEMI within 1–
3 days, particularly when considered high-risk.
• PCI involves small probes, inserted through peripheral blood
vessels such as the femoral artery or radial artery into the blood
vessels of the heart. The probes are then used to identify and
clear blockages using small balloons, which are dragged
through the blocked segment, dragging away the clot, or the
insertion of stents.

19. Medical Management
• Aspirin is continued indefinitely, as well as another antiplatelet agent
such as clopidogrel or ticagrelor ("dual antiplatelet therapy" or DAPT)
for up to twelve months.
• Beta blocker therapy such as metoprolol or carvedilol is
recommended to be started within 24 hours, provided there is no
acute heart failure or heart block.
• ACE inhibitor therapy should be started within 24 hours, and
continued indefinitely at the highest tolerated dose. This is provided
there is no evidence of worsening kidney failure, high potassium, low
blood pressure, or known narrowing of the renal arteries.[73] Those
who cannot tolerate ACE inhibitors may be treated with
an angiotensin II receptor antagonist.

20. • A myocardial infarction requires immediate medical attention.
Treatment aims to preserve as much heart muscle as possible,
and to prevent further complications.
• Treatment depends on whether the myocardial infarction is a
STEMI or NSTEMI. Treatment in general aims to unblock blood
vessels, reduce blood clot enlargement, reduce ischemia, and
modify risk factors with the aim of preventing future MIs.
• The pain associated with myocardial infarction is often treated
with nitroglycerin, a vasodilator, or opioid medications such
as morphine.
• Nitroglycerin (given under the tongue or injected into a vein)
may improve blood supply to the heart.

21. Antithrombotics
• Aspirin, an antiplatelet drug, is given as a loading dose to
reduce the clot size and reduce further clotting in the affected
artery.It is known to decrease mortality associated with acute
myocardial infarction by at least 50%.

22. Fibrinolysis
• If PCI cannot be performed within 90 to 120 minutes in STEMI
then fibrinolysis, preferably within 30 minutes of arrival to
hospital, is recommended.
• Thrombolysis involves the administration of medication that
activates the enzymes that normally dissolve blood clots. These
medications include tissue plasminogen acti
• vator, reteplase, streptokinase, and tenecteplase.
• Thrombolysis is not recommended in a number of situations,
particularly when associated with a high risk of bleeding or the
potential for problematic bleeding, such as active bleeding,
past strokes or bleeds into the brain, or severe hypertension.

23. Coronary artery bypass grafting(CABG)

28. • Coronary artery bypass surgery, also known as coronary
artery bypass graft surgery, and colloquially heart
bypass or bypass surgery, is a surgical procedure to restore
normal blood flow to an obstructed coronary artery. A normal
coronary artery transports blood to the heart muscle itself, not
through the main circulatory system.
• There are two main approaches. In one, the left internal thoracic
artery, LITA (also called left internal mammary artery, LIMA) is
diverted to the left anterior descending branch of the left
coronary artery. In this method, the artery is "pedicled" which
means it is not detached from the origin. In the other, a great
saphenous vein is removed from a leg; one end is attached to
the aorta or one of its major branches, and the other end is
attached to the obstructed artery immediately after the
obstruction to restore blood flow.

29. Cardiac rehabilitation
• Cardiac rehabilitation (CR) is defined by the World Health
Organization (WHO) as "The sum of activity and interventions
required to ensure the best possible physical, mental, and social
conditions so that patients with chronic or post-acute cardiovascular
disease may, by their own efforts, preserve or resume their proper
place in society and lead an active life.“
• Cardiac rehabilitation benefits many who have experienced
myocardial infarction,even if there has been substantial heart
damage and resultant left ventricular failure. It should start soon after
discharge from the hospital. The program may include lifestyle
advice, exercise, social support, as well as recommendations about
driving, flying, sports participation, stress management, and sexual
intercourse.

30. Prevention
• Primary prevention:
• Lifestyle:Physical activity can reduce the risk of cardiovascular
disease, and people at risk are advised to engage in 150 minutes of
moderate or 75 minutes of vigorous-intensity aerobic exercise a
week. Keeping a healthy weight, drinking alcohol within the
recommended limits, and quitting smoking reduce the risk of
cardiovascular disease.
• Secondary prevention:There is a large crossover between the lifestyle and
activity recommendations to prevent a myocardial infarction, and those
that may be adopted as secondary prevention after an initial myocardial
infarct.[73] Recommendations include stopping smoking, a gradual return to
exercise, eating a healthy diet, low in saturated fat and low in cholesterol,
and drinking alcohol within recommended limits, exercising, and trying to
achieve a healthy weight.

31. Complication of MI
• Atrial fibrillation: Atrial fibrillation (AF or A-fib) is an abnormal heart
rhythm (arrhythmia) characterized by rapid and irregular beating of
the atrial chambers of the heart.
• ventricular tachycardia:Ventricular tachycardia (V-tach or VT) is
a fast heart rate arising from the lower chambers of the heart.
• heart block:Heart block (HB) is a disorder in the heart's rhythm due
to a fault in the natural pacemaker.[2] This is caused by an obstruction
– a block – in the electrical conduction system of the heart.
• Stroke :A stroke is a medical condition in which poor blood flow to
the brain causes cell death.
• Cardiogenic shock :Cardiogenic shock (CS) is a medical emergency
resulting from inadequate blood flow due to the dysfunction of the
ventricles of the heart.

32. • pericarditis :Pericarditis is inflammation of the pericardium, the
fibrous sac surrounding the heart.

33. Nursing Management
• Based on the clinical manifestations, history, and diagnostic
assessment data, major nursing diagnoses may include.
• Ineffective cardiac tissue perfusion related to reduced coronary
blood flow.
• Risk for ineffective peripheral tissue perfusion related to decreased
cardiac output from left ventricular dysfunction.
• Deficient knowledge related to post-MI self-care.

34. Planning & Goals
• To establish a plan of care, the focus should be on the following:
• Relief of pain or ischemic signs and symptoms.
• Prevention of myocardial damage.
• Absence of respiratory dysfunction.
• Maintenance or attainment of adequate tissue perfusion.
• Reduced anxiety.
• Absence or early detection of complications.
• Chest pain absent/controlled.
• Heart rate/rhythm sufficient to sustain adequate cardiac output/tissue
perfusion.
• Achievement of activity level sufficient for basic self-care.
• Anxiety reduced/managed.
• Disease process, treatment plan, and prognosis understood.
• Plan in place to meet needs after discharge.

35. Nursing Interventions
• ursing interventions should be anchored on the goals in the nursing
care plan.
• Administer oxygen along with medication therapy to assist with relief
of symptoms.
• Encourage bed rest with the back rest elevated to help decrease chest
discomfort and dyspnea.
• Encourage changing of positions frequently to help keep fluid from
pooling in the bases of the lungs.
• Check skin temperature and peripheral pulses frequently to monitor
tissue perfusion.
• Provide information in an honest and supportive manner.
• Monitor the patient closely for changes in cardiac rate and rhythm,
heart sounds, blood pressure, chest pain, respiratory status, urinary
output, changes in skin color, and laboratory values.