Acute Myocardial Infarction (AMI), commonly known as a heart attack, occurs when blood flow to part of the heart is reduced or blocked, depriving heart muscle cells of oxygen and nutrients and leading to cell damage or death. This is usually due to a blood clot forming on a fatty buildup in the coronary arteries. Immediate treatment goals for an AMI focus on restoring blood flow through the blocked vessel to limit heart muscle damage. Management includes oxygen, aspirin, morphine, nitroglycerin, blood tests, an ECG, and reperfusion through percutaneous coronary intervention or a clot-busting drug within 12 hours when possible. Long term care focuses on lifestyle changes and controlling risk factors

1. Acute Myocardial Infarction
RN MINTU THOMAS

2. Definition
• Myocardial infarction refers to a condition
when the blood flow decreases or stops to
a part of heart which leads to ischemia
and myocardial cell damage.
• Ischemia usually occurs due to blockage
of the coronary vessels.

3. Definition contd…
• This blockage is often the result of
thrombus that is superimposed on an
ulcerated or unstable atherosclerotic
plaque formation in the coronary artery

4. Coronary Artery Anatomy

5. Coronary Artery Events

6. Coronary Artery Events
• Ischemia – Outer most area, source of
arrhythmias, viable if no further infarction.
• Injury – Viable tissue found between
ischemic and infarcted areas.
• Infarction/necrosis – Center area, dead
not viable tissue that turn into scar.

7. MI Classifications
• MI’s can be subcategorized by anatomy
and clinical diagnostic information.
Anatomic
 Transmural – infarction that involves
the whole thickness of heart muscle.
 Subendocardial – infarction that
involves the innermost layer and
parts of myocardium but does not
extend to epicardium.
Diagnostic
 ST elevation MI (STEMI)
 Non ST elevation MI (NSTEMI).

8. Risk Factors
Non Modifiable
• Age
• Gender
• Family history
Modifiable
• Smoking
• Diabetes
• Hypertension
• Hyperlipidemia
• Obesity & Physical
Inactivity

9. Pathophysiology of MI

10. Signs and Symptoms
• Chest pain/discomfort
• Hypo/hypertension
• Dyspnea
• Fatigue
• Palpitation
• Diaphoresis
• Nausea & vomiting
• Anxiety
• Insomnia

11. Cardiovascular Changes
• Initially the BP and pulse may be elevated.
• Later, BP will drop due to decreased
cardiac output.
• Urine output will decrease
• Lung sounds will change to crackles
• Jugular veinous distention

12. Diagnosis
1.Clinical features:
Pain
Signs of decreased cardiac output
Signs of sympathetic activation

13. Diagnosis contd…
2. Serum cardiac
markers: Troponin ,
CKMB/CK ratio, LDH
3. ECG changes:
 T wave inversion
 ST segment elevation
 Appearance of wide
deep Q wave

14. Localization of MI on ECG
The changes of ischemia , injury or infarction are
seen in the leads overlying the area involved.

15. Diagnosis contd..
4. Echocardiogram
5.Chest Xray
6.Angiography

16. Complications of MI
Arrhythmias
Cardiogenic Shock
Congestive Heart Failure
Cardiac Tamponade
Pericarditis
Thromboembolism
Recurrent Infarction

17. Managementof MI
The immediate goal for any acute myocardial
infarction is to restore normal coronary blood
flow to vessels and salvage myocardium
Mnemonic for the management of MI
M – Morphine
O – Oxygen Therapy
N – Nitroglycerine
A – Aspirin

18. Management of MI Contd…
Within the first 10 minutes upon arrival to
the hospital:
• Check vital signs and evaluate oxygen
saturation
• Obtain and review 12-lead ECG
• Take a brief focused history and perform a
physical examination
• Establish IV access
• Obtain blood samples to evaluate initial cardiac
markers, electrolytes and coagulation

19. Management of MI contd…
Treatment options for MI:
Reperfusion as soon as possible(within
12hours of onset of symptoms)
Antiplatelet therapy(aspirin , clopidogrel +/-
Glycoprotein iib/iiia inhibitors)
Anticoagulants (unfractionated heparin or
LMWH)
Immediate PCI or Fibrinolytic therapy –
PCI has higher reperfusion rate and is better
if patient present >1hr but thrombolysis is
gold standard if patient arrives within 1hr

20. Management for MI contd…
 Subsequent management of MI:
 Aspirin and clopidogrel, statins, ACE inhibitors,
Betablockers
 Anticoagulation therapy to prevent
thromboembolism
 Nitrates as needed
 Cardiac rehabilitation
 Antiplatelet therapy post stent:
 Aspirin for life
 Clopidogrel for the recommended period

21. Long Term Care
• Lifestyle modifications.
• Healthy eating.
• Maintaining blood pressure ,blood sugar and
cholesterol under control.
• Smoking cessation