Myocardial infraction Introduction Definition Types Etiology/Risk factor Pathophysiology Clinical manifestation Diagnostic evaluation Management Nursing Diagnosis Complications

2.  Introduction
 Definition
 Types
 Etiology/Risk factor
 Pathophysiology
 Clinical manifestation
 Diagnostic evaluation
 Management
 Nursing Diagnosis
 Complications

3. MI refers to process by which myocardial tissues are
permanently destroyed in the region of the heart that
are deprived of an adequate supply of blood because
of a reduced coronary blood flow; subsequently
necrosis or death to the myocardial tissue occurs
OR
MI is defined as a diseased condition which is caused by
reduced blood flow in a coronary artery due to
atherosclerosis & occlusion of an artery by an
embolus or thrombus.
OR
MI is irreversible damage of myocardial tissue by
prolonged ischemia and hypoxia.

6. According to
anatomic region
of left ventricle
•Anterior
•Posterior
•Lateral
•Septal
•Circumferential
•Combination-
Anterolateral,
Posterolateral,
Anteroseptal
According to
degree of
thickness of
ventricular wall
involved
•Transmural (Full
thickness)
•Laminar
(Subendocardial)
According to age
of infarcts
•Newly formed
(Acute, Recent,
Fresh)
•Advanced infarcts
(Old, Healed,
Organised)

7.  Reduced blood flow in a coronary artery due to
atherosclerosis (Increased oxygen demand &
decreased oxygen supply)
 Complete occlusion of artery by an embolus or
thrombus
 Sudden narrowing of coronary artery
 Acute blood loss (Anemia)
 Hypertension
 DM

8. MODIFYING FACTOR
NON-MODIFYING
FACTOR
 Hyperlipidemia
 Smoking
 Hypertension
 Diabetes mellitus
 Physical inactivity
 Obesity
 Stress
 Lack of estrogen in
women
 Age
 Family history of
coronary artery disease
 Gender
 Chronic kidney disease

9. Due to etiology
Cholestrol deposition within the wall of the main coronary artery
The deposited cholestrol ultimately forms a pleque in the wall of the artery called atherosclerotic
plaque
Atherosclerotic plaque formation is a long term process, required may years to establish
Sometimes plaque will rapture
It leads to activate clotting mechanism so Platelet aggregation and Fibrin deposition
Formation of occlusive thrombus in a Coronary artery
This occlusive thrombus completely block a coronary artery and interrupts blood supply to part
of the Myocardium
Lead to irreversible change & death of myocardial cells

10. Due to etiological factors
Atherosclerosis
Obstruction
Ischemia
Hypoxia
Thrombus fomation
Permanent thrombus
Necrosis
Myocardial Infarction

11.  Chest pain
 Patient may anxious &
restlessness
 Heart rate &
Respiratory rate may be
faster than Normal
 Dyspnea
 Fatigue
 Increased sweating
 Weakness
 Nausea
 Vomitting
 Light headacheness
 Palpitation
 Hypertension or
Hypotension
 Arrhythmia
 Disorientation,
Confusion, Syncope
 Low grade fever
 Decreased cardiac
contractility & cardiac
output

12.  Patient History
 Physical examination
 ECG
(Electrocardiogram)
 Angiography
 Magnetic Resonance
Imaging (MRI)
 Positron emission
tomography (PET
Scan)
 Chest X-ray
 Cardiac Enzyme Test
 Creatinine
phosphokinase (CPK)
 Lactic dehydrogenase
(LDH)
 Cardiac specific
troponins (cTn)
 Other finding
 Elevated WBC count
 Elevated Myoglobin

14.  Counselling & education of patient
 Lifestyle modification
 Avoid smoking
 Avoid alcohol intake
 Balanced diet & Nutrition
 Salt restriction

15.  Thrombolytic agent (Ex-Urokinase, Streptokinase) which are used to
dissolve clots & allow blood flow
 Anticoagulants (Ex-Heparin)
Anticoagulants are useful as an adjunct to thrombolytic therapy
 Antiplatelet agent (Ex-Aspirin)
Antiplatelets are medicines that stop cells in the blood (platelets) from
sticking together and forming a clot.
 Antihypertensive drugs (Ex-Captopril, Monopril) Antihypertensives are
a class of drugs that are used to treat hypertension
 Lipid Lowering Drugs (Ex- Lovastatin) These agents lowering the lipid
in blood.(Fat, Cholestrol)
 Vasodilators (Ex-Nitroglycerin) These agents promotes venous &
relaxation & prevents coronary artery spasm
 Others
 Analgesics (Ex-Morphine)
 Antidepressant drugs (Ex-Imipramine)

17. Coronary artery bypass surgery
A form of bypass surgery that can create new routes around
narrowed and blocked coronary arteries, permitting increased
blood flow to deliver oxygen and nutrients to the heart muscle.
CABG surgery is one of the most commonly performed major
operations

18. Percutaneous Transluminar
Coronary Angioplasty
Percutaneous transluminal coronary angioplasty (PTCA) also called
percutaneous coronary intervention (PCI) is a minimally invasive
procedure to open blocked or stenosed coronary arteries allowing
unobstructed blood flow to the myocardium.

19. Coronary Stent
A coronary stent is a
tube-shaped device
placed in the
coronary arteries
that supply blood
to the heart, to keep
the arteries open in
the treatment of
coronary heart
disease.

20. Atherectomy
An atherectomy is a
procedure that utilizes a
catheter with a sharp
blade on the end to
remove plaque from a
blood vessel. The
catheter is inserted into
the artery through a small
puncture in the artery,
and it is performed under
local anesthesia

21.  Arrhythmia
 Cardiogenic shock
 Congestive heart failure
 Thromboembolism
 Rupture
 Cardiac aneurism
 pericardiatis

22. Chest pain r/t imbalance b/w oxygen supply and
secondary to reduced coronary blood flow- Myocardial
ischemia.
Altered cardiac & peripheral tissue perfusion r/t
reduced coronary blood flow from coronary thrombus &
atherosclerosis
Decreased cardiac output r/t decreased cardiac
contractility due to cardiac rupture
Impaired gas exchange r/t ineffective breathing pattern
Activity intolerance r/t fatigue secondary to
oxygenation
Anxiety r/t chest pain, tachycardia & Hypoxia