Shows how Hypertension affects day to day life.

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Myocardial infarction (MI) refers to the process by
which areas of myocardial cells in the heart are
permanently destroyed. It occurs when myocardial
tissues are abruptly and severely deprived of oxygen.

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• Define and understand the epidemiology of MI’s
and how they are classified.
• Will be able to identify the risk factors associated
with MI’s.
• Will be able to recognize signs and symptoms of
MI and what the appropriate interventions are.
• Understand the treatment options available to
treat MI.
• Nursing responsibilities.
• Follow up care.

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Myocardial infarction is a disease
condition which is caused by
reduced blood flow in a coronary
artery due to atherosclerosis and
occlusion of an artery by an
embolus or thrombus.

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1. Non-Modifiable Risk factors:
• AGE: More than 40 years.
• FAMILY HISTORY: Myocardial infarction can be inherited
from parents to children.
• GENDER: Myocardial infarction is 3 times more in men
than women.

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2. Modifiable Risk Factors

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→ Myocardial Infarction

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1. Chest Pain:
Chest pain due to a lack of blood and oxygen supply of the heart
muscle.
• Characteristics: Severe, immobilizing chest pain.
• Usually prescribed as heaviness, pressure, tightness, burning.
• Location: Substernal, Retrosternal or Epigastric.
• Radiation: It may radiate to neck, jaw, arm or back.
• Duration: Lasts for 20 minutes or more.

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2. Cardiovascular: BP and pulse may be elevated.
3. Respiratory: Shortness of breath, Dyspnea, Pulmonary Edema.
4. Gastro Intestinal: Nausea, Vomiting.
5. Fever: Inflimatory Process caused by Myocardial cell death.
6. Skin: Cold, Clammy skin, Pallo, Cyanosis.
7. Genitourinary: Oliguria.
8. Neurogenic: Headache, visual Disturbances, Altered Speech.
9. Psychosocial: Fear feeling.
.

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ASSESSMENT/DIAGNOSTIC FINDINGS:
It is generally based on presenting symptoms, ECG and
laboratory test results.
• Patient history-it includes
• Description of presenting symptoms
• History of previous illness, family health history

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Electrocardiogram:
ECG provides information that assists in diagnosing acute
MI.
The classic ECG changes are-
• ST segment elevation
• ST depression
• T wave inversion
• Abnormal Q wave

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RECOGNITION OF ECG TIPS
REMEMEBER - SALI
• S-SEPTAL MI-V1 V2
• A-ANTERIOR WALL MI-V3 V4
• L-LATERAL WALL MI -V5 V6-1-AVL
• I-INFERIOR WALL MI- 11-111-AVF
• POSTERIOR WALL MI- ST↓ V1-V3,ST↑ V7-V9

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• CK-MB- increases 3-6 hrs after onset of chest pain, peaks in 12-18 hrs & return
to normal within 3-4 days.
• Cardiac troponin T- increases 4-6 hrs after MI & persists for 2 weeks
• Full blood count: WBC (white blood cell) count is usually elevated. ESR
(Erythrocyte sedimentation rate) and CRP (C-reactive protein) may also
elevate.
• CHEST X-RAY To detect cardiomegaly.
• Ecocardiogram: Assess Ability of heart muscle to contract and relax.
• CT & MRI: To detect site and extent of myocardial cell.
• Angiography: Detect abnormalities including stenosis or occlusion.

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DRUG THERAPY:
• ANTIPLATELET DRUG (Decrease platelet aggregation and inhibit thrombus
formation): Aspirin, Clopidogrel
• ANALGESIC
• NITRATES: Sublingual Nitroglycerine - Nitrates act as a vasodilator and relief
pain.
• MORPHINE SULPHATE: Produces central nervous system analgesia and
produce venodilation.
• BETAADRENERGIC BLOCKERS: (Propanolol) it inhibit SNS stimulation of heart
and reduces both heart rate & contractility.

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CALCIUM CHANNEL BLOCKERS (Verapamil, Nifedipine) : It causes coronary artery vasodilatation &
decreases myocardial contractility.
ANTI COAGULATION THERAPY (prevent the formation of blood clots) LMWH-Enoxaparin, Unfractioned
Heparin.
ACE Inhibitors: These medicines lower bloodpressure and reduce the strain on your heart Eg:enalapril,
captopril
FIBRINOLYTIC THERAPY
• Time of Administration: 12 hours of onset of chest pain but for best results it should be given within 1
hr after onset of chest pain.
• ACTION: These will dissolve & do lysis of thrombus in coronary artery.
• If STEMI is present, the goal is to achieve a door- to –drug time of 30 min & a door-to – balloon time
of within 90 min. Indicated for patients with STEMI MI’s.

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Surgical Management:
Angioplasty:
PTCA(Percutaneous Transluminal Coronary Angioplasty)
CABG:
Coronary Artery Bypass Graft

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Nursing diagnosis
• Acute pain R/T myocardial ischemia resulting from coronary artery occlusion
• Outcome- the client will experience improved comfort as evidenced by dec. in pain
rating scale.
• Interventions- assess characteristics of pain
• Assess respiration, BP, heart rate with each episode of chest pain.
• Obtain 12 lead ECG on admission & on each episode of chest pain.
• Monitor respond to drug therapy.
• Limit visitors.
• As morphine as ordered.
• Administer nitrates as ordered.

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• Ineffective tissue perfusion R/T thrombus in coronary
artery
• Outcome- the client will demonstrate improved cardiac
tissue perfusion as evidenced by dec. rating of pain.
• Interventions- provide bed rest.
• Administer oxygen as prescribed.
• Administer thrombolytics.
• Monitor ST segments.

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• Dysrrhythmias R/T electrical instability or irritability secondary to infarcted tissue.
• Outcome- the client will have no dysrrythmias as evidenced by normal sinus
rhythm.
• Interventions- teach client & family about need for continous monitoring.
• Assess apical heart rate.
• Give antidysrrythmic agents as ordered.
• Monitor effects of antidysrrythmics.
• Monitor serum K levels.
• Maintain patent IV line.
• Monitor ST segments & document changes.

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• Risk for bleeding R/T coagulopathies with thrombolytic therapy.
• Powerlessness R/T a near-death experience & anticipated lifestyle
changes.
• Anxiety & fear R/T hospital admission & fear of death.
• Risk for constipation R/T bed rest, pain medications & NPO or soft
diet.
• Ineffective health maintenance R/T MI & implications for lifestyle
changes.
• Risk for activity intolerance R/T an imbalance b/w oxygen supply &
demand.

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• Proper medication compliance. (right dose and right
time) Perform exercise .
• Do not smoke .
• Follow the diet plan.
• Maintain a healthy weight .
• Manage your stress.
• Signs and symptoms to be reported to physician.

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MI is a life threatening disease caused by many factors.
Health education must be given to the patients with
predisposing or risk factors to prevent it. Early diagnosis is
also very important for saving the life of the patient.
“prevention is better than cure”

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• Mosby’s Comprehensive Review of Nursing Dolores
F.Saxton,Patricia M.Nugent.
• The Lippincott Manual of Nursing Practice
• https://en.wikipedia.org/wiki/Myocardial_infarction