1) The document discusses nursing management of patients experiencing myocardial infarction (MI or heart attack). 2) MI occurs when an area of the heart muscle is permanently damaged due to reduced blood flow in a coronary artery, usually caused by a ruptured atherosclerotic plaque blocking the artery. 3) Nursing management of MI focuses on minimizing damage to heart muscle, preserving heart function, preventing complications, and educating patients on risk factor modification and self-care post-MI.

1. NURSING MANGEMENT CLIENT
WITH MYOCARDIAL INFARCTION
(MI) HEART ATTACK
ANILKUMAR BR
LECTURER
MEDICAL-SURGICAL NURSING

2. Introduction
• MI or Heart attack are terms used anonymously,
but the preferred term is MI.
• In an MI an area of the myocardium is
permanently destroyed.
• MI is usually caused by reduced or decreased
blood flow in a coronary artery due to rupture of
an atherosclerotic plaque and subsequent
occlusion of the artery by a thromus.

3. Etiopathophysilogy
• MI refers to the processes by which myocardial tissue is
destroyed in regions of the heart that are deprived of an
adequate blood supply because of reduced coronary artery
blood flow.
• Eighty percent to 90% of all acute MI are secondary to
thrombus formation.
• When thrombus develops , perfusion to the myocardium
distal to the occlusion is halted,resulting in necrosis.

4. Continue
• The acute MI process takes time. Cardiac cells can
withstand in ischaemic conditions for approximately
20 minutes before cellular death begins.
• The earliest tissue to become ischemic is the sub
endocardium (the innermost layer of tissue in the
cardiac muscle)
• If ischemia persists,it takes approximately 4 to 6
hours for the entire thickness if the heart muscle to
become necrosed.

5. Areas of the necrosis ( white arrow)

6. Continue....
• Infractions are usually described based on
location if damage ( anterior,inferior,posterior,or
lateral wall).
• Descriptions are used to further identify an
MI:the type of MI ( ST- segment elevation
myocardial infraction STEMI and non-segment-
elevation myocardial infraction NSTEMI

7. Clinical manifestations of MI
1) CARDIOVASCULAR
• Chest pain : chest pain occurs suddenly,severe immobilizing chest pain
that not relieved by rest ,position change,and medications.
• Increased jugular venous distention
• BP may be elevated because of sympathetic stimulation or decreased BP
because of decreased contractility, development if cariogenic shock
• Decrease pulse rate
• ST- segment and T-wave changes, ECG may show tachycardia,
bradycardia, or dysrhythmias.

8. Respiratory
• Shortness of breath (SOB)
• Dyspnea, tachypnea, and crackles if MI has
caused pulmonary congestion.
• Pulmonary edema

9. Gastrointestinal or GIT
• Nausea and vomiting

10. Genitourinary
Decreased urinary output may indicate
cariogenic Shock

11. Skin
• Cool.,clammy,diaphoretic, and pale
appearance on skin

12. Neurologic symptoms
• Anxiety,restlessness,and light headness

13. Psychological
• Fear with feeling of impending doom or
patient may deny that anything is worng

14. Complications
• Dysrhythmias ( the most common complications
after an MI in 80% of MI cases.
• Acute pulmonary edema
• Heart failure
• Cariogenic shock
• Papillary muscle dysfunction
• Pericarditis and cardiac tamponade

15. Assessment and diagnostic findings
• The diagnosis of MI is generally based on the
presenting symptoms, the ECG, and laboratory
test results (e.g serial cardiac biomarke valve)

16. Patient history
• The patient history has two parts: the
description of the presenting symptoms and
the history of previous illness and family
history of the cardiovascular disease.

17. Electrocardiogram or ECG

18. • The ECG provides information that assists in
diagnosing acute MI.
• It should be obtained within 10 minutes
from the patient a reports chest pain

19. Echocardiogram

20. Laboratory tests
• Laboratory tests called “CARDIAC BIOMARKERS”
are used to diagnose AMI.
• Creatine kinase –MB or CK-MB
• myoglobin
• Troponin T or I

21. Medical management
• The goal of medical management is to
1. Minmize myocardial damage
2. Preserve myocardial function and prevent
complications
*Minimizing myocardial damage is also
reducing myocardial oxygen demand and
increasing oxygen supply.

22. Pharmacologic therapy
• The patient with suspected MI given
• Aspirin
• Morphine sulphate
• Beta blockers

23. Thrombolytics
• Thrombolytics are usually administered IV,
although some may also be given directly into the
coronary artery in cardiac catheterization.
• The purpose of thrombolytics is to dissolve and
lyse thrombus in a coronary artery allowing blood
to flow through the coronary artery again
(reperfusion), minimising the size of the
infraction and preserving ventricular function.

24. Conti...
• Thrombolytics should not be used if the patient
is bleeding or has a bleeding disorders.
• To be effective,thrombolytics must be
administered as early as possible after the onset
of symptoms that indicate an acute MI, generally
within 3 to 6 hours.

25. Contraindications of thrombolytic therapy
• Previous hemorrhagic stroke
• Known intracranial tumour
• Active internal bleeding
• Severe uncontrolled hypertension
• Recent head injury
• current use of anticoagulants

26. Analgesics
• Morphine sulfate administered in IV boules to
reduce pain and anxiety
• The cardiovascular response to morphine is
monitored carefully particularly BP and
respiratory rate.

27. Angiotensin-converting enzyme inhibitors
(ACE inhibitors)

28. Emergent percutaneous coronary
intervention
• CABG
• PTCA

29. Cardiac rehabilitation
• Cardiac rehabilitation is a comprehensive
long term program that involves periodic
evaluation,prescribed exercise and
education and counseling about cardiac risk
factors modification.

30. Indications of cardiac rehabilitation
• Myocardial infarction
• Post CABG
• Angina pectoris
• Percutaneous coronary intervention
• Heart transplant
• Coronary artery disease

31. Aras of cardiac rehabilitation
• Smoking cessation
• Lipid management
• Weight control
• BP control
• Improve exercise tolerance
• Symptoms control
• Psychological well-being /strss management

32. Nursing management for a patient with acute
MI
• Achieving a balance between myocardial oxygen supply
and demand
• This are achieved via oxygen administration and
medication (Nitroglycerin)
• Prevention of complications
• Continuous monitoring of cardiac functions
• Continuous ECG monitoring
• Hemodynamic monitoring
• Monitor and record intake and urine output

33. Conti.
• Closely monitor and prevent complications
associated with MI particularly dysrhythmia and
cardiigenic shock
• Provide emotional and psychological support
• Explain and provide adequate information and
knowledge about disease cond and treatment
process

34. Risk factors modification
• Daily fat intake less than 309 % of total calories
• Maintenance of serum cholesterol level
• Maintain LDL levels less than 70 mg/dl
• Stop smoking and reduce daily salt intake
• Control Hypertension and diabetes
• Increase physical activity and reduce weight

35. Nursing diagnosis
• Ineffective cardiac tissue perfusion related to
reduced coronary blood flow from coronary
thrombus and atherosclerotic plaque
• Risk for imbalnved fluid
• Death of anxiety
• Deficient knowledge about post-MI and self care