CASE PRESENTATION ON ANTEROSPECTAL MYOCARDIAL INFARCTION

An brief explaination about CASE PRESENTATION ON ANTEROSEPTAL MYOCARDIAL INFARCTION.

1. CASE PRESENTATION ON ANTEROSEPTAL MYOCARDIAl INFARCTION PRESENTATION BY YOGESH BSN.4 TH YEAR CON-EIMS

2. INTRODUCTION Myocardial infarction (MI), also known as "heart attack," is caused by decreased or complete cessation of blood flow to a portion of the myocardium. Myocardial infarction may be" silent," and go undetected, or it could be a catastrophic event leading to hemodynamic deterioration and sudden death .

3. HISTORY COLLECTION CHIEF COMPLAINTS Chest pain and left arm pain [for 6 hrs] Shortness of breathing [for 6 hrs] Vomiting [one episode] Fever [100.6 F] HISTORY OF PRESENT ILLNESS MR X. was admitted in the XXX Hospital with complaints of central chest pain[ retrosternal ] radiating down to the left arm . He had an episode of vomiting ,shortness of breathe, palpitations and fever 100.6 F.

4. INVESTIGATION ECG [ 12 leads ] ST segment elevation [ On V2,V3,V4 ] Q wave development

5. INVESTIGATIONS TRO T raised CK- MB raised OTHER INVESTIGATIONS #Complete blood count [ NORMAL ] #ESR and CRP raised

6. HISTORY COLLECTION HISTORY OF PAST ILLNESS PAST MEDICAL HISTORY Hypertension for past 6 years PAST SURGICAL HISTORY No significant of past surgical history PAST MEDICATION HISTORY He intake Amlodipine 5mg for Hypertension[past 6 years].

7. . PERSONAL HISTORY Smoker, smoke 12 sticks per day from 10 years Regular bowel and bladder pattern No allergy to any food and drug. PHYSICAL EXAMINATION As physic. was examined 1 . LEVEL OF CONSCIOUSNESS : Conscious 2. VITAL SIGNS TEMPERATURE : 100.6 F PULSE : 86 bpm RESPIRATION : 15 Breath per min BP : 100/75mm of Hg 4 . ACTIVITY : DULL 3. CARDIO VASCULAR ASSESSMENT : Hearing of murmurs sounds

8. DISEASE CONDITION ANTEROSEPTAL MYOCARDIAL INFARCTION Antero septal myocardial infraction denotes, where the part of the heart muscle dies and scars due to poor blood supply[caused by atherosclerosis] . In this case tissue damage is around the anteroseptal wall, the area between the left and right ventricles.[ It is a historical nomenclature based on electrocardiographic (EKG) findings]

9. COMPARTIVE STUDY BOOK PICTURE PATIENT’S PICTURE CAUSES 1. Smoking 2. Alcohol consumption 3. Diabetes mellitus 4. Coronary artery disease 5. High blood pressure 6. High level of blood cholesterol CAUSES 1.SMOKING 2.HYPERTENSION CLINICAL FEATURES 1.Chest and shoulder pain 2.Shortness of breathe 3.Diaphoresis 4.Decreased urinary output 5. Vomiting 6. weakness and palpitations 7.lack of consciousness 8.sleep disturbance and fever CLINICAL FEATURES 1.Chest and shoulder pain 2.Shortness of breathe 3.Palpitation 4.Vomiting

10. Book picture Patient’s picture DIAGNOSIS 1.History collection 2.Physical examination 3.Electrocardiogram 4.Lab analysis i.e. blood test , Troponin T , HDL, LDL , CK- MB , ESR, CPR . DIAGNOSIS 1.History collection 2.Physical examination 3. Electrocardiogram 4. Lab analysis i.e. blood test , Troponin T , HDL, LDL , CK- MB , ESR, CPR .[raised ] MEDICAL MANAGEMENT 1.IV nitro-glycerine 2.Morphine sulfate 3. beta – adrenergic blockers 4.Thrombolytic therapy 5.Antidysrhythmic drugs 6.Anti platelet therapy 7. Anticoagulant therapy MEDICAL MANAGEMENT 1.IV analgesic : 5 mg morphine 2.Anti platelet therapy : aspirin 75 mg 3. Anticoagulant therapy : heparin 4.beta – adrenergic blockers : propranolol SURGICAL MANAGEMENT 1.PTCA[ Percutaneous Transluminal coronary Angioplasty] 2.Stent placement 3.CABG[ CORONARY ARTERY BYPASS GRAFT] 4.TMR[ Transmyocardial Laser Revascularization] SURGICAL MANAGEMENT Patient doesn’t go under any surgery

11. PATHOPHYSIOLOGY

12. MANAGEMENT MEDICAL MANAGEMENT IV nitro-glycerine[Reduce anginal pain] Morphine sulfate [Reduce anginal pain ,when unrelieved by NTG] beta – adrenergic blockers[ Reduce myocardial O2 demand] Thrombolytic therapy[lysing infract artery thrombosis] Antidysrhythmic drugs[prevent dysrhythmias] Anti platelet therapy[prevent platelet sticking together] Anticoagulant therapy[plasma protein antithrombin against]

13. . SURGICAL MANAGEMENT PTCA [ Percutaneous Transluminal coronary Angioplasty] Stent placement CABG [ CORONARY ARTERY BYPASS GRAFT] TMR [ Transmyocardial Laser Revascularization] NURSING PROCESS Acute pain related to tissue ischemia as evidenced by patient reporting of chest pain. Decreased cardiac output related to changes in myocardial contractility. Impaired gas exchange related to interruption of blood flow to alveoli. Hyperthermia related to inflammatory process caused by myocardial cell death. Anxiety related to hospitalization and fear of death.

14. ASSESSMENT DIAGNOSIS GOAL PLANNING RATIONALE IMPLEMENTETION EVALUATION SUBJEVTIVE DATA : OBJECTIVE DATA : Pain score increased 8/10. Fatigue Weak pulse Restlessness Acute pain related to tissue ischemia as evidenced by patient reporting of chest pain. Client is relieved from pain Monitor the vital sign, ECG, oxygen saturation and pain score regularly. Provide high fowlers position with cardiac table. Provide complete bed rest. Administer nitrates like drug. Provide diversional therapy. To identify the baseline data. To push the diaphragm down and create a enough space for breathing . Rest indicate sleep and provide comfort. For coronary vasodilation. To provide comfort. Monitored baseline data. Provided fowlers position with cardiac table. Provided complete bed rest. Administered drug Morphine 5 mg Provided comfort. Chest pain was relieved as evidenced by decrease in pain score 4/10.

15. ASSESSMENT DIAGNOSIS GOAL PLANNING RATIONALE IMPLEMENTETION EVALUATION SUBJEVTIVE DATA : Patient said that he have a shortness of breathing and palpitation. OBJECTIVE DATA : respiratory rate 15bpm palpitation reveals tactile spo2 :92% Impaired gas exchange related to interruption of blood flow to alveoli. To improve the breathe pattern and aid in respiration. Monitor the vital sign, ECG, oxygen saturation and pain score regularly. Provide well ventilated environment. Provide complete bed rest. Administer oxygen therapy with face mask Administer inotropic drugs To identify the baseline data. To prevent suffocations Rest indicate sleep and provide comfort. To aid in breathing To improve ventricular contractility. Monitored baseline data. Provided well ventilated environment Provided complete bed rest. Administered O2 therapy. - Client’s breathing pattern was improved evidenced by normal breathing sounds and respiratory rate and spo2 98%.

16. HEALTH EDUCATION Maintaining a healthy weight Avoid smoking Avoid alcohol Eating healthy food Regular aerobic exercise Reducing stress Making sure to get enough sleep Follow the prescribed drugs

17. PATIENT PROGRESS

18. PATIENT PROGRESS

19. . SUMMARY MR X. was admitted in the XXX Hospital with complaints of central chest pain[ retrosternal ] radiating down to the left arm. He had an episode of vomiting ,shortness of breathe and palpitations. He was admitted on CCU for proper and he undergone for treatment. Hence the general condition was much improved through out the treatment procedure being hospitalized. BIBLIOGRAPHY Brunner and Siddharth “ A Textbook of medical surgical nursing ’’, Third Edition; page no. 103-1034. Lewis’s “ Medical Surgical Nursing ’’, Second Edition ; page no.781-800. NET SOURCE: https://www.healthline.com/health/acute-myocardial-infraction.