Myocardial Infarction (MI) .

Ms. Yasmeen M K
2nd year BSc Nursing
BBC College of Nursing Gangavathi

1. myocardial infarction Presented by, Miss. Yasmeen M K 2 nd year B.Sc nursing BBC College of Nursing Gangavathi Supervised by, Mr. George d honnali MSc nursing HOD department of medical surgical nursing BBC College of Nursing Gangavati

2. introduction It refers to the process by which myocardial tissue are permanently destroyed in the region of heart due to reduced coronary blood flow

3. Definition It is defined as a disease condition which is caused by reduces blood flow in the coronary artery due to atherosclerosis and occlusion of an artery by a embolus or thrombus

4. Clinical classification of different types of myocardial infarction Type 1- spontaneous myocardial infarction related to ischemia caused by a primary coronary event such as plague or rupture Type 2- myocardial infarction secondary to ischemia resulting from an imbalance between oxygen demand and supply such as coronary spasm Type 3- sudden death from cardiac disease with symptoms of myocardial ischemia death occur Type 4- mi associated with primary percutaneous coronary intervention Type 5- Mi associated with coronary artery bipas graft

5. Degree of damage zone of necrosis – death of heart muscle caused by extensive and complete oxygen deprivation irreversible damage Zone of injury – region of heart muscle surrounding the area of necrosis , inflamed injured but still visible of adequate oxygenation can be restored Zone of ischemia- region of heart muscle surrounding the area of injury which is ischemia and visible endangered unless extension of the infarction occurs

6. etiology Reduced blood flow in a coronary artery due to atherosclerosis Increased oxygen demand Decreased oxygen supply Complete occlusion of an artery by an embolus or thrombus vaso spasm blood loss

7. Risk factors Modifiable – hypertension, smoking, Increased blood lipid level, obesity, diabetes mellitus, physical inactivity. Non modifiable – family history of cad, age , Gender,

8. . Pathophysiology

9. Clinical manifestations Chest pain Diaphoresis Dyspnea Decreased cardiac output Oligurea Confusion state Peripheral edema Dizziness Nausea and vomiting anxiety

10. Diagnostic evaluation Patient history ECG Angiography Cardiac enzyme test – ck-mb and ldh1 and ldh2 Others – elevated wbc count, elevated myoglobin.

11. ECG Angiography

12. Medical management The goal of medical management is — To minimize myocardial damage Preserve myocardial function Prevent complications 1. Oxygen Therapy: Administered oxygen 3 liters by nasal cannula. Oxygen therapy improves oxygenation to ischemic heart muscle or improves myocardial oxygen supply. 2. Thrombolytic Therapy: A gents such as urokinase , streptokinase and tissue plasminogen activators are used to dissolve clots & allow blood flow to the myocardium, administered IV or intracoronary. 3. Analgesic Therapy: Morphine is used to relieve pain.

13. 4 Vasodilator therapy – nitroglycerin (sublingual or iv) 5 ace inhibitor – capropril , enalapril . 6 beta blockers – propenolol 7 calcium channel blockers – nifedipine 8 anticoagulant therapy – heparin

14. Non pharmacological management Avoid smoking Intake of low cholesterol Avoid alcohol Reducing and managing stress Maintain body weight Physical activity Eating healthy foods

15. Surgical management Coronary artery bypas surgery Percutaneous trans luminary coronary angioplasty atherectomy Transmyocardial laser revascularization Coronary stent

16. Coronary artery bypass surgery Coronary stent

17. Nursing management In effective tissue perfusion related to decreased cardiac output as evidented by cyanosis Acute pain related to myocardial ischemia as evidenced by facial expression Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue

18. Thank you