Myocardial Infarction.pptx

For 2nd year B.Sc. Nursing students

1. MYOCARDIAL INFARCTION Presented By: Mr. Nandish.S Asso. Professor Mandya Institute of Nursing Sciences

2. DEFINITION : It occurs when blood supply decreases or stops in one of the coronary arteries of the heart causing damage to the heart. It is a clinical syndrome that results from occlusion of coronary artery with resultant death of cardiac myocytes . It is the permanent damage of myocardium tissue caused by reduced coronary blood supply to the myocardial tissue. It is also called as “Heart Attack”.

3. ETIOLOGY : Coronary artery thrombosis Coronary artery spasm Coronary artery embolism Atherosclerosis Other factors : Hypertension Smoking Stress Obesity

4. SITE OF MYOCARDIAL INFARCTION : Left ventricle (commonest) Anterior wall of the left ventricle + apex Lateral wall of the left ventricle Posterior wall of the left ventricle 2) Right ventricle (rare) Due to the occlusion of the right coronary artery.

5. CLASSIFICATION / TYPES : 1) STEMI : an ST Segment Elevation Myocardial Infarction it is a type of heart attack that mainly affects Heart’s lower chambers and changes electrical current travels through them. It is tend to be more severe and dangerous. 2) NSTEMI : Non ST Segment Elevation Myocardial Infarction it is a type involving partial blockage of one of the coronary arteries causing reduced flow of blood to heart muscle. It is less serious compared to STEMI.

6. PATHOPHYSIOLOGY : Due to etiological factors (coronary artery embolism) Reduced Myocardial blood supply Increase myocardial oxygen demand Myocardial Ischemia Necrosis of affected tissue Myocardial Infarction

7. CLINICAL MANIFESTATIONS : Chest pain, not relieved by rest or Nitroglycerine Diaphoresis Cool, clammy, moist skin Facial pallor Tachycardia & Tachypnoea Decreased cardiac contractibility & cardiac output Nausea & Vomiting

8. DIAGNOSTIC STUDIES : History collection Physical examination ECG (ST Segment Elevation) Blood test : to check cardiac markers like Troponin & CK-MB, CRP, Myoglobin) Coronary Angiography CT Scan

9. MANAGEMENT : MEDICAL : Follow MONATAS . Morphine : Analgesics to reduce chest pain. Oxygen : To improve oxygenation. Nitroglycerin : It causes vasodilation and increase blood supply to myocardium . (intravenous) Aspirin : Anti - platelet, which prevents formation of clot / thrombus. Thrombolytics : To break and dissolve thrombus. Anticoagulant (LMWH) : To prevent the formation of clot. Sedatives : To give rest to patient

10. DRUGS MECHANISM Beta Adrenergic Blockers : propranolol Inhibit sympathetic nervous stimulation of heart Glycoprotein IIB / IIIA inhibitors : Tirofiban Prevent binding of fibrinogen to platelets, thereby blocks platelet aggregation. Direct thrombin inhibitors : Lepirudin Prevent binding of thrombin & subsequent clot formation. Fibrinolytic therapy : streptokinase Breaks up fibrin meshwork in clots & used only in STEMI. Calcium Channel Blockers : Nifedipine , Nicardipine Coronary artery & peripheral vasodilators. Angiotensin – Converting Enzyme inhibitors : Enalapril Prevents conversion of Angiotensin I t o Angiotensin II

11. SURGICAL : Coronary Artery Bypass Graft (CABG) : it is the 1 st option when more than two arteries are blocked. Percutaneous Transluminal Coronary Angioplasty (PTCA) : It is minimally invasive procedure to open blocked arteries allowing unobstructed blood flow to myocardium. Coronary Stent : it is a tube shaped instrument placed in the coronary artery. Atherectomy : it is a procedure that utilizes catheter with sharp blade on the end to remove plaque from blood vessel.

12. NURSING MANAGEMENT : Pain, Acute, Chest related to decreased myocardial blood supply. Interventions : monitor the severity of pain by using rating scale (0 to 10) & evaluate the pain for intensity, location, radiation, duration and precipitating factors. Provide comfortable position (Semi fowlers) Advice complete bed rest. Monitor the vital signs frequently. Administer medications as per the advice ( Nitroglycerin , Morphine sulphate)

13. 2. Ineffective tissue perfusion related to myocardial injury and pulmonary congestion. Interventions : Monitor oxygen saturation every hour to get baseline data. Provide oxygen through nasal cannula. Ensure the patient rest to reduce oxygen demand. Make sure about the positioning of patient (Fowlers / Semi fowlers) Educate the patient about breathing & Coughing exercises. Administer the medications (vasodilators, B eta blockers)

14. 3. Anxiety related to perceived or actual threat to death, pain and possible lifestyle changes. Interventions : Monitor patient for verbal & non verbal signs of anxiety. Use a calm and reassuring approach while talking to patients. Encourage the family members to stay with patient. Instruct patient on the use of relaxation techniques (guided imagery) Motivate the patient to ventilate his feelings. Clear all the doubts of patient by using simple local language.

15. 4. Activity intolerance related to fatigue, decreased cardiac output and poor tissue perfusion. Interventions : Monitor the patient’s response to activity & antiarrhythmic medications. Explain the patient about energy conservation principles. Arrange the exercise and bed rest alternatively. Encourage patient to do self care activities that minimize oxygen consumption. Provide calm environment & limit visitors. Assist patient in self care activities if needed.

16. THANK YOU