MYOCARDIAL INFARCTION [presentation ]

EASY AND EFFECTIVE PRESENTATION ABOUT HEART ATTACK /MI.

1. BY :- MANISHA KUMARI IGIMS COLLEGE PATNA -14 MYOCARDIAL INFARCTION { HEART ATTACK }

2. INTRODUCTION DEFINITION EPIDEMIOLOGY TYPES/LOCATION CLASSIFICATION RISK FACTORS PATHOPHYSIOLOGY CLINICAL MANIFESTATION DIAGNOSTIC TESTS MANAGEMENTS PROGNOSIS HEALTH EDUCATION BIBLIOGRAPHY INDEX :

3. HH LET'S START WITH :- ANATOMY OF HEART PHYSIOLOGY OF HEART

4. ANATOMY :- HEART IS A MUSCULAR ORGAN . LOCATED IN THORACIC CAVITY , POSTERIOR TO STERNUM , SUPREIOR TO DIAPHRAGM , BETWEEN THE LUNGS . HEART HAS 3 LAYERS - PERICARDIUM , ENDOCARDIUM , MYOCARDIUM . 4 CHAMBERS - 2 ATRIUM , 2 VENTRICLES . 4 VALVES - MITRAL , AORTIC , TRICUSPID , PULMONARY

5. HEART PUMPS BLOOD THROUGHOUT THE BODY VIA THE CIRCULATORY SYSTEM , SUPPLYING OXYGEN AND NUTRIENTS TO THE TISSUES AND REMOVING CARBON DIOXIDE AND OTHER WASTES . HEART CONTAINS ELECTRICAL ‘PACEMAKER’ CELLS , WHICH CAUSE IT TO CONTRACT - PRODUCING HEARTBEAT . THE FUNCTION OF RIGHT HEART IS TO COLLECT DE-OXYGENATED BLOOD FROM BODY AND PUMP IT INTO RIGHT VENTRICLE . THE FUNCTION OF LEFT VENTRICLE IS TO OXYGENATION OF BLOOD AND PUMP IT IN ALL OVER BODY PARTS . PHYSIOLOGY :-

6. LET'S SEE ABOUT MI :

7. MYOCARDIAL INFARCTION REFERS TO THE PROCESS BY WHICH AREAS OF MYOCARDIAL CELLS IN THE HEART ARE PERMANENTLY DESTROYED . ACUTE MI IS MOST COMMON SERIOUS DISEASE IN THE SOCIETY WHICH LEADS TO HIGH MORTALITY AND MORBIDITY OF THE SOCIETY . IT IS THE IRREVERSIBLE DEATH OF THE HEART MUSCLE SECONDARY TO PROLONGED LACK OF OXYGEN SUPPLY . CHEST PAIN OR DISCOMFORT TRAVEL INTO THE SHOULDER , ARM , BACK , NECK , OR JAW – MAIN SYMPTOMS SEEN IN MI. INTRODUCTION:

8. MYOCARDIAL INFARCTION IS A DISEASED 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. DEFINITION :

9. EVERY YEAR ABOUT 7,35000 AMERICAN HAVE A HEART ATTACK , OF THESE 5,25000 ARE A FIRST HEART ATTACK AND 2,10000 HAPPEN IN PEOPLE WHO HAVE ALREADY HAD A HEART ATTACK . IN 2010 , APPROX. 1 IN 6 PEOPLE DIED OF MI . EVERY 34 SECONDS , 1 HAS CORONARY EVENT. EVERY 1 MINUTE 23 SECONDS , AN AMERICAN WILL DIE OF ONE . INCIDENCE OF MI IN INDIA IS 64.37/1000 PEOPLE IN MEN AGED 29 – 69 YEARS . EPIDEMIOLOGY :-

10. TYPES OF MI :-

11. CLASSIFICATION OF MI :- 1 . ACCORDING TO ANATOMIC REGION OF LEFT VENTRICLE INVOLVED : ANTERIOR POSTERIOR LATERAL SEPTAL CIRCUMFERENTIAL COMBINATION- ANTEROLATERAL , POSTEROLATERAL, ANTEROSEPTAL

12. 2 . ACCORDING TO DEGREE OF THICKNESS OF VENTRICULAR WALL INVOLVED : TRANSMURAL ( FULL THICKNESS ) LAMINAR ( SUBENDOCARDIAL ) . 3 . ACCORDING TO AGE OF INFARCTS : NEWLY FORMED ( ACUTE , RECENT , FRESH ) ADVANCED INFRACTS (OLD , HEALED , ORGANISED ) CONT.

13. 1. NON – MODIFIABLE RF : RISK FACTORS : AGE -SEEN MAINLY IN MORE THAN 40 YEARS SEX - 3 TIMES MORE IN MEN THAN WOMEN . FAMILY HISTORY - INHERITED FROM PARENTS TO CHILDREN .

14. 2 . MODIFIABLE RF : CONTD . STRESS OBESITY SMOKING DIABETES MELLITUS HYPERTENSION PHYSICAL INACTIVITY HIGH BLOOD LIPID LEVEL

15. PATHOPHYSIOLOGY ;

16. STEPS OF MI :-

17. CONTD ..

18. CONTD..

19. CONTD..

20. CLINICAL MANIFESTATION : CHEST PAIN DYSPNOEA FATIGUE INCREASED SWEATING WEAKNESS NAUSEA VOMITING LIGHT HEADACHE PALPITATION ANXIETY SLEEPLESSNESS ARRHYTHMIAS

21. 1. HISTORY COLLECTION :- 2. ECG :- ASSISTS IN DIAGNOSING ACUTE MI. THE CLASSIC ECG CHANGES ARE ; ST SEGMENT ELEVATION T WAVE INVERSION ABNORMAL Q WAVE DIAGNOSTIC TESTS :-

22. 3 . ANGIOGRAPHY :- ANGIOGRAPHY IS AN IMAGING TEST THAT USES X - RAY AND SPECIAL CONTRAST DYE TO VIEW BLOOD VESSELS AND TO STUDY NARROW , BLOCKED , ENLARGED , MALFORMED ARTERIES OR VEINS . CONTD..

23. SEE THE DIFFERENCES :-

24. 4. CHEST X – RAY :- IT IS USEFUL ADDITIONAL INDEX OF THE SEVERITY OF HEART FAILURE IN MI . PULMONARY CONGESTION OR CARDIAC ENLARGEMENT ARE THE INDICATOR OF HEART FAILURE CONTD..

25. 5 . BLOOD TESTS :- CERTAIN HEART PROTEIN SLOWLY LEAK INTO BLOOD AFTER HEART DAMAGE FROM MI . Eg … 1 . CK - CREATINE KINASE 2. TROPONIN – I $ T 3. MYOGLOBIN etc. BOTH TROPONIN I & T LEVEL ELEVATED WITHIN 2 -4 hrs AFTER INFRACTION AND PEAK AT 48 hrs AND STAY ELEVATED FOR 7 -10 DAYS. CK –MB LEVEL ELEVATED 2-4 hrs AFTER INFARCTION AND PEAK AT 48 hrs AND RETURNS NORMAL MORE QUICKLY - SO IT IS USED TO DIAGNOSE REINFARCTION. CONTD..

26. 6 . ECHOCARDIOGRAM : - AN ACCURATE NON – INVASIVE TESTS THAT ENABLES DETECTION OF EVIDENCE OF MYOCARDIAL DYSFUNCTION CAUSED BY ISCHEMIA OR NECROSIS . EVALUATION OF WALL MOTION WHILE A PATIENT IS EXPERIENCING CHEST PAIN CAN BE USEFUL WHEN THE ECG IS NONDIAGNOSTIC . CONTD..

27. 7. CT SCAN :- COMPUTED TOMOGRAPHY PAINLESS IMAGING TEST THAT USES X –RAYS TO TAKE MANY DETAILED PICTURES OF HEART AND ITS BLOOD VESSELS . IT PRODUCES HIGH QUALITY PICTURES OF THE BEATING HEART AND CAN DETECT CALCIUM OR BLOCKAGE IN THE CORONARY ARTERIES CONTD..

28. 8. NUCLEAR STRESS IMAGING :- AN IMAGING METHOD THAT USES RADIOACTIVE MATERIAL TO SHOW HOW WELL BLOOD FLOWS INTO THE HEART MUSCLE , BOTH AT REST AND DURING ACTIVITY . POSITIVE IN 75 -90 % OF PATIENTS OF SIGNIFICANT CORONARY DISORDERS . FALSE POSITIVE TEST MAY SEEN IN WOMEN DUE TO BREAST TISSUES . CONTD..

29. COMPLICATION : -

30. CONTD..

31. CONTD..

32. CONTD..

33. MANAGEMENT :-

34. 1. MEDICAL MANAGEMENT :- MORPHINE OXYGEN NITRATES ASPIRIN REPERFUSION CLOPIDOGREL HEPARIN BETA - BLOCKERS ANTICOGULANTS STATIN ANGIOTENSIN 2 INHIBITORS CORRECTION OF RISK FACTORS

35. INTRA – AORTIC BALOON PUMP 2. SURGICAL MANAGEMENT :-

36. B . PERCUTANEOUS CORONARY INTERVENTION / ANGIOPLASTY CONTD..

37. C. TRANSMYOCARDIAL LASER REVASCULARIZATION : CONTD..

38. D. CORONARY ARTERY BY – PASS ( CABG ) : CONTD..

39. E . MINIMAL INVASIVE DIRECT CORONARY ART ERY BYPASS ( MIDCAB ) :- CONTD..

40. 1 . ASSESSMENT ASSESS THE PATIENT’S COMPLAINTS ABOUT FATIGUE , WEAKNESS , MALAISE ASSESS THE PRESENCE OF PAIN IN CHEST , NECK , HAND AND FINGERS ASSESS ALL THE DIAGNOSTIC FINDINGS . ASSESS THE RESPIRATORY DISTRESS AND NEED FOR VENTILATORY SUPPORT . 3. NURSING MANAGEMENT :-

41. ACUTE PAIN r/t MYOCARDIAL ISCHEMIA RESULTING FROM CORONARY ARTERY OCCLUSION WITH LOSS / RESTRICTION OF BLOOD FLOW TO AN AREA OF THE MYOCARDIUM AND NECROSIS OF THE MYOCARDIUM . ACTIVITY INTOLERANCE r/t CARDIAC DYSFUNCTION CHANGES IN OXYGEN SUPPLY AND CONSUMPTION AS EVIDENCED BY SHORTNESS OF BREATH . DEFICIENT KNOWLEDGE r/t NEW DIAGNOSIS AND LACK OF UNDERSTANDING OF MEDICAL CONDITION . 2 . NURSING DIAGNOSIS :-

42. INITIAL EVALUATION AND STABILIZATION . RELIEF OF ISCHEMIC CHEST DISCOMFORT. EFFICIENT RISK STRATIFICATION. FOCUSED CARDIAC CARE. EARLY RESTORATION OF BLOOD FLOW TO THE INFARCT-RELATED ARTERY TO PREVENT INFARCT EXPANSION . INCREASE MYOCARDIAL OXYGGEN DELIVERY. PREVENTATION OF DEATH OTHER COMPLICATION . 3. GOALS :-

43. MONITOR AND DOCUMENT CHARACTERISTIC OF PAIN. OBTAIN FULL DESCRIPTION OF PAIN FRON PATIENT IMCLUDING LOCATION, INTENSITY, DURATION AND RADIATION . REVIEW HISTORY OF PREVIOUS ANGINA, ANGINAL EQUIVALENT, OR MI PAIN. INSTRUCT PATIENT TO REPORT PAIN IMMEDIATELY. PROVIDE QUIET ENVIRONMENT, CALM ACTIVITIES AND COMFORT MEASURES . INSTRUCT PT. TO DO DEEP AND SLOW BREATHING. CHECK VITAL SIGNS BEFORE AND AFTER NARCOTIC MEDICATION. ADMINISTER SUPPLEMENTAL OXYGEN, IF NEEDED. 4. NURSING INTERVENTION :-

44. MI ARE A SERIOUS EVENTS , APPROXIMATELY 25% OF PATIENTS DIE FROM THE INITIAL EVENTS i.e THEY MAY DIE BEFORE REACHING HOSPITAL , OR IN THE FIRST DAY OR SO OF THE REST , 25% WILL DIE WITHIN THE NEXT TWO YEARS , USUALLY DUE TO RECURRENT MI OR COMPLICATIONS . ABOUT 50 % OF THE INITIAL SURVIVORS ARE ALIVE AFTER 10 YEARS . PROGNOSIS :

45. 1gff HEALTH EDUCATION :- SN. DURING HOSPITAL STAY ON DISCHARGE TAKE MEDICINESS AS PRESCRIBED. SAME TELL DOCTORS ABOUT CURRENT PROBLEMS TELL PATIENTS ABOUT FOLLOW – UP . KEEP HYGIENE DURING HOSPITAL STAY . REDUCE THE RISK FACTORS OF MI . 1. 2. 3. STRICT BED REST 24-48 hrs ON 100% OXYGEN . PREPARE IMMEDIATE GENERAL MANAGEMENT. 4.

46. DIET RESTRICTING SALT REDUCING WT. EXERCISE QUITTING ALCOHOL QUITTING SMOKING REDUCE STRESS. LIFESTYLE CHANGES:-

47. SMELTZR C. SUZANNE (2004 ) , “BRUNNER AND SUDDARTH’S TEXTBOOK OF MEDICAL AND SURGICAL NURSING “ LIPPINCOLT PUBLICATIONS PHILDELPHIA . WAUGH ANX. (2007) ROSS AND WILSON ANATOMY AND PHYSIOLOGY IN HEALTH AND ILLNESS ; 9 th ED . CHRUCHILL PUBLICATIONS , LIVINGSTONE . GOOGLE @ SLIDESHARE #Dr. RAMESH KRISHNAN BIBLIOGRAPHY :-