MYOCARDIAL INFRACTION

DEFINITION:-

It is defined as death of a segment of heart muscle, which follows interruption of its blood supply.
In other words...
When in myocardium layer of heart, blood supply coronary artery branch is interrupted or stopped then Oxygen supply also stop in any area in heart, after absence of oxygen necrosis happens there.
It is called myocardial infraction or myocardial death.


CAUSES:-

Acute coronary thrombosis: About 90% cases of Myocardial infraction are due to severe coronary heart disease.

Arteriosclerosis: Hardening of arteries.

Other factors are:

Sudden constriction / vasospasm of coronary arteries.

CA (coronary artery) embolism.

Infectious disease.

Hypoxia.

Smoking.

Increase fatty diet intake.

Excessive exercise.


SIGN/SYMPTOMS:-

 PULSE Signs and Symptoms 

 P Persistent Chest Pain/Palpation 

 U Upset Stomach 

 L Light Headache 

 S S.O.B 

 E Excessive Sweating 


CLINICAL MANIFESTATIONS:-

Severe chest pain

Cold calm skin

Tachycardia

Palpitation

Nausea, vomiting

Feeling of indigestion

Diaphoresis (excessive sweating)

Hypertension

Disorientation

Dyspnoea

Anxiety

S.O.B. (Shortness of breath).


CLINICAL MANIFESTATIONS:-

Severity: More than angina pectoris.

Radiation: Pain radiated to nose, jaw, shoulder, forearm, 4th, 5th fingers.

Duration: More than 15 minutes and not relieved by nitroglycerine.


CLINICAL MANIFESTATIONS:-

Most common anterior wall of left ventricle due to thrombus in left arm.

Posterior wall of heart due to blockage in right coronary artery.

Inferior wall of hearty due to right coronary artery blockage.


PATHOPHYSIOLOGY:-

Due to arteriosclerosis and coronary thrombus

↓

Produce ischemia in myocardium

↓

Produce tissue necrosis

↓

Ultimately

↓

Reduced conductivity

↓

Decreased ventricular contraction


DIAGNOSTIC EVALUATION:-

Echocardiography

By ECG (ST elevation)

Lab findings

Elevated CK= Creatinine kinase within 3-6 hrs.

AST = Aspirate amino transferase.

LDH = Lactate dehydrogenase in 12-24 hrs.

ESR = Erythrocytes sedimentation rate

PET (Positron Emission Tomography)

MRI (Magnetic Resonance Imaging).

Coronary Angiography (it shows CAD)



COMPLICATIONS:-

Pulmonary embolism

Heart failure

Pericarditis, Myocarditis, Endocarditis.

Shock

Dysrhythmia.


MEDICAL MANAGEMENT:-

(Drug of choice) Pain management by morphine sulphate 5-10 mg .

Vasodilators

Nitrates

Beta-blockers

Calcium channel blockers.


Anxiolytics drugs

Benzodiazepines.

Anticoagulant

heparin.

Thrombolytic

Streptokinase

urokinase.

Antidysrhythmic

Lignocaine

xylocaine.


SURGICAL MANAGEMENT:-

PTCA (Percutaneous transluminal coronary angioplasty).

CABG (Coronary artery bypass grafting).

DIETARY MANAGEMENT:-

  • We should advice to patient for low fat and low cholesterol diet. They increases extra pressure on heart.
  • Advice to take light and fibers diet.
  • Avoid caffeine intake.
  • Advice to take low sodium diet.
  • Avoid alcohol use.


NURSING MANAGEMENT:-

Assessment

  • Collect information about chest pain from the patient.
  • observe patient's symptoms.
  • Take a medical history.
  • Assess anxiety level of patient.
  • Assess side effect and drugs effects.


NURSING DIAGNOSIS

  1. Pain related to decrease blood supply to heart.
  2. Anxiety related to chest pain and fear of death.
  3. ↓es cardiac output related to dysrhythmias.
  4. Activity intolerance related to disease conditions.
  5. Altered tissue perfusion related to infraction.

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