Transcript Myocardial Infarction - Dr. Ahmad Abanamy Hospital

MYOCARDIAL
INFARCTION
-Heart Attack-
Carina Amor Bernardo, RN
OPD-IM Staff
DEMOGRAPHIC DATA
 Patient
J
 Case #: 157***
 Age: 37 years old
 Sex: Male
Nationality:
Filipino
Inferiorposterior
Myocardial Infarction
 Diagnosis:
PHYSICAL ASSESSMENT
GENERAL
 Conscious
and coherent
 Slightly weak
 In pain; presented by facial grimaced while
clutching his chest.
 Vital signs:
 BP: 90/80mmHg
 Temp: 37°C
 PR: 80 bpm
 RR: 32 cpm
 SPO2: 99%
 GCS: 15/15
INTEGUMENTARY
 Cold
and clammy skin.
 Diaphoretic.
HEAD AND NECK
 Hair are evenly distributed.
 Facial symmetry.
 No deformity noted.
 No lesions and masses palpated.
 Slightly sunken eyeballs, no redness, no
discharges, pupils are reactive to light.
 No
nasal congestion or drainages noted.
 Lips are dry and pale but no ulcers are noted.
 Also no palpable lymph nodes are noted.
BODY AND EXTREMITIES
 No
physical deformities are noted.
 Good range of motion.
 Thorax is symmetric, slight retraction of the
intercostal muscles during inspiration.
 Bilateral chest movements present. No crackles,
no wheezing are noted.
 Soft abdomen palpated. Positive bowel sound
noted.
PAST MEDICAL HISTORY
 NO
DM
HTN
IHD
 YES
 SMOKER FOR
MORE THAN
10 YEARS
PRESENT MEDICAL HISTORY
 Patient
J was brought to the hospital by a
private car with the complaint of chest pain
radiating to his left shoulder and arm, pain
scale results 8-9/10 in severity with sweating
and nausea but no vomiting. Pain started one
hour before he came to our hospital. He denies
dyspnea, cough, or other symptoms. Patient
was diaphoretic in severe pain. ECG showed
sinus rhythm (SR) and 3 mm ST elevation II,
III, AVF and 2 mm ST depression in V2-V3 and
I, AVL leads, heart rate 80bpm. Myocardial
Infarction.
DEFINITION
 Myocardial
Infarction
(MI) or Acute
Myocardial Infarction
(AMI), commonly known
as a Heart Attack,
results from the partial
interruption of blood
supply to a part of the
heart muscle causing
the heart cell to be
damaged or die.
BASIC ANATOMY OF THE HEART
The heart is the hardest
working muscle in the human
body. Located almost in the
center of the chest, the adult
human heart is about the size
of one fist.
The cardiovascular system,
composed of the heart and
blood vessels, is responsible
for circulating blood
throughout our body to
supply the tissues with
oxygen and nutrients.





The heart is the muscle that pumps
blood filled with oxygen and nutrients
through the blood vessels to the body
tissues. It is made up of:
Four chambers (two atria and two
ventricles) that receive blood from the
body and pump out blood to it:
 The atria receive blood coming back
to the heart.
 The ventricles pump the blood out of
the heart.
Blood vessels, which compose a network
of arteries and veins that carry blood
throughout the body:
 Arteries transport blood from the
heart to the body tissues.
 Veins carry blood back to the heart.
Four valves to prevent backward flow of
blood:
 Each valve is designed to allow the
forward flow of blood and
prevent backward flow.
An electrical system of the heart that
stimulates contraction of the heart
muscle.
STRUCTURE OF THE HEART

Pericardium - it is a tough
double layered
membrane/sac which
covers the heart.

Myocardium - is the
muscular tissue of
the heart.

Endocardium - is the
innermost layer of tissue
that lines the chambers of
the heart.
BLOOD CIRCULATION
INFARCTED HEART
PATHOPHYSIOLOGY
Predisposing factors
Premature, Accelerated Atherosclerosis
Progressive narrowing
of blood vessels
Risk for excessive
blood clot formation
Ischemia of the muscle
Thromboembolism
Hypoxia
Necrosis
Aerobic to Unaerobic
metabolism
Release of
Lysozomal
Enzyme
Lactic Acid
formation
Altered
Depolarization
Cardiac Output
Altered
Repolarization
Renal
Ischemia,
Oliguria
Chest Pain/Muscle
Spasm
Myocardial
Infarction
Myocardial
Contractility
IMPORTANT RISK FACTORS
Previous cardiovascular disease
 Older age
 Tobacco smoking
 High levels of certain lipids and low
levels of high density lipoprotein
 Excessive alcohol consumption and
drug abuse
 Diabetes
 High blood pressure
 Obesity
 Chronic kidney disease
 Heart failure
 Chronic high stress levels

SIGNS AND SYMPTOMS
SUDDEN
CHEST PAIN
SHORTNESS OF
BREATH
ANXIETY
SEEK
HELP
SWEATING
PALPITATIONS
NAUSEA AND
VOMITING
SOME CASES . .
25%
are silent
WITHOUT CHEST PAIN OR OTHER SYMPTOMS
CLASSIFICATIONS


Transmural: associated with atherosclerosis
involving a major coronary artery. It can be
subclassified into anterior, posterior, inferior, lateral
or septal.
Subendocardial: involving a small area in the
subendocardial wall of the left ventricle, ventricular
septum, or papillary muscles.
PATIENT J’S ECG
BLOOD CHEMISTRY
Test
Result
Adult Reference Range
SODIUM
138
135-150 mmol/l
POTASSIUM
3.8
3.5-5.0 mmol/l
CHLORIDE
106
98-111 mmol/l
CPK (CK)
275
26-308 u/l
CK-MB
64.4
7.0-25.0 u/l
AST (SGOT)
36
M: 10-38 U/L
ALT (SGPT)
74
10-41 U/L
CHOLESTEROL
6.9
3.1-5.2 mmol/L
TRIGLYCERIDES
1.38
0.34-2.30 mmol/L
HDLc
1.14
M: 0.9-1.87 mmol/L
LDLc
5.05
3.9-4.7 mmol/L
Troponin Quantitative
0.628
<0.120 ng/ml
MEDICAL MANAGEMENT
 Oxygen
administration is initiated at the onset
of chest pain.
 Cardiac Monitoring (ECG/2D Echo)
 Emergent Percutaneous Transluminal Coronary
Angioplasty (PTCA).
 Coronary Artery Bypass or Minimal Invasive
Direct Coronary Artery Bypass (MIDCAB).
 Angiography

DIET: Low Salt, Low Fat.
PHARMACOLOGIC THERAPY
Drugs
Aspirin
Plavix
Dose/Route/Frequency
Action
81mg tab., PO, OD
Pain killer, it also thins the blood
in order to lower the risk of blood
clots in coronary artery.
75mg tab., PO, OD
Crestor
20mg tab., PO, OD
Morphine Sulfate
2mg/ml, I.V., PRN
Clexane
80mg/0.8ml, S.C., BID
Used to prevent blood clots after
a recent heart attack or stroke,
and in people with certain
disorders of the heart or blood
vessels.
Reduces levels of "bad"
cholesterol (low-density
lipoprotein, or LDL) and
triglycerides in the blood, while
increasing levels of "good"
cholesterol (high-density
lipoprotein, or HDL).
Pain killer.
an anticoagulant (blood thinner)
that prevents the formation of
blood clots.
NURSING INTERVENTIONS
Monitor and record the patient’s vital signs and ECG
readings.
 Assess level of consciousness.
 Evaluate chest pain, give analgesics as ordered.
 Check the patient’s blood pressure before and after giving
nitroglycerin, especially on the 1st dose.
 Observe urinary output and check for edema; an early sign
of cardiogenic shock is hypotension with oliguria.
 Assess bowel motility; mesenteric artery thrombosis is a
potential fatal complication.
 Provide emotional support, and help reduce stress and
anxiety.
 Organize patient care and activity to minimize periods of
uninterrupted rest.

NURSING DIAGNOSIS
 Acute
pain related to myocardial infarction.
 Anxiety related to fear of death.
 Impaired gas exchange related to fluid
overload due to left ventricular dysfunction.
POTENTIAL COMPLICATIONS
 Dysrhythmias
and Cardiac Arrest.
 Acute Pulmonary Edema.
 Heart Failure.
 Thromboembolism.
 Myocardial Rupture.
 Pericardial Effusion and Cardiac
Tampobade.
NURSING CARE PLAN
ASSESSMENT
Cues/Evidence
Nursing
Diagnosis
SUBJECTIVE: Acute Pain
“I feels like
there is a
heavy object
over my chest,
and it cause a
lot of pain.”
OBJECTIVE:
* Sweating,
Cold and
clammy skin.
* Clutching his
chest.
* Facial
grimaced, Pain
Scale
8-9/10.
related to
Myocardial
Infarction.
PLANNING
IMPLEMENTATION
EVALUATION
Goals and
Desired Outcome
Nursing
Interventions
Rationale
Evaluation
After 6-8 hours
of nursing
interventions,
patient will be
relieve from pain.
*Monitor the
vital signs.
BP: 90/80mmHg
T: 37°C
PR: 80bpm
RR: 32cpm
*Provide
baseline
data
regarding
the patient’s
condition.
After 6-8 hours
of nursing
interventions the
goals were
partially met as
evidenced by:
*Administer
oxygen in
tandem with
analgesia as
ordered.
Aspirin
81mg,OD
Plavix 75mg,
OD
*Assist patient
in relaxation
techniques.
*To ensure
maximum
relief of
pain.
*Assist in
the
reduction in
the
perception /
response to
pain. Giving
*Less facial
grimaced, Pain
scale 4-5/10.
*Expresses less
anxiety.
*Complies with
self-care
program.
NURSING HEALTH TEACHING

Explained the importance of totally giving up smoking,
because it is the single most effective way to reduce the risk of
having a further MI.

Suggest some changes in diet can make a big difference.
People who eat a healthy diet may halve their chance of a
further heart attack compared to those who do not eat
healthily.

Advised to have normal physical activity and regular exercise.

Emphasized the importance of take home medications
prescribed by the physician.
CONCLUSION
When someone is suffering from chest pain, an ECG
should be run to assess electrical activity of the heart
and initial treatment should be given. Then further
tests, such as an angiography, should be run as quickly
as possible to learn more about the prognosis and
apply findings to distinguish a more appropriate
treatment.
For any health problems, early detection is very
important, even with or without any signs and
symptoms persist.
The importance of healthy living, especially healthy
diet is the most effective way to avoid such disease like
myocardial infarction.
BIBLIOGRAPHY



Brunner & Suddarth’s Medical-Surgical Nursing Textbook 10th
Edition.
http://www.patient.co.uk/health/Myocardial-Infarction-After-theMI.htm
http://www.webmd.com/heart-disease/understanding-heart-attackbasics
THANK YOU^__^