MYOCARDIAL INFRACTION

GROUP 1 :
1. KIKI ROZALIA 21115056
2. EGA ZINNIA PALAR 21115070
3. RIANDINI PANDANSARI 21115089

PROGRAM STUDI ILMU KEPERAWATAN

SEKOLAH TINGGI ILMU KESEHATAN
MUHAMMADIYAH PALEMBANG
TAHUN AJARAN 2017/2018
 MYOCARDIAL INFRACTION

1. DEFINITION

Myocardial infarction (MI) is caused by marked reduction/loss of blood flow

through one or more of the coronary arteries, resulting in cardiac muscle ischemia and
necrosis.

2. SIGN AND SYMPTOMS

Patients with typical MI may have the following symptoms in the days or even
weeks preceding the event (although typical STEMI may occur suddenly, without
warning):
Fatigue
Chest discomfort
Malaise
The crushing, substernal pain is the cardinal symptom of myocardial
infarction. This pain may radiate to the left arm, jaw, or shoulder blades.
Nausea and vomiting
Dyspnea
Diaphoresis
Feeling of impending doom
Left-sided chest pain
Midscapular pain
Pain radiating down the right arm

Typical chest pain in acute MI has the following characteristics:

Intense and unremitting for 30-60 minutes.
Substernal, and often radiates up to the neck, shoulder, and jaw, and down the
left arm.
Usually described as a substernal pressure sensation that also may be
characterized as squeezing, aching, burning, or even sharp.
In some patients, the symptom is epigastric, with a feeling of indigestion or of
fullness and gas.

The patients vital signs may demonstrate the following in MI:

The patients heart rate is often increased (tachycardic) secondary to a high
sympathoadrenal discharge.
The pulse may be irregular because of ventricular ectopy, an accelerated
idioventricular rhythm, ventricular tachycardia, atrial fibrillation or flutter, or
other supraventricular arrhythmias; bradyarrhythmias may be present.
In general, the patient's blood pressure is initially elevated because of
peripheral arterial vasoconstriction resulting from an adrenergic response to
pain and ventricular dysfunction.
However, with right ventricular MI or severe left ventricular dysfunction,
hypotension and cardiogenic shock can be seen.
 The respiratory rate may be increased in response to pulmonary congestion or
anxiety.
Coughing, wheezing, and the production of frothy sputum may occur

3. TRIGGERS

Of the 13 triggers identified, only six were evaluated in multiple studies. The
single-study results include the triggers with highest strength (cocaine, heavy meals), and
most of those with the largest PAFs (traffic, alcohol, coffee). Hence, the studies will need
to be replicated as these high risk/burden estimates may just represent the winners
curse. In addition, several MI triggers have been loosely defined. Traffic exposure, for
instance, might be considered a composite trigger resulting from air pollution, driving-
related stress, and noise.
One major area of research that has been understudied is how triggers contribute
to health care disparities by interacting with each other and with cardiovascular risk
factors (Figure). For instance, the models assume a prevalence of 100% for air pollution,
but it is established that air pollution is inordinately concentrated in lower socioeconomic
neighborhoods. Similarly, triggers may be most relevant to individuals with higher levels
of cardiovascular risk factors, which also are clustered disproportionately in racial
minorities and individuals with lower socioeconomic status.

4. COMPLICATION

Myocardial infarction (MI) due to coronary artery disease is a leading cause of

death in the United States, where more than 1 million people have acute myocardial
infarctions (AMIs) each year.
The advent of coronary care units and early reperfusion therapy (lytic or
percutaneous coronary intervention) has substantially decreased in-hospital mortality
rates and has improved the outcome in survivors of the acute phase of MI.
Complications of MI include arrhythmic, mechanical, and inflammatory (early
pericarditis and post-MI syndrome) sequelae, as well as left ventricular mural
thrombus (LVMT). In addition to these broad categories, right ventricular (RV)
infarction and cardiogenic shock are other possible complications of acute MI. (See
the image below.)
Modified 2-dimensional (top) echocardiogram and color flow Doppler image
(bottom). Apical 4-chamber views show a breach in the interventricular septum and
free communication between ventricles through a large apical septum ventricular
septal defect in a patient who recently had an anterior myocardial infarction.