Myocardial Infarction

A. According to the world health organization cardiovascular disease is the leading cause of death
worldwide, as well as here in Barangay San Jose Gusu.
B. Out of all those cardiovascular disease, a large percentage are caused by heart attacks, also known
as acute myocardial infarction or simply myocardial infarction or MI.
C. The word infarction means that some area of tissue has died due to lack of blood flow, and
therefore for a lack of oxygen
D. “Myo” refers to the muscle, and “cardial” refers to the heart tissue.
E. So, Myocardial infarction (MI) is defined as the irreversible death (necrosis) of heart muscle
secondary to prolonged lack of oxygen supply (ischemia).
F. As the cells are deprived of oxygen, ischemia develops, cellular injury occurs, and lack of oxygen
leads to infarction or death of the cells.
G. Now, the heart’s main job is to pump blood throughout our body right? Well, the heart also needs
blood, and so it also pumps blood to itself using the coronary circulation – The coronary circulation
is a system of small arteries and veins that surrounds the heart, and responsible for supplying blood
to the heart, therefore keeping the heart cells supplied with fresh oxygen.
H. Myocardial Infarction happen when these small arteries becomes completely occluded or blocked
by PLAQUES that can take years to build up, therefore blood (which carries oxygen) can’t reach the
heart tissue, and if this happens for long enough, heart tissue dies.

CAUSES:

#1 Damage to the endothelial cells.

#2 VASOSPASM – sudden constriction or narrowing of the coronary artery

I.Smoking
II.Age
III.Family History
IV. High blood pressure
V. Lack of Physical Activity
- Obesity
- High “bad” cholesterol
VI. Diabetes
VII. Stress

However there are several factors contributing to this:

1. Smoking – nicotine, a toxin that is found in the cigarette, can flood through the blood and damage
these endothelial cells. And it’s been proven that nicotine causes narrowing of the blood vessels,
thus increasing the blood pressure and stimulating the heart, and raises the blood fat level. So, the
damage endothelial cells, then becomes a site for Atherosclerosis (deposition of fat, cholesterol,
protein, calcium and WBC’s) that can build a PLAQUE (takes years to build up) and then causes a
blockage of blood flow to the heart tissue.
2. Age - Men age 45 or older and women age 55 or older are more likely to have a heart attack than
are younger men and women.
3. Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks
(by age 55 for male relatives and by age 65 for female relatives), you may be at increased risk.
4. High blood pressure - Over time, high blood pressure can damage arteries that feed your heart by
accelerating atherosclerosis. High blood pressure that occurs with obesity, smoking, high
cholesterol or diabetes increases the risk even more.
5. Lack of physical activity - An inactive lifestyle contributes to high blood cholesterol levels
(triglycerides – a fat you on the food you eat) and obesity. People who get regular aerobic exercise
have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also
beneficial in lowering high blood pressure.
6. Diabetes - Insulin, a hormone secreted by your pancreas, allows your body to use glucose, a form
of sugar. Having diabetes — not producing enough insulin or not responding to insulin properly —
causes your body's blood sugar levels to rise. Diabetes, especially uncontrolled, increases your risk
of a heart attack.
7. Stress - You may respond to stress in ways that can increase your risk of a heart attack.

SIGNS AND SYMPTOMS:

 1. CARDINAL SIGN!!! Angina: Early Warning Sign of a Heart Attack
 Frequent episodes of unstable angina (CHEST PAIN) provoked by ischemia.
 Characterized by: Pressure, tightness, pain or a squeezing or aching sensation in your chest or
arms that may spread to your neck, jaw or back.
 With angina, blood flow is restores pain recedes within minute.

About 25% of all heart attacks occur without any previous warning signs. They are sometimes associated
with a phenomenon known as "silent ischemia" -- sporadic interruptions of blood flow to the heart that,
for unknown reasons, are pain-free, although they may damage the heart tissue.

2. Nausea, indigestion, heartburn or abdominal pain

3. Tachycardia and tachypnea – To compensate for the decreased oxygen supply, the heart rate and
respiratory rate speed up.
4. Fatigue
5. Lightheadedness or sudden dizziness

DIAGNOSTIC TESTS:

1. Laboratory Exams, such as:

 CBC - Certain heart enzymes slowly leak out into your blood if your heart has been damaged by
a heart attack. A blood sample will be taken to test for the presence of these enzymes.
- WBCs increases
- Myoglobin is release from damages muscles
 Checking the Troponin Levels which is not normally found in the serum, and is only release when
myocardial necrosis occurs.
2. Electrocardiogram (ECG) – which is the most important tool in the initial evaluation and triage of
patients in whom an acute coronary syndrome (ACS), such as MI, is suspected. It is confirmatory of
the diagnosis in approximately 80% of cases.
3. Chest X-ray – An X-ray image of your chest allows your doctor to check the size of your heart and
its blood vessels and to look for fluid in your lungs.
4. Coronary catheterization (angiogram) – A liquid dye is injected into the arteries of your heart
through a long, thin tube (catheter) that's fed through an artery, usually in your leg or groin, to the
arteries in your heart. The dye makes the arteries visible on X-ray, revealing areas of blockage.
5. Computerized tomography
6. Magnetic Resonance Imaging
7. Exercise Stress Test

COMPLICATIONS:

1. Heart Failure – this occurs when the heart is unable to pump sufficiently to maintain blood flow to meet
the body's needs.

2. Aneurysm – this refers to a weakening of an artery wall that creates a bulge, or distention, of the artery.

3. Cardiac Rupture – Is a laceration of the ventricles or atria of the heart, of the interatrial or interventricular
septum, or of the papillary muscles.

4. Thrombosis and embolic – The plaques are thrombogenic

5. Cardiogenic Shock – the heart can’t supply blood to the body. Results in the blood pressure to fall and
organs may begin to fail.

TREATMENT:

A. Thrombolytics. These drugs, also called clot busters, help dissolve a blood clot that's blocking blood
flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the
chance you'll survive and with less heart damage.

B. Antiplatelet agents. Emergency room doctors may give you other drugs to help prevent new clots
and keep existing clots from getting larger. These include medications, such as clopidogrel (Plavix)
and others, called platelet aggregation inhibitors.
 C. Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make
your blood less "sticky" and less likely to form clots. Heparin is given intravenously or by an injection
under your skin.

D. Pain relievers. You may receive a pain reliever, such as morphine, to ease your discomfort.
E. Nitroglycerin. This medication, used to treat chest pain (angina), can help improve blood flow to
the heart by widening (dilating) the blood vessels.
F. Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease
blood pressure, making your heart's job easier. Beta blockers can limit the amount of heart muscle
damage and prevent future heart attacks.
G. ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart.

SURGICAL INTERVENTIONS:

1. Coronary angioplasty and stenting. Doctors insert a long, thin tube (catheter) that's passed through
an artery, usually in your leg or groin, to a blocked artery in your heart. If you've had a heart attack,
this procedure is often done immediately after a cardiac catheterization, a procedure used to
locate blockages.
- This catheter is equipped with a special balloon that, once in position, is briefly inflated to open
a blocked coronary artery. A metal mesh stent may be inserted into the artery to keep it open
long term, restoring blood flow to the heart. Depending on your condition, your doctor may
opt to place a stent coated with a slow-releasing medication to help keep your artery open.

2. Coronary artery bypass surgery. In some cases, doctors may perform emergency bypass surgery at
the time of a heart attack. If possible, your doctor may suggest that you have bypass surgery after
your heart has had time — about three to seven days — to recover from your heart attack.
- Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed
coronary artery, allowing blood flow to the heart to bypass the narrowed section.

NURSING INTERVENTIONS:

1. Assess for chest pain not relieved by rest or medications.

2. Monitor vital signs, especially the blood pressure and pulse rate.
3. Assess for presence of shortness of breath, dyspnea, tachypnea, and crackles.
4. Assess for nausea and vomiting.
5. Assess for decreased urinary output.
6. Assess for the history of illnesses.
7. Perform a precise and complete physical assessment to detect complications and changes in the
patient’s status.
8. Assess IV sites frequently.

PREVENTION:

Lifestyle Modification
- Proper diet
- Exercise (It has been found that cardiac rehabilitation which includes physical exercise improves coronary
risk factors and reduces the risk of major cardiac events in people after MI.)
- Stop smoking

Goals of treatment during MI are to minimize myocardial damage, preserve myocardial

function, and prevent complications. These goals can be achieved by reperfusing the area
with the emergency use of thrombolytic medications or by PCI. Reducing myocardial oxygen
demand, and increasing oxygen supply with medications, oxygen administration and bed rest
can minimize myocardial damage.
  I: IV access

Two IV lines are placed usually to ensure that access is available for administering

emergency medications.

 N: Narcotic analgesics

Morphine is the analgesic of choice for MI and is administered in IV boluses to

reduce pain and anxiety; reduces preload and afterload and relaxes bronchioles to enhance

oxygenation.

 F: Facilities for defibrillation (DF)

Have the crash cart available and ready.

 A: Aspirin

Inhibits platelet aggregation. Treatment should be initiated immediately and continued for

years.

 R: Rest

Bed rest promotes comfort and healing.

 C: Converting enzyme inhibitor

ACE-inhibitors lowers the blood pressure and the kidneys excrete sodium and fluid.

 T: Thrombolytics

Administered via IV to dissolve the thrombus in a coronary artery, allowing blood

reperfusion, minimizing the size of the infarction and preserving ventricular function.

 I: IV beta blocker

Long-term therapy with beta-blockers decreases the future incidences of cardiac events.

 O: Oxygen

Administer at a modest flow rate for 2 to 3 LPM.

 N: Nitrates

To increase cardiac output and reduce myocardial workload; relieves pain by redistributing

blood to ischemic areas of the myocardium.

 S: Stool Softeners

To prevent straining during defecation, which causes vagal stimulation and may slow the

heart rate.

NURSING MANAGEMENT:

 B: Bed rest

Bed rest helps reduce myocardial oxygen consumption.

 E: ECG Monitoring

Frequently monitor ECG to detect rate changes or arrhythmias; place rhythm strips in the

patient’s chart for evaluation.

 E: Emotional support

Provide support and help reduce stress and anxiety; administer tranquilizers as needed.

 C: Cluster/Organize Patient Care

To maximize periods of uninterrupted rest.

 A: Antiembolism stockings

Can help prevent venostasis and thrombophlebitis.

 B: Bedside commode

Allow use of bedside commode and provide privacy as much as possible.

 S: Stool Softener

To prevent straining during defecation causing vagal stimulation and slow heart rate.

 C: Cardiac Rehabilitation Program

Includes education regarding heart disease, exercise, and emotional support for the patient

and the family.

 O: Oxygen therapy

Increases available oxygen; set at 2-3 LPM.

 R: Range-of-motion Exercises

Provides physical activity for the patient; if immobilized, turn him often.

 E: Educate and inform

Explain procedures and answer questions.