Acute Myocardial

Infarction
Anna Bianca Marie F. Watanabe | April Joy Cubil

What is
AMI?

Commonly known as a heart attack,

occurs when blood flow stops to a part
of the heart causing damage to the
heart muscle. The most common
symptom is chest pain or discomfort
which may travel into the shoulder,
arm, back, neck, or jaw.

 Chest pain not relieved by rest or nitroglycerin

Heart sounds may include S3, S4, and onset of murmur
Increased jugular vein distention (if MI has caused heart
failure)
Elevated blood pressure

Assessing
for
Myocardial
Infarction

Irregular pulse (may indicate atrial fibrillation)

Tachycardia, bradycardia or other dysrhythmias
SOB, crackles (if MI has caused pulmonary congestion)
Nausea and vomiting
Decreased urine output (may indicate cardiogenic shock)
Cool, clammy, diaphoretic and pale appearance (due to
sympathetic stimulation and may indicate cardiogenic shock)
Anxiety, restlessness, lightheadedness (decreased cerebral
oxygenation)
Fear with feeling of impending doom, or denial that anything
is wrong

Patients are
diagnosed
with one of
the
following
forms of
Acute
Coronary
Syndrome:

Unstable Angina: The patient has

clinical manifestation of coronary
ischemia, but ECG and cardiac
biomarkers show no evidence of
acute MI.
STEMI: The patient has ECG evidence of
acute MI with characteristic changes in
two contiguous leads on a 12-lead ECG.
There is significant damage to the
myocardium.
NSTEMI: The patient has elevated
cardiac biomarkers but no definite
ECG evidence of acute MI.

 12-lead ECG: T wave inversion, ST

segment elevation, abnormal Q wave
(develops within 1 to 3 days)
Echocardiogram: can detect hypokinetic and
akinetic wall motion
Laboratory Tests:

Diagnostics

There are three creatinine kinase

isoenzymes: CK-MM (skeletal muscle), CK-MB
(heart muscle), and CK-BB (brain tissue).
CK-MB increases only with cardiac damage.
Levels begin to increase within a few hours.
Myoglobin: found in cardiac and skeletal
muscle. An increase in myoglobin is not very
specific in indicating an acute cardiac event.

Troponin: three isomers C, I and T. I and T

are specific for cardiac muscle.

Normal ECG
Tracing

 Use rapid transit to the hospital

Obtain 12-lead ECG to be read within 10 minutes
Obtain laboratory blood specimens of cardiac biomarkers
Obtain other diagnostics to clarify diagnosis

Treatment
Guidelines
for AMI

Begin routine medical interventions:

Supplemental oxygen
Nitroglycerin
Morphine
Aspirin 162 to 325mg
Beta-blocker
ACE inhibitor within 24 hours
Anticoagulation with heparin and platelet
inhibitors
Evaluate for indications for reperfusion therapy: PCI or
thrombolytic
Continue therapy as indicated:
Intravenous heparin or LMWH
Clopidogrel
Glycoprotein IIb/IIIa inhibitor

 Ineffective cardiac tissue perfusion

related to reduced coronary blood flow
Risk for imbalanced fluid volume

Nursing
Diagnoses

Risk for ineffective peripheral tissue

perfusion related to decreased cardiac
output from left ventricular dysfunction
Death anxiety related to cardiac event
Deficient knowledge about post ACS self
care

Biancas
Quotable
Quote of
the Day: