PREPARED BY:

MICHELLE C. ADOPTANTE
MYOCARDIAL INFARCTION
 Is the medical term for an event commonly known as
Heart Attack.
 It happens when blood stops flowing properly to part of
the heart and the heart muscles is injured due to not
enough oxygen.
 Usually this is because one of the coronary arteries that
supplies blood to the heart develops a blockage due to an
unstable buildup of white blood cells, cholesterol and fat.
 The event is called “acute” if it is sudden and serious.
SIGNS AND SYMPTOMS
 Chest Discomfort
 The early signs of heart attack include pain in the chest.
But not all the heart attacks cause chest pain, and chest
pain can stem from other disorders that have nothing to do
with the heart. The Heart-related severe chest pain is
centered under the breastbone. The pain can also be an
uncomfortable sensation of squeezing, pressure, or
fullness.
SIGNS AND SYMPTOMS
 Cough
 Persistent wheezing or coughing can be one of the most
important heart attack signs- a result of fluid accumulation
in the lungs. In many cases, people with a heart failure
cough up bloody phlegm.
 Anxiety
 Heart attack can cause intense anxiety or extreme fear of
death. The Heart attack survivors often talk about having
experienced a sense of “impending doom.”
SIGNS AND SYMPTOMS
 Dizziness
 Heart attacks can cause loss of consciousness and
lightheadedness, so can potentially dangerous heart
rhythm abnormalities, commonly known as arrhythmias.
An arrhythmia is an irregular heartbeat; heart can beat too
fast, too early, too slowly, or too irregularly. Arrhythmias are
heart rhythm problems; they occur when the electrical
impulses to the heart that always coordinate heartbeats are
not acting properly, making the heart beat too slow/fast or
inconsistently.
SIGNS AND SYMPTOMS
 Fatigue
 Among men and women, unusual fatigue can occur during
a heart attack. And feeling extremely tired all the time can
be a symptom of heart failure. Of course, one can also
feel fatigued or tired for several other reasons. If one does
not feel well and all the wind is knocked out of the sails, do
not ever try to figure it out on the Internet or from a book.
Wasting time is dangerous.
SIGNS AND SYMPTOMS
 Nausea or lack of appetite
 It is not uncommon for men and women to feel sick to the
stomach or throw up during a heart attack. Abdominal
swelling associated with the heart failure can interfere with
the appetite.

 Pain in other parts of the body

 In many heart attacks, pain commences in the chest and
spreads to the arms, shoulders, elbows, neck, jaw, back, or
abdomen. But many times there is no chest pain, just pain
in these other body portions such as one or both arms, or
between the shoulders. The severe pain might come and go.
 SIGNS AND SYMPTOMS
 Rapid or irregular pulse
 Doctors say that there is usually nothing worrisome about an
occasionally skipped heartbeat. But an irregular or rapid pulse,
especially when accompanied with dizziness, weakness, or
shortness of breath can be evidence of a heart failure, heart
attack, or an arrhythmia. Left untreated, some arrhythmias can
lead to heart failure, stroke or sudden death.

 Shortness of Breath
 Men and women who feel winded at rest or with minimal
exertion may have a pulmonary complaint such as asthma or
chronic obstructive pulmonary disease (COPD). But
breathlessness can also indicate a heart attack or heart failure.
 Many times people having a heart attack do not have chest
pain or pressure but feel extremely short of breath. It is like
they have just run a marathon when they have not even
moved. During a heart attack, the shortness of breath often
accompanies extreme chest discomfort, but it can also
occur before or without chest discomfort.

 Sweating
 Breaking out in a cold sweat is the most
common symptom of heart attack. Doctors say, “You
might be sitting in an easy chair when all of a sudden you
are sweating like you had just worked out”.
INTERVENTION
 M- stands for morphine
 O- is for oxygen
 N- is for nitrates
 A- stand for aspirin
SIGNS AND SYMPTOMS
 Swelling
 Heart attack can cause the fluid to accumulate in the body.
This can cause swelling (often in the ankles; feet, legs, or
abdomen) as well as sudden weight gain and many times a
loss of appetite.
 Weakness. In the days leading up to a heart failure, as well
as during one, some men and women experience
unexplained, severe, weakness. Some women told that it
felt like they couldn’t hold a piece of paper between their
fingers.
NURSING DIAGNOSIS
 Decreased Cardiac Output
related to:
changes in the frequency of heart rhythm.

 Impaired Tissue Perfusion

related to:
decrease in cardiac output.

 Ineffective Airway Clearance

related to:
accumulation of secretions.

 Ineffective Breathing Pattern

related to:
lung development is not optimal.
NURSING DIAGNOSIS
 Impaired Gas Exchange
related to:
pulmonary edema.
 Acute Pain
relate to:
increase in lactic acid.
 Fluid Volume Excess
related to:
retention of sodium and water.
NURSING DIAGNOSIS
 Activity Intolerance
relate to:
imbalance between myocardial oxygen supply and needs.
 Self-Care Deficit
related to:
physical weakness.
 Knowledge Deficit
related to:
lack of information.
 DIAGNOSTIC TEST
1. ECG: trace the electrical signals in the heart and testing
the blood for substances associated with damage to the
heart muscle. Common blood tests are creatinekinase
(CK-MB) and troponin, ECG testing is used to
differentiate between two types of MI based on the
shape of the tracing . When the ST section of the tracing
is higher than the baseline it is called an ST-elevation
myocardial infarction (STEMI) which usually requires
more aggressive treatment. Immediate treatments for a
suspected myocardial infarction include aspirin,
With prevents further blood clotting, and sometimes
nitroglycerin to treat chest pain and oxygen.

• STEMI is treated by restoring circulation to the heart,

called reperfusion therapy, and typical methods are
angioplasty, where the arteries arepushed opened and
thrombolysis where the blockage is removed using
medications.
• Non-ST elevation myocardial infarction (NSTEMI)
May be managed with medication, although
angioplasty may be required if the person is
considered to be at high risk,
 People who have multiple blockages of their coronary
arteries, particularly if they also have diabetes, may
also be treated with bypass surgery (CABG)
 Ischemic heart disease, with includes myocardial
infarction, angina and heart failure when it happens
after myocardial infarction, was the leading cause o
death for both men and women worldwide in 2011.

 TROPONIN T AND I
 these isoform are very specific for cardiac injury.
 Preferred markers for detecting myocardial cell injury
 Rise 2-6 hours after injury
 Peak in 12-16 hours
 stay elevated for 5-14 days
 Creatinine kinase is found in heart muscle (MB),
skeletal muscle (MM), and brain (BB).
 Increased in over 90% of myocardial infarction
 however, it can be increased in muscle trauma,
physical exertion, post-op, convulsion, and other
conditions.
COMPLICATION
 ARRHYTHMIAS
 Since the electrical characteristics of the infarcted tissue
change, arrhythmias are a frequent complication.[6]The re-
entry phenomenon may cause rapid heart rates (ventricular
tachycardia and even ventricular fibrillation), and ischemia
in the electrical conduction system of the heart may cause
a complete heart block (when the impulse from
the sinoatrial node, the normal cardiac pacemaker, does
not reach the heart chambers).
COMPLICATION
 CARDIOGENIC SHOCK
 A complication that may occur in the acute setting soon
after a myocardial infarction or in the weeks following
is cardiogenic shock. Cardiogenic shock is defined as a
hemodynamic state in which the heart cannot produce
enough of a cardiac output to supply an adequate amount
of oxygenated blood to the tissues of the body.

 RUPTURE of the necrotic heart tissue, particularly in

hypertensive patients or with ventricular aneurysm. This
usually develops 3 to 7 days after the MI.
COMPLICATION
 CONGESTIVE HEART FAILURE
 A myocardial infarction may compromise the function of
the heart as a pump for the circulation, a state called heart
failure. There are different types of heart failure; left- or
right-sided (or bilateral) heart failure may occur depending
on the affected part of the heart, and it is a low-output type
of failure. If one of the heart valves is affected, this may
cause dysfunction, such as mitral regurgitation in the case
of left-sided coronary occlusion that disrupts the blood
supply of the papillary muscles. The incidence of heart
failure is particularly high in patients with diabetes and
requires special management strategies.
COMPLICATION
 PERICARDITIS
 As a reaction to the damage of the heart
muscle, inflammatory cells are attracted. The
inflammation may reach out and affect the heart sac.
This is called pericarditis. In Dressler's syndrome, this
occurs several weeks after the initial event.
TREATMENT
 Angioplasty: Special tubing with an attached deflated
balloon is threaded up to the coronary arteries.
 Angioplasty, Laser: Similar to angioplasty except that the
catheter has a laser tip that opens the blocked artery.
 Artificial Heart Valve Surgery: Replaces an abnormal or
diseased heart valve with a healthy one.
 Atherectomy: Similar to angioplasty except that the
catheter has a rotating shaver on its tip to cut away plaque
from the artery.
 Bypass Surgery: Treats blocked heart arteries by creating
new passages for blood to flow to your heart muscle.
 Cardiomyoplasty: An experimental procedure in which
skeletal muscles are taken from a patient's back or
abdomen.
TREATMENT
 Heart Transplant: Removes a diseased heart and replaces it
with a donated healthy human heart.
 Minimally Invasive Heart Surgery: An alternative to standard
bypass surgery.
 Radiofrequency Ablation: A catheter with an electrode at
its tip is guided through the veins to the heart muscle to
destroy carefully selected heart muscle cells in a very small
area.
 Stent Procedure: A stent is a wire mesh tube used to prop
open an artery during angioplasty.
 Trans myocardial Revascularization (TMR): A laser is
used to drill a series of holes from the outside of the heart
into the heart's pumping chamber.
PROGNOSIS
 Acute myocardial infarction (MI) is associated with a 30%
mortality rate; about 50% of the deaths occur prior to
arrival at the hospital. An additional 5-10% of survivors die
within the first year after their myocardial infarction.
Approximately half of all patients with an MI are
rehospitalized within 1 year of their index event.
 Overall, prognosis is highly variable and depends largely
on the extent of the infarct, the residual left ventricular
function, and whether the patient underwent
revascularization.