Myocardial Infarction

Definition: irreversible death (necrosis) of heart muscle

secondary to prolonged lack of oxygen supply (ischemia)
Anatomy and Physiology:

Etiology:
Predisposing Factors
90% of myocardial infarctions (MIs) result from an
acute thrombus that obstructs an atherosclerotic
coronary artery (endothelial dysfunction, vascular
inflammation, and the buildup of lipids, cholesterol,
calcium, and cellular debris within the intima of the
vessel wall)
Hyperlipidemia, DM, HPN
Age, Sex, Family History
Precipitating Factors
Smoking, Sedentary lifestyle, Drug use
Symptomatology:
Fatigue, Malaise, Pain that radiates up to the neck,
shoulder, and jaw and down to the ulnar aspect of
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

Medical Management:
Laboratories:
Cardiac biomarkers/enzymes: Troponin levels,
Creatine kinase (CK) levels, Myoglobin levels
Complete blood count
Lipid profile

C-reactive protein and other inflammation markers

Electrocardiography - It is confirmatory of the
diagnosis in approximately 80% of cases.
Cardiac imaging
Medical:
Antianginals: nitroglycerin useful for pain control by
coronary vasodilating effects, which increase
coronary blood flow and myocardial perfusion.
Beta-blockers: propranolol important second-line
agents for pain control through effect of blocking
sympathetic stimulation, thereby reducing heart rate,
systolic BP, and myocardial oxygen demand.
Aspirin prevents blood clot
Surgical:
percutaneous coronary intervention (PCI), or
coronary artery bypass graft (CABG) surgery
Prognosis:
Fair
Successful early reperfusion (ST-elevation MI [STEMI]
goals: patient arrival to fibrinolysis infusion within 30
minutes OR patient arrival to percutaneous coronary
intervention [PCI] within 90 minutes)
Preserved left ventricular function
Short-term and long-term treatment with betablockers, aspirin, and angiotensin-converting enzyme
(ACE) inhibitors
Poor
Advanced age
Diabetes mellitus
Previous vascular disease (eg, cerebrovascular
disease or peripheral vascular disease)
Elevated thrombolysis in MI (TIMI) risk score for
unstable angina/nonST elevation acute coronary
syndrome (NSTE-ACS) Delayed or unsuccessful
reperfusion
Poorly preserved left ventricular function (the
strongest predictor of outcome)
Nursing Diagnosis:
Ineffective tissue perfusion related to reduced
coronary blood flow
Decreased cardiac output related to altered
myocardial contractility
Potential impaired gas exchange related to fluid
overload
Pain related to tissue ischemia
Nursing Management:
1. Monitor and document characteristic of pain, noting
verbal reports, nonverbal cues (moaning, crying,
grimacing, restlessness, diaphoresis, clutching of
chest) and BP or heart rate changes.
2. Instruct patient to do relaxation techniques: deep
and slow breathing
3. Administer supplemental oxygen by means of nasal
cannula or face mask, as indicated
4. Maintain strict CBB WBP
5. Administer pain medications as prescribed by the
doctor
6. Provide emotional support, and help reduce stress
and anxiety.
7. Check blood pressure after giving nitroglycerin,
especially during first dose.
8. Thoroughly explain the medication and treatment
regimen.
9. Review dietary restriction with the patient.
10. Refer to cardiac rehabilitation program.