Myocardial infarction

 Myocardial infarction (MI)

refers to the process by which
areas of myocardial cells in the
heart are permanently destroyed.
 It occurs when myocardial

tissues are abruptly and

severely deprived of oxygen.
 Management
EARLY MANAGEMENT
 The patient’s history and 12-lead ECG are the
primary methods used to determine initially
the diagnosis of MI.
 The ECG is examined for the presence of ST
segment elevations of 1 mV or greater in
contiguous leads.
 1. Administer aspirin, 160 to 325 mg chewed.

 2. After recording the initial 12-lead ECG,

place the patient on a cardiac monitor and
obtain serial ECGs.
 3. Give oxygen by nasal cannula.
 4. Administer sublingual
nitroglycerin (unless the systolic
blood pressure is less than 90 mm
Hg or the heart rate is less than 50
or greater than 100 beats/minute).
 5. Provide adequate analgesia with
morphine sulfate. Provide adequate
analgesia with morphine sulfate.
Primary coronary intervention (PCI):
angioplasty and stenting

 PCI is the most effective alternative to reestablish

blood flow to ischemic myocardium.
 Primary PCI is an invasive procedure in which the
infarct-related coronary artery is dilated during
the acute phase of an MI without prior
administration of thrombolytic agents.
 Primary PCI may be an excellent reperfusion
alternative for patients presenting within 2 hours
of symptoms onset
 Door-to-baloon time should be attained in 60 min
interval
 Clopidogrel loading dose 300-600 mg or
ticagrelor 180 mg is given prior to the PCI. Dual
antiplatelet therapy with aspirin and clopidogrel
or ticagrelor is given afterwadrs for 12 months.
 Thrombolytic drugs lyse coronary thrombi by
converting plasminogen to plasmin.
 Thrombolytic therapy provides maximal benefit if
given within the first 3 hours after the onset of
symptoms.
 Significant benefit still occurs if therapy is given up to
12 hours after onset of symptoms.
Contraindications
■ Previous hemorrhagic stroke at any time; other
stokes
or cerebrovascular events within 1 year
■ Known intracranial neoplasm
■ Active internal bleeding (does not include menses)
■ Suspected aortic dissection
Cautions/Relative Contraindications
■ Severe uncontrolled hypertension on presentation
(blood pressure >180/110 mm Hg)
■ History of prior cerebrovascular accident or known
intracerebral disease not covered in contraindications
■ Current use of anticoagulants in therapeutic doses
(international normalized ratio [INR] ≥2:3); known
bleeding diathesis
■ Recent trauma (within 2–4 weeks), including head
trauma
or traumatic or prolonged (>10 minutes)
cardiopulmonary resuscitation (CPR) or major surgery
(<3 weeks)
■ Noncompressible vascular punctures
 ■ Recent (within 2–4 weeks) internal
bleeding
 ■ For streptokinase/anistreplase: prior
exposure (especially within 5 days to 2
years) or prior allergic reaction
 ■ Pregnancy

 ■ Active peptic ulcer

 Prophylactic antidysrhythmics during the first 24 hours
of hospitalization are not recommended.
 IV nitroglycerin is continued for 24 to 48 hours.
 Daily aspirin is continued on an indefinite basis.
 Clopidogrel or other P2Y12 antagonist is continued for
1 year.
 IV beta blocker therapy should be administered within
the initial hours of the evolving infarction, followed by
oral therapy provided there are no contraindications.
 They reduce oxygen demand by decreasing the heart
rate and contractility.
 They also increase coronary artery filling by prolonging
diastole.
 Angiotensin-converting enzyme (ACE) inhibitors
are administered to patients with anterior wall MI
and to patients who have an MI with heart failure
in the absence of significant hypotension.
 ACE inhibitors help prevent ventricular
remodeling (dilation) and preserve ejection
fraction.
 Heparin is given to patients undergoing
percutaneous or surgical revascularization and for
those receiving thrombolytic therapy with
alteplase.
 Low–molecular-weight heparin should be used for
patients with non–Q-wave MI
SURGICAL MANAGEMENT

 PTCA (Percutaneous Transluminal Coronary Angioplasty)

- a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate
unobstructed to the heart muscle.

o ATHERECTOMY

- a minimally invasive endovascular surgery technique for removing atherosclerosis from blood
vessels within the body.
- With Atherectomy the plaque is shaved off using a type of rotational blade.

o CORONARY ARTERY BYPASS GRAFT (CABG)

- Surgical treatment where saphenous vein is harvested from the lower leg and used
to bypass the occluded vessels.
General Treatment for the MI
Patient
(M O N A)

 Morphine
 O2 (Oxygen)
 Nitroglycerin
 Aspirin
Nursing Management
Promoting Oxygenation and Tissue Perfusion

- Instruct patient to avoid over fatigue; stop activity

immediately in the presence of chest pain, dyspnea,
light headedness, faintness.

- 0xygen therapy in the first 24-48h or longer if pain,

hypotension, dyspnea, dysrhythmia persist.

- Monitor VS changes.

- Position patient to Semi-Fowler’s

Promoting Adequate Cardiac Output

 Monitor:
• - Dysrhythmias, ECG tracings
• - VS
- Effects of ADL’s on cardiac status
- Rate and rhythm of pulse
 Administer pharmacotherapy as
prescribed.
 Promote rest, minimize unnecessary
disturbances.
Promoting Comfort

• Relieve pain

• Administer morphine sulfate as ordered

- To decrease sympathetic stimulation,

which increases myocardial oxygen
demand.
- Prevent shock from severe pain.
Providing Rest

- Complete bed rest

-Administer Diazepam(Valium) as ordered

- Provide psychosocial to patient and

significant others
Promoting Activity
- Gradual increase in activity after 24-
48h.

- - May be allowed to sit on chair for

increasing periods of time.

- - Monitor for signs of dysrhythmia,

chest pain, changes in VS during
activity.
Promoting Nutrition and
Elimination
- Small frequent feedings
- Low-cholesterol and low sodium diet

- Avoid use of valsalva maneuver

- Use bedside commode
- Administer stool softener as ordered
Facilitate Learning
- Start teaching when the patient is
free of pain and anxiety.

- Promote positive attitude and

active participation of patient and
significant others.