ERA UNIVERSITY COLLEGE OF NURSING

LUCKNOW

SEMINAR
ON
“MYOCARDIAL INFARCTION”

SUBMITTED TO-: SUBMITTED BY-:

Ms. GODHULI GOSH DEEPANSHI MASIH

ASSISSTENT PROFESSOR M.Sc. NURSING 1ST YR.

ECON ECON

LUCKNOW LUCKNOW
MYOCARDIAL INFARCTION
INTRODUCTION
A myocardial infarction (MI), also known as a heart attack, occurs when blood flow
decreases or stops to a part of the heart, causing damage to the heart muscles. It often occurs
in the centre or left side of the chest and lasts for more than a few minutes. About 30% of
people have a typical symptom. Women more often present without chest pain and instant
have neck pain, arm pain or feel tired. Among those over 75 years old, about 5% have had an
MI with little or no history of symptoms. An MI may cause heart failure an irregular
heartbeat, cardiogenic shock or cardiac arrest.

DEFINITION
1. MI is defined as a diseased condition which caused by reduced blood flow in a
coronary artery due to atherosclerosis and occlusion of an artery by an embolus or
thrombus.
2. MI or heart attack is the irreversible damage of myocardial tissue caused by
prolonged ischemia and hypoxia.
3. Acute myocardial infarction (MI) is a clinical syndrome that results from occlusion
of a coronary artery, with resultant death of cardiac myocytes in the region supplied
by that artery.

INCIDENCE
 In industrial countries MI accounts for 10.25% of all deaths.
 Incidence is higher in elderly people, about 5% occurs at people under age 40.
 Males have higher risk.
 Women during reproductive period have low risk.
 Over last 30 years the rate of disease increased from 2 – 6 % in rural population and 4
– 12 % in urban population.

CLASSIFICATION
The three types of MI are-:
1. ST segment elevation myocardial infarction (STEMI)
2. Non-ST segment elevation myocardial infarction (NSTEMI)
3. Coronary spasm, or unstable angina.

A. ST-SEGMENT ELEVATION MYOCARDIAL

INFARCTION(STEMI) – A STEMI occurs when coronary artery becomes
completely blocked and a large portion of the muscles stops receiving blood. It is a
serious heart attack that can cause significant damage. A STEMI has the classic
symptoms of pain in the center of the chest. This chest discomfort may be described
 as a pressure or tightness rather than a sharp pain. Some people who experience
STEMIs also describe feelings pain in one or both arms or their back, neck or jaw.
B. NON-ST SEGMENT ELEVATION MYOCARDIAL INFARCTION
(NSTEMI)- Unlike in a STEMI, the affected coronary artery is only partially
blocked in a NSTEMI. A NSTEMI wont show any change in the ST segment on the
electrocardiogram. A coronary angiography will show the degree to which the artery
is blocked. A blood test will also show elevated troponin protein levels. While there
may b less heart damage, an NSTEMI is still a serious condition.
C. CORONARY SPASM OR UNSTABLE ANGINA -: The coronary artery
spasm is also known as a coronary spasm, unstable angina, or silent heart attack. It
occurs when one of the heart arteries tightens so much that blood flow stops or
becomes drastically reduced. Only imaging and blood test results can tell if the patient
had a silent heart attack. There is no permanent damage during a coronary artery
spasm. While silent heart attacks aren’t as serious, they do increase the risk of another
heart attack or one that may be more serious.

ETIOLOGY
 Acute coronary thrombosis
 Atherosclerosis rupture
 Hypoxia / hypoxemia
 Vasospasm

RISK FACTORS
I. NON-MODIFIABLE RISK FACTORS
1.AGE: -More than 40 years
2.FAMILY MEMBER: -Myocardial infarction can be inherited from parents to
children.
3.GENDER: - MI is 3 times more in men than women.

II. MODIFIABLE RISK FACTORS

 High blood pressure
 High blood lipids levels
 Smoking
 Physical inactivity
 Obesity
 Diabetes mellitus
 Stress
PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS
1. Chest pain / chest discomfort

 CHARACTERSTICS – Severe, immobilizing usually described as heaviness,

pressure, tightness, burning
 LOCATION -substernal, retrosternal orepigastric
 RADIATION- It may radiate to neck, jaw, arm, back
 DURATION -Lasts for 20 minutes or more

2. Dyspnea
3. Fatigue
4. OTHER SYMPTOMS INCLUDE-

 Increased sweating
 Weakness
 Nausea
 Vomiting
 Light headedness
  Palpitations

5. Anxiety, sleeplessness, hypertension or hypotension, arrhythmia

COMPLICATIONS
1. Arrhythmia
2. Cardiogenic shock
3. Congestive heart failure
4. Thromboembolism
5. Rupture
6. Cardiac aneurism
7. Pericarditis

DIAGNOSTIC STUDIES
1. History taking and physical examination
2. Electrocardiogram – ECG provides information that assists in diagnosing acute MI.
The classic ECG changes are :-
 T- wave inversion
 ST – segment elevation
 Abnormal Q wave

3. SERUM CARDIAC MARKERS-

 Myocardial cells produce certain proteins and enzymes associated with
cellular functions.
  When cell death occurs these cellular enzymes are released into the blood
stream.

A. CPK

 Creatine phosphokinase
 Begin to rise 3 to 12 hours after acute MI
 Peak in 24 hours
 Return to normal in 2 to 3 days

B. TROPONIN

 Myocardial muscles protein released into circulation after injury

 These are highly specific indicators of MI
 Troponin rises quickly like CK but will continue to stay elevated for 2 weeks

C. MYOGLOBIN

 Lack cardiac specificity

 Rises in 1-4 hours
 Returns to normal within 24 hours
4. Magnetic resosance imaging (MRI)
5. Angiography
6. Positron emission tomography (PET-scan)
7. Chest X-ray

MANAGEMENT
MEDICAL MANAGEMENT- The goal of medical management is to
i. Minimize myocardial damage
ii. Presence myocardial function and prevent complications
PHARMACOLOGICAL MANAGEMENT- The patient with suspected MI given
1) Aspirin
2) Betablockers
3) Thrombolytics:- Thrombolytics are usually administered IV, although some may
also be given directly into the coronary artery in cardiac catheterization.
The purpose of thrombolytics is to dissolve analyse thrombus in a coronary artery
allowing blood to flow through the coronary artery again, ministering the size of
the infarction and preserving ventricular functions.
Thrombolytics should not be used if the patient is bleeding or has a bleeding
disorders, and should be administered as early as possible after the onset of
symptoms that indicate an acute MI, generally within 3 to 6 hours
4) Analgesics morphine sulphate administered in IV boules to reduce pain and
anxiety
5) Angiotensin-converting enzymes inhibitors (ACE inhibitors)

SURGICAL MANAGEMENT
a) Intra – aortic balloon pump
b) Percutaneous coronary intervention / angioplasty
c) Transmyocardial laser revascularization
d) Coronary artery by – pass (ABG)
e) Minimal invasion direct coronary artery by pass

NURSING MANAGEMENT
Nursing management of acute myocardial infarction arms to help the patient overcome
various physical and psychological insults. Therapeutic goals are designed to promote healing
of the damaged myocardium, prevent complication and facilitate the patients return to normal
health and lifestyle.

THEORY APPLICATION
OREM’S THEORY
AIR Decreased cardiac Ineffective tissue perfusion related to
tissue perfusion thrombus in coronary artery.

NUTRITION Severe pain and Risk for constipation related to bedrest,

NBM status pain medication and NBM status

WATER

ACTIVITY AND Pain in chest and Acute pain related to myocardial

REST anxiety ischemia resulting from coronary artery
occlusion

SOCIAL Initiability and Risk for activity intolerance related to

INTERACTION generalyzed imbalance between oxygen supply and
weakness demand

PREVENTION OF Dysrrythmias Dysrythmias related to electrical

HAZARDS instability or irritability secondary to
inforced tissue.

NURSING DIAGONIS
1. Risk for bleeding related to coagulopathies with thrombolytic therapy
2. Anxiety and fear related to hospital admission and fear of death
3. Ineffective health maintenance related to MI and implications for lifestyle changes.

HEALTH EDUCATION
1. Proper medication compliance (right dose and right time)
2. Perform exercise
3. Do not smoke
4. Follow the diet plan
5. Maintain a healthy weight
6. Manage the stress
7. Signs and symptoms to be reported

RESEARCH INPUT
Myocardial infarction patients learning needs: “perceptions of patients, family members and
nurses.”
International journal of nursing sciences – by Emil Huriani

PURPOSE- This descriptive study aimed to identify and compare patient with myocardial
infarction, their family member, and cardiac nurse perception on the learning needs of
patients with myocardial infarction in the acute, sub-acute, and post-acute phase.

METHODS- A total of 288 patients with myocardial infarction, 145 family members, and
40 cardiac unit nurses were enrolled in this study. Data were collected by survey method
using the cardiac patient learning need inventory (CPLNI).

RESULTS- The results showed that the learning needs of patients with myocardial
infarction were high according to the perceptions of patients, patients family members, and
nurses. There were differences in the priority of learning that the patient need in relation to
the disease and healing process.

CONCLUSION-Patients, family members, and nurses have different perceptions

regarding the learning needs of patients with myocardial infarction. To create adequate
intervention to meet patient’s learning needs, there should be an accurate assessment. The
results of this study support the importance of patient- centered, individualized education and
attention to learning priorities.

CONCLUSION
MI is a life threatening disease caused by many factors. Health education must be given to
the patients with predisposing or risk factors to prevent it. Early diagnosis is also very
important for saving the life of the patient.

“ PREVENTION IS BETTER THAN CURE”

BIBLIOGRAPHY
 Burner and suddarths, textbook of medical surgical nursing
Volume 2; 13th edition
Wolters Kluwer publication
Page no. 1416-1461

 Lewis, medical surgical nursing

Volume 2; 3rd edition
ELSEVIER publication
Page no.674-730