45019897 Myocardial Infarction

7/29/2019 45019897 Myocardial Infarction

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MYOCARDIAL

INFARCTION


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BASE LINE DATA

Name : Mr.Venkatesh

Age : 59yrs

Sex : Male

Ip no :1169288 D.O.A : 13.07.2010

Ward : CCU

Diagnosis : Myocardial Infarction

Date of care stat : 14.07.10 Date of care end : 18.07.10


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Chief complaints:- patient came with the

history of chest pain and breathlessness since

1 day and pedal edema present over both legs.

PHOI:- patient is conscious and oriented and

he is on room ventilation maintainingsaturation upto 92%.

Past medical history:- patient known historyof HTN since 3yrs and he is on medication

like Tab Betaloc 25mg 1-0-1/2 tab.Aten 50mg

1-0-0.


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Surgical history:- there is no evidence of past and

present surgical history.

Family history:-there is no family history of CAD,

MI and any cardiac disease and also any other

communicable diseases.

Physical examination:-

CVS-ECG shows that ST segment elevation

present, bradhycardia HR-42b/m.Respiratory system:-crepitation present in left lower

lung region.

Musculo skeletal system:- pedal edema present over

both legs.


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Investigation:-Elevated CPK(177IU/mt), Troponin

positive, FBS-144mg/dl, Triglycerides-

268mg/dl,HDL-86mg/dl

ECG-ST elevation present in 2nd lead.

Echo cardiogram-Anterior wall myocardial

infarction. Coronary artery disease.

X-rayHomogenous opacity in left lower zone,

pleural effusion.


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Inj . Magnex 1gm iv BD

Tab . Imdur 30mg 1-0-1

Tab . Lasix 40mg 1-1-0

Tab . Ramipril 2.5mg 1-0-1

Tab . Atorva 10mg 0-0-1

Tab . Deplatt 75mg 0-1-0


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DEFINITION

Myocardial infarction is life threatening

condition it is also called as heart attack and

characterized by death of myocardial cells

from inadequate oxygenation often cost by a

sudden and complete blockage of coronary

artery.


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ETIOLOGY

Book picture

Atherosclerosis

Occlusion of an artery byembolus or thrombi.

Coronary artery spasm

Decreased oxygen supplydue to blood loss, anemia,low BP.

Increased demand of oxygenrapid heart rate, ingestionof coccin

Patient picture

Coronary artery disease.


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RISK FACTORS

Book picture

NON MODIFIABLE

FACTORS

1. Hereditary

2. Ageover 40 years

3. Sexmore in males

4. Raceblacks

Patient picture

Age -57yrs

Sex - male


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MODIFIABLE FACTORS

1. Book picture

2. Environment

3. Elevated serum

cholesterol

4. Hypertension

5. Cigarette smoking

6. Diabetes

Patient picture

Environment

Elevated s.cholestrol

HDL 86mg/dl,Triglyceride 286mg/dl.

HTN BP 180/100mm of

hg.


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CONTRIBUTING FACTORS

1. Obesity

2. Lack of exercise

3. Stress


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PATHOAHYSIOLOGY

Changes in the condition of plaque in the coronary artery

Activation of platelets

Formation of thrombus

Ischemia of tissue in the region supplied by the artery

Myocardial cell death

Altered repolarization of the myocardium Releases of enzymes

Myocardial irritability

Decreased contractility

Decreased left ventricular failure

Decreased cardiac output


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CLINICAL FEATURES

BOOK PICTURE

CVS:-

Chest pain

Palpitation

Increased jugular viendistention

Cardiogenic shock

ST segment and T wavechanges

ECG showstachycardia,bradycardia&dysrhythmia.

Heart failure.

PATIENT PICTURE

Chest pain

Palpitation

ST segment changes

elevated in 2nd

lead ECG shows bradycardia.

BP- 180/100mm of hg.


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RESPIRATORY SYSTEM

1. Book picture

2. Shortness of breath

3. Dyspnoea

4. Tachypnea

5. Crackles caused by

pulmonary congestion

6. Pulmonary edema

Patient picture

Dyspnoea

Crackle present in left

lower lobe of the lung.


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BOOK PICTURE

GI SYSTEM

1. Nausea2. Vomiting

GENITO URINARYSYSTEM

1. Decreased urine output

PATIENT PICTURE

Absent

Decreased urine output20ml/hr


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Book picture

SKIN

1. Cool, clammy skin

2. Pale appearance

NEUROLOGICAL SYSTEM

1. Anxiety2. Decreased cerebral

oxygenation

3. Cardiogenic shock

4. Headache, visual disturbance

PHYSIOLOGICAL

Fear

anxiety

Patient picture

Pedal edema present

Headache

Anxiety

Fear

Anxiety


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DIAGNOSTIC EVALUATION

BOOK PICTURE

History collection

physical examination

Electrocardiogram Echocardiogram

Laboratory testesCKMB, TROPONINE,

MYOGLOBIN.MRI

PATIENT PICTURE

History collection

Physical examination

ECG Echo cardiogram

LabsCKMB,TROPONIN

X-ray


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MEDICAL MANEGEMENT

GOALS

1. Prevention of further attack

2. Rehabilitation and education of the client


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ACUTE MANAGEMENT

1. Immediate admission to the hospital with in ICU

2. Pain controladministermorphine

3. Oxygen administration

4. Continuous ECG monitoring

5. Administer anti-dysrhythmias

6. Anticoagulant are given to decrease the risk of embolism

7. Thrombholytic therapy


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MEDICAL MANAGEMENT

Thrombolytic therapy:-thrombolytic are medication when are usually administeredintravenously, although some may be given directly into the coronary artery in cathlab.

The purpose of thrombolytic is to dissolves

the lyses the thrombus in a coronary artery

Allowing the blood flow through the coronary artery

Minimize the size of the the infarction Preserving the ventricular function

Thrombolytic must be administered as early as possible after the onset of thesymptoms

Eg;-streptokinase, urokinase, tissu plasminogen activator


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continued

Angiotensin converting enzyme inhibitor;-Eg;-Ramipril

Emergent percutaneous coronary intervention;-

Suspected MI may refer to percutaneouscoronary intervention. It may be used open theoccluded coronary artery. It will helps to treatthe underlying atherosclerosis lesion and alsopromote reperfusion to the area that has beendeprived by oxygen.


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Analgesics;-the analgesic of choice is

Morphine sulphate administered through IV.

Morphin reduces the pain and anxiety,and also

relaxes bronchioles to enhance oxygenation.


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COMPLICATION

1. Bleeding

2. Allergic reaction

3. Stroke

4. Dysrrhythmic

5. Cardiogenic shock

6. Heart failure

7. pericarditis


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NURSING DIAGNOSIS

1. Pain related to MI with reduced blood flow.

2. Decreased cardiac output related to MI

3. Impaired gas exchange related to decreased cardiac output.

4. Activity intolerance r/t imbalance between the oxygen

supply5. Fear and anxiety r/t hospitalization and death

6. Risk for heart failure r/t disease process.

7. Deficit knowledge r/t disease condition and treatment.


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Reference

Medical and surgical nursingJoyce .M.Black

Medical and surgical nursingBrunner and

Suddarths

Nursing drug referance - Mosby

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45019897 Myocardial Infarction

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