Myocardial

Infraction
Group 6
Aznita Nor Azmi
Petroneilah Paulus
Patricia Gamang
Siti Nor Syida Mohd musa
Rose Kartini md Derus
Defination
• A myocardial infarction (MI),commonly known
as a heart attack.
• Occurs when the blood supply to part of the
heart is interrupted causing some heart cells to
die.
• Myocardial infraction :-Kematian suatu segmen
otot jantung yang menyusuli gangguan bekalan
darah.
Pathophysiology(disease process )
• A myocardial infarction occurs when BLOCKAGE
of a CORONARY ARTERY following the
RUPTURES of a ATHEROSCLEROTIC PLAQUE
which is an unstable COLLECTION OF LIPID &
WBC(especially macrophages) in the wall of an
ARTERY.
• The resulting ISCHEMIA(restriction in blood
supply) & OXYGEN shortage,if antreated for a
sufficient period can cause damage or
death(infarction) of the heart muscle
tissue(myocardium)
Etiology (cause)

1) Older age(above 40 years)

2) Gender-male more then female.
3) Family History of heart disease(keturunan)
4) Tobacco use(smoking)
5) Obesity.
6) Stress(tekanan)
7) Lack of activity.
8) HBP(high blood pressure/hypertension)
9) HBC(high blood cholesterol)
10)Diabetes mellitus(penyakit kencing manis)
Clinical manifestation(S+S)
1) Dyspnoe(Difficulty of breathing)
2) skin
3) Nausea & vomiting
4) Chest pain
5) Fatigue &weakness
6) Heart rate(dyspnea)
7) Blood pressure
8) Anxiety
9) Temperature
10)Sense of impending doom(fear of death)
TYPES

. According to location of heart damaged.

 . Inferior infarction(depan)
 . Anterior infarction(bawah)
 . Lateral infarction(sisi)
 . Posterior infarction(belakang)
Investigation
a) Blood Urea and Serum Electrolyte(BUSE)
-to detect renal function and eletrolyte
imbalance.

b) Random blood sugar(normal: < 11.1 mmol/L)

c) Heamoglobin(HB%) - to rule out anemia

Cont…investigations(specific)
e) Cardiac enzyme – 3 times.
-to detect infarction in the heart muscle.
-Enzyme is high during infarction
i) Serum Lactate Dehydrogenase.
ii) Serum creatinine Phosphokinase.
iii) Serum Asparate Transaminase.
f) Serum Lipid Profile
-to measure the amount of cholesterol in the
body
g) Electrocardiogram (ECG)-to detect heart rhythm.
 Cont….investigation

(Pic #1) The patient (Pic #2) ECG as it

clearly has risk appears while patient is (Pic #3) The patient has
factors for having a had a MI.
coronary artery MI. During heart attack,
disease, symptoms notice the atrial &
suggestive of ventricular
angina and an spikes.
abnormal ECG.
Treatment

 Pharmachology
a).Medications:
i). Anti-emetic: -Phenergam (25mg).
-Stemetil (12.5mg).
ii). Inj.valium to sedate clients
iii). Aspirin(150mg-daily)
iv). Clopidogrel (plavix) help prevent new clots
from forming
Cont…treatment
v). Thrombolytic therapy –to dissolve blood clot.
- Streptokinase(1-5 mega unit in 50ml. N.S. in
1 hour as a anticoagulant).
vi). Nitrate : isordil (Isosorbide Dinitrate- 5-
10mgTDS).
vii). Beta Blockers – t0 reduce cardiac output and
heart rate
: propanolol (Inderal- 20- 40mgTDS).
: Atenolol (-20mg TDS).
viii). Frusemide ( -20mg daily).
Cont..treatment
b). -Iv morphine sulfhate : To reduce pain
- (1-10mg slowly)
- Oxygen therapy: to improve oxygenation
to ischemic muscle.
c). Intravenous therapy:
-For medication administration.
-For blood sampling.
-For iv infusion.
Cont…
d). Surgical
1) Coronary anginoplasty and stenting.
2) coronary artery bypass surgery.
Complications

1) Dysrhythmias.
2) Cardiogenic shock.
3) Heart failure.
4) Percarditis.
5) Papillary Muscle Dysfunstion.
6) Ventricular Aneurysm.
7) Cardiac rupture.
8) Dressler syndrome.
9) Pulmonary edema.
10)Pulmonary embolism.
Nursing Diagnosis
1) Acute pain relate to decreased coronary blood
flow causing myocardial ischemia.

GoaL:
p.t will exhibit sign of decreased pain,p.t will
exhibit sign of relaxation.
NURSING MANAGEMENT

1).INTERVENTION
i. Monitor location,duration intensity, and radiation
of pain;use a scale of ‘0 to 10’ ,To identifies types
and severity of pain.
ii. Monitor blood pressure,pulse and respiration, To
vital sign may elevate with episodes of pain.
iii. Obtain ECG as orderd, To helps prevent hypoxia.
iv. Instruct p.t to report pain at first onset, To helps
control pain quickly to prevent further ischemia.
v. Instruct p.t to rest during pain,To activity
increases oxygen demand and can increase chest
pain.
Cont….
iv). Remain with p.t to rest during chest pain until
it is relieved, To provides comfort and
reassureance to decrease anxiety and fear.
vii).Assist with alternative pain relief measures;
such as positioning,diversional activities
and,relaxtion techiniques. To these measure
help decrease painful stimuli allowing the p.t to
focus on other things.
viii).Medication as ordered, To help eliminate pain.
Nursing Diagnosis
2). Decreased cardiac output related to ischemia
or infarction,changes in heart rate and rhythm.

 GoaL:
 P.t will maintain adequate cardiac output and
tissue perfusion.
NURSING MANAGMENT
2) INTERVENTION
I. Monitor blood pressure,heart rate, and urine output, To
indirect indicator of cardiac output.
II. Listen to lung sound, To crakles indicate heart failure.
III. Monitor peripheral circulation,pulse ,capilary refill,
edema,color and temperature, To indicate of adequate tissue
perfusion.
IV. Monitor ECG, To indentifies dysrhythmias.
V. Administer medication as orderd by physicisn. Such as
vasodilators, beta blocker,calcium channel blockers and
cardiac glycosides, To helps improve contrac output, and
tissue perfusion.
VI. Promot and provide for adequate rest, quiet environment
bedrest;place in semi Fowler’s position, To decreases cadiac
workload and stress and allows for improved breating.
Nursing Diagnosis
3). Activity intolerance related to imbalance
between oxygen supply and demand,weakness
and fatigue.

GoaL;
 p.t tolerance progressive activity such as, heart
rate,blood pressure,pulse oximetry,and
respiratory rate within normal limits.
NURSING MANAGMENT
3) INTERVENTION
I. Obtain p.t’s vital signs before activity, To identifies baseline data
comparation with activity.
II. Observe p.t during and after activity and document abnormal
responses to activity which include; increased heart rate over 120
beats per minute or 20 beats over resting heart rate, increased
blood pressure over 20 mmHg systolic during activity, chest pain,
dizziness,skin color changes,diaphoresis,
dyspneo,dysrhythmias,excessive fatigue and ST segment changes
on ECG, To obeservation allow detection of abnormal responses to
stop activity.
III. Position p.t for comfort and ease breating. For semi fowler’s
position is usually preferred by p.t’s having respiratory
distress.when p.t’s are sitting upright in bed,supporting their arms
on pillows reduces the workload of the heart by eliminating the
force of gravity on unsupported arms.
Cont…
Iv). Maintain progression of activites as ordered
by physician or cardiac rehabilation program.
( >stage one activities- ADLs,dangle at
bedside for 15 minutes,use commode with
assistance)
(>stage two activities- Out of bed to chair for
30 to 60 minutes,partial bath,rom)
For the p.t should have increasing activity to
condition the myocardium.
Thank You
Any Questions ?
Thank You
Any Questions ?