This document provides information about critical care nursing related to myocardial infarction (MI) or heart attack. It begins with an introduction to MI, defining it as the death of heart muscle tissue due to obstructed blood flow. It then discusses the causes of MI including cholesterol, saturated fats, and risk factors like hypertension. The document outlines the diagnostic measures for MI and treatments including medications to relieve pain, reduce workload on the heart, and prevent clotting. Potential complications of MI are also listed.

1. 01/08/15 ABDULLAH KHAMIS NGWALI 1
 CRITICAL CARE NURSING
 PRESENTED BY:
 ABDULLAH KHAMIS NGWALI
 BSc.N ,STUDENT
 SUPERVISED BY : MADAME RAHMA

2. 01/08/15 2CRITICAL CARE
At the end of session each student
should be able to:-
Define Myocardial infarction
Explain causes of Myocardial
infarction
List the Pre-disposing factors of
Myocardial infarction
Describe the pathophysiology of
Myocardial infarction

3. Identify the diagnostic measures of
Myocardial infarction
Explain the medical treatment of
Myocardial infarction
Explain general nursing management of
Patient with Myocardial infarction
Describe nursing care plan of patient
with Myocardial infarction01/08/15 CRITICAL CARE 3

4. 01/08/15 CRITICAL CARE 4
Normal Heart

5. Myocardial infarction is commonly known as a
heart attack, “Myo” means muscle “cardial”
pertains to the heart and “infarction” means
death of tissue due to lack of blood supply.
The heart like any organ requires blood for
oxygen and other nutrients, so it can do its work.
01/08/15 5CRITICAL CARE

6.  The heart does not gather oxygen or
nutrients from the blood flowing inside
it. Instead, it receives blood from
coronary arteries that eventually carry
blood into the heart muscle.
 A heart attack occurs when blood
vessels that supply blood to the heart
are blocked, preventing enough oxygen
from getting to the heart. The heart01/08/15 CRITICAL CARE 6

7. 01/08/15 CRITICAL CARE 7
Coronary Arteries for the heartCoronary Arteries for the heart

8.  Myocardial infarction (MI) or heart attack is a
medical emergency condition in which the blood
supply to the heart suddenly reduces or stop,
causing the myocardium to die from lack of
oxygen.
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9. 01/08/15 CRITICAL CARE 9
 Heart is the main organ in cardiovascular
system, which includes different types of
blood vessels.
 Some of the most important vessels in
your body are the Coronary arteries. They
take blood, rich in oxygen, to every location
in the body.
 When arteries become blocked or
restricted by buildup, they can cause blood

10. 01/08/15 10
Several factors may cause a heart attack:
Bad Cholesterol: -
 Also called low-density lipoprotein (LDL), is
one of the leading problems that cause
blockage.
 Cholesterol can stick to the walls of the arteries
and produce plaque. Plaque is a hard matter
that blocks blood flow in the arteries.

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Saturated Fats (found mostly in meat):-
 May contribute to the buildup of plaque in the
coronary arteries.
 Saturated fat may lead to acute myocardial
infarction by increasing the amount of bad
cholesterol in the blood system and reducing the
good HDL (high-density lipoprotein)
cholesterol.

12. Certain risk factors may make to susceptible for
heart attack which includes:-
High Blood Pressure
Obesity
Diabetes or High Blood Sugar
Smoking
Overweight
Excessive alcohol intake
Stress
01/08/15 CRITICAL CARE 12

13.  The most common cause of an MI is a
blood clot (thrombosis) that forms inside
a coronary artery, or one of its
branches.
 This blocks the blood flow to a part of
the heart.
 Blood clots do not usually form in
normal arteries. However, a clot may01/08/15 CRITICAL CARE 13

14.  Atheroma is like fatty patches or
plaques that develop within the inside
lining of arteries. (This is similar to
water pipes that get furred up.)
 Plaques of atheroma may gradually
form over a number of years in one or
more places in the coronary arteries.
 Each plaque has an outer firm shell with01/08/15 CRITICAL CARE 14

15.  What happens is that a crack develops in the outer shell of
the atheroma plaque. This is called plaque rupture.
 This exposes the softer inner core of the plaque to blood.
 This can trigger the clotting mechanism in the blood to
form a blood clot. Therefore, a build-up of atheroma is the
root problem that leads to most cases of Myocardial
Infarction.
01/08/15 CRITICAL CARE 15

16. 01/08/15 GROUP NO.1 CRITICAL CARE 16
The diagram below shows four patches of atheroma as an
example. However, atheroma may develop in any section
of the coronary arteries.

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18. SIGNS: Physical signs
 Signs of Sympathetic activation (e.g. pallor,
sweating tachycardia)
 Signs of vagal activation (e.g. nausea, vomiting,
bradycardia)
 Signs of impaired myocardial function (e.g.
hypotension, oligurea, cold peripheries)
 Signs of complication (mitral, regurgitation,
pericarditis)
01/08/15 CRITICAL CARE 18

19. SYMPTOMS
 Chest pain is a major symptom of heart attack.
Pain may be felt in only one part of your body,
or it may move from your chest to your arms,
shoulder, neck, teeth, jaw belly area or back.
The pain can be severe or mild.
 Other symptoms of a heart attack includes:-
01/08/15 CRITICAL CARE 19

20.  Anxiety
 Cough
 Fainting
 Light headedness
 Dizziness
 Nausea or vomiting
 Shortness of breath
 Sweating which may be
extreme
 Palpitation (feeling like
your heart is beating
too fast or irregularly.
01/08/15 CRITICAL CARE 20
SYMPTOMS

21. 01/08/15 CRITICAL CARE 21
Some people (the elderly, people with diabetes and
women) may have little or no chest pain, or they
may experience unusual symptoms (shortness of
breath, fatigue, weakness)
Note: - A silent heart attack is a heart attack with
no symptoms (ischemia).

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Back view
Diagram of pain zones in myocardial
infarction; dark red: most typical area,
light red: other possible areas; view of
the chest

23. Diagnostic measures based on:-
Medical history/symptoms
Physical examination
Test results
01/08/15 CRITICAL CARE 23

24.  The history includes a description of the pain with
regard to location, type, duration, intensity, and
whether it radiates to other areas, such as down the
arm or to the jaw.
 A medical history, including a drug history, also is
important because other disorders, such as diabetes
mellitus and hypertension, may alter or require
additional treatment modalities.
01/08/15 CRITICAL CARE 24
Medical history/symptoms

25.  Monitor vital signs frequently. Acuscultate heart
and lungs, and assess peripheral pulses with
particular attention to their amplitude. Note pallor,
diaphoresis, nausea, cyanosis, and apprehension.
 Monitor cardiac output by assessing urine volume
and color.
01/08/15 CRITICAL CARE 25
Physical examination

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CRITICAL CARE
26
Test results
Electrocardiogram (ECG):-
 This is the recording of the electrical activity of the
heart.
 Abnormalities in the electrical activity usually occur
with heart attacks and can identify the areas of the
heart muscle that are deprived of oxygen and or areas
of the muscle that have died.
 Use 12 leads ECG in myocardial infarction ST-T
wave elevated by greater than 1 mm or more in two
continuous lead.

27. 01/08/15 GROUP NO.1 CRITICAL CARE 27

28. Blood test (Cardiac enzymes)
 A blood test that measures a chemical called tropinin
is the usual test that confirms Myocardial Infarction.
 This chemical is present in heart muscles cells.
 Damage to heart muscles cells releases tropinin into
the blood stream.
 In MIs the blood level of tropinin increases 3-12hrs
from the onset of chest pain, peaks at 24-48hrs and
returns to a normal level over 5-14days.
01/08/15 CRITICAL CARE 28
Test results

29. Coronary angiography:
 A coronary angiogram is a procedure that uses
special dye (contrast material) and X-ray imaging
to see your heart's blood vessels.
 Coronary angiograms are part of a general group of
procedures known as heart (cardiac) catheterization.
01/08/15 CRITICAL CARE 29
Test results

30.  During a coronary
angiogram, a type of dye
that's visible by an X-ray
machine is injected into the
blood vessels of your heart.
 The X-ray machine rapidly
takes a series of images
(angiograms), offering a
detailed look at the inside of
your blood vessels.
01/08/15 CRITICAL CARE 30
Test results- coronary angiogram

31. Another testing may include: -
 Nuclear scan
 Exercise stress test.
 Echocardiogram
 Chest radiographs
 Cardiac computerized tomography (CT) or
magnetic resonance imaging (MRI).
01/08/15 CRITICAL CARE 31

32.  Initial management of the patient with Myocardial
Infarction is best to accomplished in a cardiac
care unit (CCU) or intensive care unit (ICU),
where constant monitoring is available.
 Treatment is directed toward reducing tissue
hypoxia, relieving pain, treating shock (if
present), and correcting arrhythmias if they occur.
01/08/15 CRITICAL CARE 32

33. Drugs Used in the Treatment of Myocardial
Infarction includes:-
 Analgesics: - Therapy includes Morphine to relief
and control pain; improve cardiac hemodynamic by
reducing preload and after load.
Dose:- 2- 4mg, IV in every 5 minute diluted in sodium
chloride solution until pain relief
Note: - those who are allergic to morphine, meperdine
may be giving to avoid respiratory depression.
01/08/15 CRITICAL CARE 33

34.  Acetylsalicylic acid soluble 300mg, oral
immediately, followed by 150mg daily
 Isosobide dinitrate 5mg,sublingual,
immediately
Analgesics: Cont’

35.  Nitrates or Nitroglycerin: - Therapy includes
Relieves chest pain by dilating coronary arteries,
Re-establishes blood flow around thrombi.
 Diuretics Furosemide (Lasix):- Decreases work of
the heart by promoting the excretion of sodium and
water thus reducing circulating blood volume.
Dose:-20mg-40mg daily od PO or 80mg IV od
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36.  Anticoagulants (Heparin sodium -Hepalean):-
Therapy includes Inhibits thrombus and clot
formation by blocking the conversion of
prothrombin to thrombin and fibrinogen to fibrin.
Dose :-500Iu,8hly in the acute phase and then Wafarin
5-10mg oral, in 24hrs.
 Sedatives (Benzodiazepine):- therapy includes
promoting rest and reduces anxiety.
01/08/15 36

37.  Beta-adrenergic Blockers Propranolol (Inderal):-
Therapy includes Prevents or inhibits sympathetic
stimulation, decreasing myocardial oxygen demand.
Used to prevent angina attacks. Dose 60-240mg
three times a day
01/08/15

38. Note: - Complete bed rest is prescribed but is not
recommended for uncomplicated MIs after the first 24
hours.
Activity is adjusted according to the extent of the MI, the
occurrence of complications, and the client’s response
to therapy.
 Smoking is forbidden during the acute phase and
permanent cessation is advised. Intake of fat, sodium,
and calories are restricted.
01/08/15 38

39.  Allow client to express fears and anxieties.
 Carry out procedures in a calm, relaxed manner.
 Promote uninterrupted time for clients to rest,
sleep, or visit with family members
01/08/15 39

40.  Check on client frequently and answer call
promptly.
 Acknowledge feelings of grief over perceived or
actual lost lifestyles.
 Administer sedatives and antianxiety
medications as indicated.
01/08/15 40

41. 01/08/15 CRITICAL CARE 41

42. 01/08/15 42
 Diastolic dysfunction
 Systolic dysfunction
 Heart failure
 Cardiogenic
shock/hypotension
 Right ventricular
infarction
 Myocardial repture
 Pericarditis
 Pericardial effusion
 Dressler’s syndrome
MYOCARDIAL
COMPLICATION
PERICARDIAL
COMPLICATION

43.  Recurrent ischemia
 Recurrent infarction
 Left ventricular free
wall repture
 Ventricular septal
repture
 Papillary muscle
repture withacute
mitral regurgitation
01/08/15 ABDULLA KHAMIS NGWALI
43
VASCULAR
COMPLICATION
MECHANICAL
COMPLICATION

44.  Ventricular
tachycardia
 Ventricular
fibrillation
 bradydysrhythmias
 Mural thrombosis
 Systemic
thromboembolism
 Pulmonary
embolism
01/08/15 44
ELECTRICAL
COMPLICATION
THROMBOEMBOLIC
COMPLICATION

45. 01/08/15 ABDULLA KHAMIS NGWALI 45

46. 01/08/15 46
Barbara.K, Glenora.E, Audrey. B & Shirlee.S (2004), Fundamentals
of nursing. Concepts process and practice. Textbook. (7th
Ed): New
Jersey.
Bickey L.S. (2003), Bates Guide to Physical Examination.
Textbook. (8th
Ed): Elsevier St Louis, Missouri.
Brunner & Suddarth (2010). Medical- Surgical Nursing. (10th
Ed.)
Lippincott: Wilkins.
Fausi. B. (1998), Principles of internal medicine. Volume 2, page
1419-1426. Textbook. (14th
Ed): New York. St Louis.
Luckman J. (2004) Medical- Surgical Nursing.Volume 4, page 390-
397 Textbook. (3th
Ed): Elsevier St Louis, Missouri.