MYOCARDIAL INFARCTION AND
HEART FAILURE
BY DR MADIHA EHSANULHAQ
Cardiovascular diseases
• Are one of the major cause of death
• Heart attack /Myocardial infarction is still the
leading cause of death of cardiovascular
diseases
• Myocardium-heart muscle,infarction-
coagulative necrosis/cell death due to
ischemia
Definition
• Myocardial infarction is a diseased condition
of the heart which is caused by reduced blood
flow in coronary artery due to atherosclerosis
or spasm due to thrombus/embolus
• Irreversible process
• In an MI, an area of the myocardium is
permanently destroyed because plaque
rupture and subsequent thrombus formation
result in complete occlusion of the artery.
Causes
• Occlusion of coronary arteries-
Atherosclerosis, embolism, spasm
• Decreased blood flow- shock,hemorhage
• Direct trauma
RISK FACTORS
Modifiable
• Atherosclerosis Nonmodifiable
• Obesity • Increasing age
• Hyperlipidemia • Gender
• Smoking • Family history
• Stress
• Bad diet habits
• Sedentary lifestyle
• Drugs-cocaine
• Type A personality
• Hypertension
•
Atherosclerosis
• Narrowing of blood vessels due to plaque
Types of myocardial infarction
• Depends on the coronary artery affected and
area of heart muscle affected
• Depends on ECG findings
ST elevation
Non ST elevation
Clinical Findings
• Chest pain/ discomfort
• Palpitations
• Elevated Blood pressure
• Shortness of breath , edema, crackles
• Nausea , vomitting
• Decreased urinary output
• Cool skin
• Fever
• Anxiety
• Light headedness
• Altered state of consciousness
CLINICAL MANIFESTATIONS
• Angina pectoralis
• Acute coronary syndrome – (Heart
attack/Myocardial infarction)
• Sudden cardiac death
DIAGNOSIS
• History –presenting complaint,past medical
history and family history
• ECG- ST elevation ,inverted T wave,Q waves
• Cardiac enzymes and isoenzymes-CPK-
MB ,Myoglobin
• LDH
• TROPONINS- more specific
• Other labs- WBCS,ESR,Electrolytes,ABGS,Lipids)
• Chest X ray
• Echocardigram
• MUGA
• Nuclear imaging studies
• Angiography
• MRI
• Exercise stress test
• CPK MB -(within 4–8 hr, peaks in 12–20 hr,
returns to normal in 48–72 hr)
• LDH- Elevates within 8–24 hr, peaks within 72–
144 hr, and may take as long as 14 days to
return to normal
• TROPONINS- Troponin I (cTnI) and troponin T
(cTnT): Levels are elevated at 4–6 hr, peak at
14–18 hr, and return to baseline over 6–7 days
Medical managment
• Analgesic
• Anti emetic
• Antithrombotic therapy
• Anti anginal therapy
• Anti depressionts/Anxiolytics
• Surgical procedure-CABG, PTCA
Nursing Intervention
• Monitor baseline vital signs (pulse, bp,
respiratoy rate,temp,urineoutput )
• Assess IV line
• Monitor continous ECG (Evolution of MI,life
threatening arrhythmias)
• Assess for Pain “Pain relief is priority”
• Assess for Shortness of breath,tachypnea,
crackles
• Administer Oxygen
• Bed rest (elevated)
• Change in positions frequently
• Prevent complications
• Education
Complications OF MI
• Cardiogenic shock
• Arhythmias
• Pericarditis
• Aneurysm
• Heart failure
• Rupture of myocardium
• Cardiac tamponade
• Acute pulmonary edema
