What is MI?
MI refers to the process by which areas of the myocardial cells in the heart are permanently destroyed.
Definition :
MI is a disease condition which is caused by reduced blood flow in the coronary artery due to atherosclerosis & occlusion of the artery by embolus or thrombus.
Pathophysiology :
Causative factors will lead to atherosclerosis causing inadequate oxygen supply to myocardial cells due to narrowing of coronary arteries followed by cell death causing inflammation & release of cardiac enzymes leading to accumulation of lactic acid due to anerobic glycolysis leading to infarction & chest pain.
Etiology & Risk factors :
Modifiable :
- High blood pressure
- Stress
- High blood cholesterol
- Obesity
- Smoking & Alcoholism
- Sedentary lifestyle
- Diabetes Mellitus
Non modifiable :
- Age : more than 40 years
- Gender: Male:Female = 3:1
- Family history : Inherited to children from parents
Types of MI:
Transmural Infarction : Extension of infarcts through the whole thickness of heart muscle & are usually a result of complete occlusion in the area's blood supply. It is also called as ST Elevation MI [STEMI].
Subendocardial Infarction : Involves the small area in the endocardial wall of left atrium, left ventricles or papillary muscles. It is also called as Non transmural or Non ST Elevation MI [NSTEMI]
Sign & Symptoms :
- Chest pain unrelieved by rest or NTG
- Pain that radiates to arms, jaw, back or neck
- Dyspnea
- Nausea & Vomiting
- Tachycardia > 100 beats/min
- Variable blood pressure
- Anxiety
- Restlessness
- Diaphoresis
- Pale, Cool, Clammy skin
- Death
Medical & Nursing Management :
- Administer oxygen & Aspirin
- AntiArhythmics : Amiodaron
- Antihypertensive to keep BP low ; Hydralazine
- Thrombolytics to reestablish blood flow in occluded artery : streptokinase
- Heparin following thrombolytic therapy
- Calcium channel blockers to prevent reinfarction & ischemia : Verapamil
- Beta adrenergic blockers to reduce duration of ischemic pain & ventricular fibrillation : Propanolol, nadolol, metoprolol
- Analgesics to relieve pain : Morphine
- Nitrates to dilate blood vessels : Nitroglycerine
- Note foe PQRST [Precipitating events, Quality of pain, Radiation of pain, severity of pain, Timing]
- Electrical Cardioversion
- Assess heart sounds & heart murmur
- Assess Cardinal Signs
- Educate patients for lifestyle mofification
Distinctive facts :
- Ix- ECG,Cardiac enzymes : CK-MB elevated, Troponin-I & Troponin T elevates within 1 hour of MI
- T- wave inversion : Ischemia
- ST elevation/depression : Injury
- Significant Q waves : Infarction
- Also called as Heart Attack
- Silent MI more common in diabetic patient
- Accronym for treatment - MONAT Therapy [Morphine,Oxygen,Nitroglycerine, Aspirin, Thrombolytics]
- Complications include death
- Surgical Rx- PTCA, Stenting, CABG, Athrectomy,
- CPR in case of arrest
- Obstruction of LAD results in Anterior or Septal wall MI
- Obstruction of Circumflex artery results in Posterior or Anterior wall MI
- Obstruction of Right Coronary Artery results in Inferior wall MI
Prognosis :
Prognosis is good in patients receiving appropriate medical attention & lifestyle modification as early as possible. Mortality is however high among patients of MI
Prognosis is good in patients receiving appropriate medical attention & lifestyle modification as early as possible. Mortality is however high among patients of MI
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