myocardaial infarction

CORONARY ARTERY DISEASEANGINA Pectoris MYOCARDIAL INFARCTION (MI)Presenter Hina KarimNES Instructor

www.health-nurses-doctors.blogspot.com

Objectives Coronary Artery DiseasesAnginaTypes MechanismCauses Clinical manifestation Complication Nursing care

*www.health-nurses-doctors.blogspot.com


Coronary Artery Disease

Definition: CAD is a term that refers to the effect of the accumulation of atherosclerosis plaque in the coronary arteries that obstructs blood flow to the myocardium *www.health-nurses-doctors.blogspot.com


Cont.conditions result from CAD1. Angina Pectoris 2. Myocardial Infarction



Angina Pectoris Definition:Angina: Choking or suffocation.Pectoris: Chest.Angina pectoris, is the medical term used to describe acute chest pain or discomfort.Angina occurs when the hearts need for oxygen increases beyond the level of oxygen available from the blood nourishing the heart. It has 3 types Stable AnginaUn stable angina & Variant Angina (Prinzmetals or resting angina) :



Cont.Types of Angina Stable angina: People with stable angina have episodes of chest discomfort that are usually predictable.That occur on exertion or under mental or emotional stress.Normally the chest discomfort is relieved with rest, nitroglycerin (GTN) or both. It has a stable pattern of onset, duration and intensity of symptoms.*www.health-nurses-doctors.blogspot.com


Cont.Unstable angina:It is triggered by an un predictable degree of exertion or emotion. (progressive), more severe than stable. Characterized by increasing frequency & severity. Provoked by less than usual effort, occurring at rest &interferes with pt lifestyle.*www.health-nurses-doctors.blogspot.com


Cont.

Variant Angina (Prinzmetals or resting angina) :occur spontaneously with no relationship to activity. Occurs at rest due to spasm. Pt discomfort that occurs rest usually of longer duration. Appears to by cyclic & often occurs at about the same time each day (usually at night). Thought to be caused by coronary artery spasm*www.health-nurses-doctors.blogspot.com


Mechanism Of Angina *www.health-nurses-doctors.blogspot.com


CausesCoronary atherosclerosis (atheroma )Factors increasing preload :HyperthyroidismExercise Anemia Factors increasing after load:Hypertension Aortic stenosis Obstructive cardio myopathyCoronary artery spasm *www.health-nurses-doctors.blogspot.com


Clinical ManifestationsCharacteristics: Squeezing, burning, pressing, choking, or bursting pressure.Onset: Quickly or slowly Location: Chest, right or left arms, shoulder, or neck, jaw.Duration: Less then 5 minutes.Associated: Dyspnea, Sweating, faintness, palpitation, dizziness ect.Relieving: GTN and rest. Aggravating: exertion, exercise, heavy meal, emotional upset, and anger.*www.health-nurses-doctors.blogspot.com


InvestigationsElectrocardiogram ( ECG)Coronary angiography Exercise Electrocardiogram (Stress test).

Complications:Myocardial infarctionCardiac Arrhythmias *www.health-nurses-doctors.blogspot.com


Myocardium Infarction Myo means muscle, Cardiac heart, infarction means death of tissues due to lack of blood supply.

It is also called heart attack. It occurs when coronary arteries become blocked and the part of myocardial muscles become dead due to prolonged lack of oxygen supply to the muscle cells.*www.health-nurses-doctors.blogspot.com


PATHOPHYSIOLOGYCoronary artery cannot supply enough blood to the heart in response to the demand due to CADWithin 10 seconds myocardial cells experience ischemia

Ischemic cells cannot get enough oxygen or glucose

Ischemic myocardial cells may have decreased electrical & muscular function

Cells convert to anaerobic metabolism.

Cells produce lactic acid as waste

Pain develops from lactic acid accumulation Pt feels anginal symptoms until receiving demand increase 02 requirements of myocardial cells*www.health-nurses-doctors.blogspot.com


ECG changes in Angina & MIZone of Ischemia: T wave inversionZone of Injury: ST elevationZone of Necrosis: Abnormal Q wave*www.health-nurses-doctors.blogspot.com


Sign and SymptomClassic symptom of heart attack are chest pain radiating to neck, jaws, back of shoulder, or left arm The pain can be felt like:Squeezing or heavy pressure A tight band on the chestAn elephant sitting on the chest*www.health-nurses-doctors.blogspot.com


Cont Other symptoms include:Shortness of breath (SOB) Weakness and tirednessAnxietyLightheadednessDizzinessNausea vomitingSweating, which may be profuse*www.health-nurses-doctors.blogspot.com


Collaborative ManagementAssessment:HistoryClinical manifestationCardiovascular assessmentLaboratory assessmentTroponin T & ICK-MB*www.health-nurses-doctors.blogspot.com


Radiographic Assessment

ECGStress TestMyocardial perfusion imagingMRICardiac Catheterization



IMPORTANT INFORMATION TO REMEMBERIncrease supply of Oxygen

Decreasing the demand of Oxygen: Stop activity and lie down (CBR)Take Tab. Angisid sublingually and wait till it dissolves.If pain continues take up to 03 Tab. Angisid one every five minutes. If pain is not relieved yet take another tab. and rush to EMERGENCY services.



IMMEDIATE MANAGEMENT OF MI:

GOALS:To prolong life.Minimize infarct size.Reverse ischemia.Reduce cardiac work.Prevent and treat complications.A) INITIAL TREATMENT:Rapid triage.OMI (oxygen, monitor and I/V line).Check vital signs and O2 saturation.ECG within 10 minutes and repeat ECG.Blood samples for enymes, CBC, lytes, and lipid profile.*www.health-nurses-doctors.blogspot.com


InterventionMedication:Morphine Sulphate Nitrates (GTN)Beta blockersCalcium Channel BlockerAnti platelets / Anti coagulant Thrombolytic therapy



Surgical managementPTCA (Percutaneous Transluminal Coronary Angioplasty*www.health-nurses-doctors.blogspot.com


Coronary Artery Bypass Graft surgery (CABG)*www.health-nurses-doctors.blogspot.com


Nursing DiagnosisAcute pain R/T imbalance between myocardial oxygen supply and demandIneffective tissue perfusion R/T interruption of arterial blood flow Ineffective coping R/T effects of acute illness and major changes in life styleImpaired gas exchange related to ineffective breathing pattern and decreased systemic tissue perfusion.Anxiety related to present status and unknown future, possible lifestyle changes, pain, and perceived threat of death.Activity intolerance related to fatigue*www.health-nurses-doctors.blogspot.com


Prevention

Recognize the symptomsReduce your risk factors:Lose weightQuit SmokingKeep your cholesterol at a normal level. Keep your blood pressure under control. Use techniques to ease stress.Control blood sugar level.Eat RightREGULER EXERCISE



COMPLICATIONS OF MI:ArrhythmiasAtrial arrhythmias.Ventricular arrhythmias.Bradycardia and heart block.Asystol. Hypertension. LV failure. Cardiogenic shock.*www.health-nurses-doctors.blogspot.com


CARDIAC REHABILITATION:Cardiac rehabilitation provides a venue for continued education, re-enforcement of lifestyle modification, and adherence to a comprehensive prescription of therapies for recovery from MI, which includes exercise training Goals of Rehabilitation program:Develop a program for progressive physical activityLives as full, vital and productive life Remain within the limits of the hearts ability to respond to increases in activity and stress.*www.health-nurses-doctors.blogspot.com


FOLLOW UP



**Pre load Right Aterialpresure After load After contraction left over lood

myocardaial infarction

Documents