MIDTERM NRG 401 MYLENE GRACE C.

ELARCOSA
Acute Myocardial Infarction

DEFINITION
• The term myocardial infarction is derived from
myocardium (the heart muscle) and infarction (tissue
death due to oxygen starvation)
• It is a diagnosis at the end of the spectrum of
myocardial ischemia or acute coronary syndromes.
MIDTERM NRG 401 MYLENE GRACE C. ELARCOSA

ASSESSMENT
• Cardiovascular
– Chest pain
– Increased jugular venous
distention
– Increased Blood Pressure
– Irregular pulse
• Respiratory
– Shortness of breath
– Dyspnea
– Tachypnea
– Crackles
– Pulmonary Edema
• Gastrointestinal
– Nausea
– Indigestion
– Vomiting
Genitourinary
- Decreased Urinary Output
• Skin
-Cool, clammy, diaphoretic, and pale appearance
• Neurologic
-Anxiety, restlessness, and lightheadedness
• Psychological
-Fear with feeling of impending doom
DIAGNOSTIC FINDINGS:
Electrocardiogram (ECG 12 Leads)
• Q wave duration of more than 0.04 seconds
• Q wave depth of more than 25% of ensuing r
wave
• ST elevation in leads facing infarct (or
depression in opposite leads)
• Deep T wave inversion overlying and adjacent
to infarct
 MIDTERM NRG 401 MYLENE GRACE C. ELARCOSA
• Cardiac arrhythmias Laboratory Tests
Sequence of changes in evolving AMI
- Myoglobin- is a heme protein that helps
transport oxygen

COMPLICATIONS
• Dysfunction or rupture of papillary muscle
• Rupture of the heart
• Embolism
• Ventricular aneurysm
• Post-myocardial infarction syndrome (Dressler
syndrome)
• Shoulder-hand syndrome
MEDICAL MANAGEMENT
• Monitoring: coronary care unit (CCU)
• Rest and bedside care
• Oxygen
• Relief of pain :give morphine sulfate, 3~5mg IV
slowly. nitroglycerin can be given sublingually
NON-SURGICAL MANAGEMENT
Emergent Percutaneous Coronary Intervention
• The procedure treats the underlying
• ECG
atherosclerotic lesion.
• Stress test
• The procedure is used to open the occluded
• Angiogram
coronary artery and promote reperfusion to the
• Echocardiogram
area that has been deprived of oxygen.
Laboratory Tests
• The duration of oxygen deprivation determines
• Troponin
the number of myocardial cells that die, the
- protein found in myocardial cells, regulates the
time from the patient’s arrival in the ED to the
myocardial contractile process.
time PCI is performed should be less than 60
minutes.
Laboratory Tests
Creatine Kinase and Its Isoenzymes
There are three CK isoenzymes:
- CK-MM (skeletal muscle)
- CK-MB (heart muscle)
- CK-BB (brain tissue).
 MIDTERM NRG 401 MYLENE GRACE C. ELARCOSA
SURGICAL MANAGEMENT

PHARMACOLOGIC
Thrombolytic therapy
• indicated for MI and ST segment elevation
greater than 0.1 mV in 2 contiguous EKG leads,
or new onset of a bundle branch block, who
present less than 12 hours but not more than
24 hours after symptom onset.
• Intravenous streptokinase and recombinant
tissue-type plasminogen activator (rt-PA)
• the "door-to-needle" time is 30 minutes or less
• Nitroglycerin
• Beta blocker
• Calcium channel blockers
• Angiotensin converting enzyme inhibitor (ACEI)
• Anti-platelet agents
• Anti-coagulation agents
• Lipid-lowering drugs
NURSING MANAGEMENT
Assessment
• Systematic assessment
• Evaluate time, duration, and the factors
of the symptoms
• Focused physical assessment
• Any change in patient status.
NURSING DIAGNOSES
• Acute pain related to increased myocardial
oxygen demand and decreased myocardial
oxygen supply
• Risk for decreased cardiac tissue perfusion
related to reduced coronary blood flow
• Risk for imbalanced fluid volume
 MIDTERM NRG 401 MYLENE GRACE C. ELARCOSA
• Risk for ineffective peripheral tissue perfusion CARDIOGENIC SHOCK
related to decreased cardiac output from left • Cardiogenic shock is a condition of diminished
ventricular dysfunction cardiac output that severely impairs cardiac
• Anxiety related to cardiac event and possible perfusion.
death • It reflects severe left- sided heart failure.
• Deficient knowledge about post-ACS self-care • Also sometimes called “pump failure”.
Classification
• Coronary. Coronary cardiogenic shock is more
common than non coronary cardiogenic shock
and is seen most often in patients with acute
myocardial infarction.
• Noncoronary. Noncoronary cardiogenic shock is
related to conditions that stress the
myocardium as well as conditions that result in
an ineffective myocardial function.
Causes
• Myocardial infarction (MI).
• Myocardial ischemia.
• End-stage cardiomyopathy
CLINICAL MANIFESTATIONS
• Clammy skin.
• Decreased systolic blood pressure.
• Tachycardia.
• Rapid respirations.
• Oliguria.
• Mental confusion.
• Cyanosis.
 MIDTERM NRG 401 MYLENE GRACE C. ELARCOSA
• Monitor hemodynamic status.
• Administer medications and intravenous fluids.
• Maintain intra-aortic balloon counter pulsation.
Nursing Interventions
• Prevent recurrence.
• Identifying at-risk patients early
• Promoting adequate oxygenation of the
heart muscle
• Decreasing cardiac workload can
ASSESSMENT AND DIAGNOSTIC FINDINGS
prevent cardiogenic shock
• Auscultation
• Hemodynamic status.
• Pulmonary artery pressure (PAP)
• Arterial lines and ECG monitoring
• Arterial pressure monitoring.
equipment must be well maintained
• ABG analysis.
and functioning
• Electrocardiography
• changes in hemodynamic, cardiac, and
• Echocardiography
pulmonary status and laboratory values
• Enzyme levels
are documented and reported
Medical Management
• adventitious breath sounds, changes in
• Oxygen.
cardiac rhythm, and other abnormal
• Pain control
physical assessment findings are
• Angioplasty and stenting.
reported immediately
• Balloon pump.
• Fluids.
• Hemodynamic monitoring.
• IV infusions must be observed closely
• Fluid therapy.
because tissue necrosis and sloughing
MEDICAL MANAGEMENT
may occur if vasopressor medications
• Angioplasty and stenting
infiltrate the tissues
• Balloon pump
• it is also necessary to monitor the
Pharmacologic Therapy
intake and output
• IV dopamine.
• Intra-aortic balloon counter pulsation.
• IV dobutamine.
• make ongoing timing adjustments of
• Norepinephrine.
the balloon pump to maximize its
• IV nitroprusside.
effectiveness by synchronizing it with
Surgical Management
the cardiac cycle
• Intra-aortic balloon pump (IABP)
• Enhance safety and comfort.
Nursing Assessment
• Administering of medication to relieve
• Vital signs
chest pain
• Fluid overload
• preventing infection at the multiple
Nursing Diagnosis
arterial and venous line insertion sites
• Decreased cardiac output
• protecting the skin integrity
• Impaired gas exchange
• monitoring respiratory and renal
• Excess fluid volume
functions help in safeguarding and
• Ineffective tissue perfusion
enhancing the comfort of the patient
• Acute pain
• Arterial blood gas
• Activity intolerance
NURSING CARE PLANNING & GOALS
• Prevent recurrence of cardiogenic shock.
 MIDTERM NRG 401 MYLENE GRACE C. ELARCOSA
• Monitor ABG values to measure
oxygenation and detect acidosis from
poor tissue perfusion.
• Positioning
• If the patient is on the IABP, reposition
him often
• perform passive range of motion
exercises to prevent skin breakdown
• don’t flex the patient’s “ballooned” leg
at the hip because this may displace or
fracture the catheter.