MYOCARDIAL INFARCTION AND VARIOUS MANAGEMENT APPROACHES

PRESENTED BY: Harpreet Dhatt

INTRODUCTION
Infectious Diseases

Non Infectious Diseases

 Globalization

Industrialisation

Urbanization

DEMOGRAPHIC TRANSITION increasing life expectancy. increased death rates at old age

arteriosclerosis

DEFINITION

INCIDENCES
AGE:

Young ( 35 years Indians; 60 years- US)

GENDER: Men.

NON MODIFIABLE

MODIFIABLE

Age Gender Race Genetic predisposition

Smoking Cholesterol Blood pressure Blood glucose Sedentary lifestyle- lack of exercise. Central obesity Stress

RISK FACTORS

PREDISPOSING FACTORS
Increases

levels of cholesterol Increases levels of triglycerides. Decreased level of HDL. Central obesity. Diabetes mellitus Hypertension.

These risk factors if addressed, can be significantly prevented or reduced by making intelligent choices through simple

Lifestyle Modifications.

Quit Smoking

Sensible Dietary approach: Salt consumption Refined sugar consumption. Avoid saturated fat consumption. Avoid empty calorie diet: Fast Food. Fruit and vegetable consumption.

( WHO) believes that 75% of the risks of MI can be prevented by LIFESTYLE modifications Maintenance of: Ideal body weight Absence of truncal obesity- belly fat. Control of blood pressure. Control of blood sugar. Control of lipid profile.

Regular Medical Checkup.

Risk Awareness

Through judicious combination of Lifestyle measures and Drugs Risks can be avoided or even reversed.

ASSESSMENT & DIAGNOSTIC FINDINGS

Clinical Manifestations

Nature of the chest pain Angina is generally described as "heavy", "crushing" or "gripping".

Intensity of the chest pain Angina can range from a mild ache to a most severe pain that provokes sweating and fear.

Location of the chest pain Angina is usually behind the sternum. Radiation of the chest pain Angina may radiate to the arms, jaw, throat or back.

Aggravating factors Angina usually is aggravated by exercise, emotion, after a meal or in cold weather.

Relieving factors Angina usually fades quickly with rest or with nitroglycerine spray.

Past medical history High blood pressure, High cholesterol and Diabetes increase the risk of angina and heart attacks.

Cigarette smoking Increase the risk of angina and heart attacks.

Exercise history lack of exercise increases the risk of angina and heart attacks. Family history Of angina or early heart attacks. Have you experienced any chest pain/chest pressure? Chest pain and chest pressure/tightness are the hallmarks of angina.

Can you describe your chest pain/chest pressure? Diffuse pain/tightness which is not easily identified as coming from any particular single point on the chest. Angina pain may additionally be felt in one or both arms, the neck and jaw. It may sometimes be mistaken for reflux pain/indigestion/heartburn/dyspepsia.

When did this chest pain start, or, when do you experience it? Typical anginal pain may be brought on by exertion (stable angina), on lying down (decubitus angina), or even at rest (unstable angina or Prinzmetal Angina). The frequency of anginal pain is another important detail not to be missed as it may give some idea of the severity of your current condition.

Does anything make your episodes of angina better or worse? If there are any particular factors (such as rest) which relieve your angina, then they may be important in determining its cause. Similarly, anything which brings it on or makes it worse is important for helping to formulate a management plan for your condition.

Have you ever been diagnosed with anemia? This can be a cause of angina.

Have you ever been diagnosed with diabetes, impaired glucose tolerance, obesity, hypertension, or hypercholesterolemia?

Have you ever been diagnosed with any thyroid diseases such as hyperthyroidism? Hyperthyroidism can increase the amount of "work" that your heart has to perform, and may bring on episodes of angina.

Have you ever had any heart investigations, such as electrocardiography, echocardiography, a thallium scan, or angiography?

Have you experienced any shortness of breath (dyspnea), light-headedness, nausea or "clamminess" recently? These are all symptoms which can assist in the diagnosis of the underlying cause of your chest pain.

History ECG, Echo ECG Stress Test TMT.

Cardiac Catheterization.

Coronary artery angiography & Angioplasty

Lipid profile. Blood glucose Serum creatinine, BUN. Enzymes

Bio Markers: CRP ( C- reactive Protein) CK- MB Cardiac Troponin

NURSING MANAGEMENT

MANAGEMENT

Goals of care: Initiate prompt care. Reduce pain. Prevent complications Rehabilitate and educate the patient and significant others.

Patients need to be hospitalized.

Emergenc y medicine OPD

shifted

ICC U

 Treat

acute attack immediately: The time lapse between door to needle is less than 30 minutes ie. From the onset of pain till thrombolytic therapy. Reduce pain: Morphine intravenously Monitor heart rate. Administer oxygen therapy.

Pharmaceutical Management: Drugs used are : Anti- ischemic therapy: beta blockade & IV NTG Anti thrombotic therapy: Initiated with administration of aspirin, heparin therapy being the next step. In case of aspirin allergy, clopidogrel and ticlopidine are used.

Thrombolytic therapy: Streptokinase. Urokinase. Tissue type plasminogen activator (t-PA).

Antidysrhythmic agents: Beta blockade. ACE inhibitors.

Monitor for complications: Dysrhythmias Cardiogenic shock Heart failure Pulmonary embolism Recurrent myocardial infarction Pulmonary edema.

REFERENCE: Smeltzer Suzanne C, Bare Brenda G. Myocardial Infarction. 10th edition. Philadelhipa. Williams and Wilkins. 2004. P: 731-735. Woods L Susan, Halpenny Jean C et al. Myocardial ischemia and infarction. Cardiac Nursing 3rd edition. Lippincott Publications. 1995. P: 291-295. Kluver wolters,. Common Cardiovascular Disorders. MedicalSurgical Nursing made incredibly easy. 2nd edition. Lippincott. Williams and Wilkins. 2008. P: 315-321. Hudak. M. Carolyn, Gaiter. M. Barbara et al. Myocardial Infarction. A holistic approach to critical care. Lippincott publishers. 1997. 7th ed. P: 738-748. Available at URL:http//www.wikipedia.org/. http://www.google.co.in/images?hl=en&biw=1280&bih=610&q=he art%20attack&um=1&ie=UTF-8&source=og&sa=N&tab=wi