MYOCARDIAL INFARCTION IN ENGLISH

                                                  

                            MYOCARDIAL INFARCTION  IN ENGLISH

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MYOCARDIAL INFARCTION-

            MI is defined as a sudden cardiac arrest caused by obstructed oxygen supply to the heart muscles. is an emergent situation characterized by an acute onset of myocardial ischemia that results in myocardial cell death. It is also known as heart attack or acute coronary syndrome (ACS)

CAUSATIVE FACTORS-

Ø  The main causative factor of MI is coronary artery atherosclerosis. In an MI, an area of the myocardium is permanently destroyed, typically because plaque rupture and subsequent thrombus formation result in complete occlusion of the artery and stopping oxygen supply to the area.

Ø  Other causative factor of MI includes-

Ø  Vasospasm (sudden constriction or narrowing) of a coronary artery,

Ø  Decreased oxygen supply (from acute blood loss, severe anemia, or low blood pressure), and

Ø  Increased demand for oxygen (eg, from a rapid heart rate, thyrotoxicosis or ingestion of cocaine)

CLINICAL MANIFESTATIONS-

Ø  Main clinical manifestation of MI is chest pain.

Ø   Chest pain starts suddenly and continues  despite rest and medication

Ø  Other clinical manifestations include-

Ø  Shortness of breath,

Ø  Indigestion,

Ø  Nausea and vomiting,

Ø  Anxiety,

Ø  Cool, pale, and moist skin,

Ø  Increased heart rate,

Ø  Increased respiratory rate.

DIAGNOSTIC INVESTIGATIONS-

Ø  History and Physical examination. (presence of clinical manifestations of MI)

Ø  ECG (The classic ECG changes are T-wave inversion, ST-segment elevation  and development of an abnormal Q wave.

Ø  Eco-cardiography.

Ø  Angiography.

Ø  Blood investigations includes S. CK-MB

TREATMENT-

Ø  The goals of medical management of MI are to minimize myocardial damage, preserve myocardial function, and prevent complications.

Ø  These goals may be achieved by reducing myocardial oxygen demand and increasing oxygen supply with medications (aspirin, nitroglycerin, morphine, an IV beta-blocker etc.), oxygen administration, and bed rest.

Ø  Thrombolyticsare used to treat some patients with acute MI. These agents are administered IV according to specific prescriptions & instructions.

Ø  Angiography with stent insertion (PTCA), atherectomy and open heart surgery (bypass surgery) may be performed to make a way for blood to flow through coronary arteries.

NURSING MANAGEMENT-

Ø  Proper assessment is done by health history and physical examination and a nursing care plan is prepared.

Ø  IV sites are examined frequently. Two IV lines are typically placed for any patient with MI to ensure that access is available for administering emergency medications.

Ø  The nurse then continues to assess the patient, measuring vital signs and observing for signs of respiratory distress and notifying any emergency.

Ø  The nurse should provide oxygen inhalation therapy as prescribed by the physician.

Ø  All medications are given as prescribed and the patient’s response is assessed and recorded in nurses notes.

Ø  If surgery of PTCA is decided  for  the patient, nurse provides effective  pre and  post operative  care  to the patient.

Ø  The nurse should closely monitor the patient for complications. Early identification of their signs and symptoms are very important Because the complications in MI can be life-threatening.

Ø  Patients with MI often fear loss of their roles within society and the family. They may also fear that the chest pain may lead  death. The nurse alleviates fear by providing proper information.

Ø  During discharge planning the Nurse provides health education regarding self care at home , adherence to drug schedule, diet management and to come for follow up  as needed.