Myocardial Infarction

                           Myocardial Infarction 

• M.I. is define as Damage or Death of myocardial muscle due to Abrupt blood flow to the Heart.
• the blockage may be cause by formation of thrombus in coronary artery ,sudden progression of atherosclerosis,prolong narrowing of arteries.

Etiology:

• atherosclerosis
• arteries
• prolong narrowing
• thrombus
• agnoist

Risk factor:

• genetic cardial disorder
• smoking 
• alcohol consumption
• diet - like high cholesterol, high fat
• activity - low physical exercise

Pathophysiology:

• due to etiological factor
• myocardial ischemia 
• decrease myocardial oxygen supply
• increase cellular hypoxia
• decrease myocardial contractility
• decrease arterial pressure
• stimulation of baro-receptor and chemo-receptor 
• sympathetic response
• increase myocardial contractility
• increase heart rate
• increase myocardial oxygen demand 
• further myocardial ischemia
• necrosis of myocardial cells
• myocardial infarction or Heart Attack

Clinical manifestation:

• sever chest pain(more then angina pectoris )
• pain may radiant to the chest, shoulder, neck , jaw , back
• nausea
• unexplained anxiety
• dizziness
• dysponea
• sweating

Diagnostic Evaluation:

• ECG (elevated S & T segment)
• laboratory test : serum createnin kinase, myoglobin, cardiac troponin, ESR, (all level is increased)

Management:

Early management :

• morphine sulfate
• Anti-hematic : Domperidon, Alizapride
• Acute deperfusion therapy
• Primary percutaneous coronary intervention
• Maintaining vessel potassium
• Adjuncentive therapy

late management :

• life style modification : Diet control, stop smoking, regular exercise
• Secondary prevention : Anti-platelets , beta-blocker

Nursing management :

       The probable nursing diagnosis will be :

• pain related to an imbalance in oxygen supply and demand.
• Anxiety related to chest pain, fear of death, threatening environment.
• Decrease cardiac output related to impaired contractility.
• Activity intolerance related to insufficient oxygenation to perform ADL and deconditioning effect of bed-rest.
• Risk for injury related to dissolution of protective clot.