2. Myocardial infarction My objectives are: Define MI or heart attack Identify people at risk Know pathophysiology of MI Know the sign & symptom Learn the way that diagnoses MI Identify treatment that given to person who has MI

3. What is heart attack or MI ……??? Its the death of apportion of heart muscle in an area where there is sudden loss of blood supply.

4. Introduction Myocardial infarction is the most common disease which spread in this world it must take more important as subject to know about it

5. Myocardial Infarction Causes Chest pain resulting in rapid& disorganized heart beat (ventricular fibrillation( electrical instability of heart muscle tissue

6. Pathophysiology Caused by a complete block of a coronary artery by a blood clot forming This block related to accumulation of fat on the wall of the blood vessel Increase demand for O2 Decrease oxygen supply Sudden constriction of coronary artery

7. Signs & symptoms Severe chest pain Increase B.P or decrease B.P Tachycardia,bradycardia,dyshythmia Shortness of breathing,dyspnea,tachypnea,pulmonary edema Decrease U.O Nausea and vomiting

8. Signs & symptoms Anxiety, fear, headache, visual disturbances, altered speech Skin cool, clammy, pale,diaphoresis, moist skin

9. Classification of M.I The location of the injury mostly to the left ventricular wall Anterior v3, v4 Inferior L2,L3, AVF Posterior or lateral wall L1,AVL.V 6,or V5

10. Diagnoses of M.I ECG (electrocardiogram) Laboratory test : cardiac enzyme Creatinine kinase (ck) isoenzymes CK_MB(heart muscle) Troponin : regulate the myocardial contractility LDH

11. Risk factor Smoking Lack of exercise Hyper lipidemia Obesity Diabetes Stress Hypertension

12. Medical management for M.I M.I can treat by open the blocked artery & restore blood flow to the affected area of the heart muscle by : Reperfusion : established in the first 4_6 hrs of heart attack by using (percutanous transluminal coronary angioplasty (PTCA) or thrombolytic medication :

13. Pharmacological Treatment Streptokinase Increase amount of plasminogen activator clump & clot Increase amount of blood circulation ATP ACE Inhibitor

14. Pharmacological Treatment Antiplatelets medicine like aspirin to reduce tendency of platelets in the blood to clump&clot. Nitroglycerine: vasodilator.

15. Complications Heart block. Acute pulmonary edema. Cardiogenic shock Congestive heart failure (CHF). Myocardial rupture. Pericardial effusion & cardiac temponade.

16. Nsg process for pt with MI assessment A systemic assessment include careful history, particularly as it related to symptom. Each symptom must be evaluated with regard to time, duration, factors that precipitate the symptom and relieve it

17. Nsg diagnosis 1. Ineffective cardiopulmonary perfusion related to reduced coronary blood flow 2. Potential impaired gas exchange related to fluid overload from L.V 3. Potential altered peripheral tissue perfusion related to decreased cardiac output 4. Anxiety related to fear of death

18. Nsg diagnosis The major goals of the pt include relief the pain, prevention of further myocardial damage, absence of respiratory dysfunction, reducing anxiety and absence of recognition of complications

19. Nsg interventions 1. Relieve pain and other symptom of ischemia : collaboration among the pt, nurse and physician is critical in assessing the pts response to therapy 2. Improving respiratory function : encouraging the pt to breathe deeply and change position frequently helps keep fluid from pooling in the bases of the lungs.

20. Nsg interventions 3. Promoting adequate tissue perfusion : checking skin temp and peripheral pulses frequently is important to ensure adequate tissue perfusion

21. Evaluation Expected pt outcomes may include 1. Relief of angina 2. No signs of respiratory difficulties 3. Adequate tissue perfusion 4. Decreased anxiety 5. Absence of complications

22. Summary Myocardial infarction is the process by which area of myocardial cells in the heart are permanently destroy and death due to sudden loss of blood supply MI maybe was: 1- anterior :V3,V4 2- inferior II III AVF 3-lateral: V6.V5.AVL.

23. Summary MI caused sever chest pain radiation in Lt arm and lower jaw,short of breathing, nausea, vomiting, tachy-bradycardia diaphoresis, anxiety, pale, dysrhythmia, fear. The key of tools for diagnosis MI was ECG which indicate may change in waves and cardiac enzyme and history

24. Summary Medical treatment was try to open blocked artery and restore blood flow to affected area and preventing future damage and complication. The thrombolytic medication : streptokinase, morphine, aspirin, nitroglycerine. NSG intervention to relief chest pain give good care put him in semi sitting position

25. Summary O2 mask apply if necessary MI cause fatal disease which should be treated immediately to prevent any complication may be happened such as heart block,acute pulmonary edema, CHF