Slide 1 M I Presenting By Name Designation Name of the institute YOCARDIAL NFARCTION With 1 HEART, 1 SOUL 1 GOAL Here we start Let’s start with an INTRODUCTION Give a case history and ask students t.
YOCARDIAL M I NFARCTION Presenting By: Name Designation Name of the institute With HEART, SOUL & GOAL… Here we start… Let’s start with an Give a case history and ask students to find out the diagnosis u can write the case history in this box Need help? contact me k? (08867375968) For example: a 72 year male patient came to emergency dep with complaints of chest pain, diaphoresis etc add more even wat done as a mngmt INTRODUCTION Quick review about the THE HEART What is myocardial infarction? Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die Most commonly due to occlusion (blockage) of a coronary artery following the rupture of the wall of an artery The resulting ischemia and ensuing oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium) INCIDENCE : The average incidence of myocardial infarction for those aged between 30 and 69 years is about 600 per 100,000 for men, and 200 per 100,000 for women Coronary heart disease (CHD) is the leading cause of death in India and worldwide In India-130.7 deaths per 1,00,000(2009-last survey) CLASSIFICATION : Based on pathology 1.TRANSMURAL 2.SUBENDOCARDIAL •Particularly susceptible to ischemia •Involves a small area in the subendocardial wall of left ventricle, ventricular septum, or papillary muscles •ECG: ST depression CAUSES : Most frequent cause is rupture of an atherosclerotic lesion within coronary wall with subsequent spasm and thrombus formation Coronary artery vasospasm Ventricular hypertrophy Hypoxia Coronary artery emboli CAUSES : Coronary anomalies Cocaine Aortic dissection Pediatrics Kawasaki disease, Takayasu arteritis Increased afterload which increases myocardial demand RISK FACTORS : Age above 50yrs Male Gender Diabetic mellitus Hypertension Family History Dislipidemia Tobacco smoking Excess alcohol intake Obesity Hyperhomocysteinemia (high homocysteine) Use of Oral contraceptive pills SIGNS AND SYMPTOMS : Neurologic: •Anxiety •Restlessness Psychological: •Fear with impending doom ASSESSMENT AND DIAGNOSTIC FINDINGS : •History Collection •Physical Examination •Chest X-ray •Electrocardiogram(ECG/EKG) •Echocardiography •Laboratory tests UNDERSTAND UNDERSTAND ECG ECG MORE MORE : : ECG VARIATIONS IN MI •ST -segment elevation/non-ST elevation •T wave inversion •Abnormal Q waves LABORATORY TESTS : CARDIAC BIOMARKERS CREATINE KINASE AND ITS ISOENZYMES MYOGLOBIN TROPONIN LABORATORY TESTS : CARDIAC BIOMARKERS MYOGLOBIN TROPONIN CREATINE KINASE AND ITS ISOENZYMES Myoglobin is heme protein that helps transport oxygen A protein found in myocardium, regulates the myocardial Its found in cardiac and skeletal muscles •CK-MB isprocess the cardiac specific isoenzyme found mainly in contractile Starts increasing within to hours and peaks within 12 Troponin cardiac cells and therefore only when there has as T and I are specificincreases and are currently recognized hours after the onset of symptoms been damage to these cells reliable and critical markers of myocardial injury Negative results are an excellent parameter for ruling out an Its level for begins to period increase within a few hours and peaks Elevated a long acute MI within 24 hours of an MI • TREATMENT GUIDELINES : •RAPID transport to hospital •Obtain 12 Lead ECG, •Laboratory blood specimens BEGIN ROUTINE MEDICAL INTERVENTIONS: •Supplemental oxygen •Nitroglycerin •Morphine •Aspirin 162-325mg •Beta-blocker •Angiotensin- converting enzyme inhibitor within 24 hours TREATMENT GUIDELINES : EVALUATE for indications for reperfusion therapy: •Percutaneous coronary intervention •Thrombolytic therapy CONTINUE therapy as indicated: •IV heparin or low-molecular-weight heparin •Clopidogrel or ticlopidine •Glycoprotein inhibitor •Bed rest for minimum 12 to 24 hours NURSES ALWAYS REMEMBER… MINIMIZE SKIN PUNCTURE AVOID INTRAMUSCULAR INJECTIONS DRAW BLOOD FOR TESTS WHEN STARTING THE IV LINE START IN LINE BEFORE THROMBOLYTIC THERAPY AVOID CONTINUAL USE OF NONINVASIVE BLOOD PRESSURE CUFF MONITOR FOR HYPOTENSION AND DYSRHYTHMIAS MONITOR ECG CHECK FOR COMPLICATIONS TREAT MAJOR BLEEDING BY DISCONTINUING THROMBOLYTIC THERAPY, APPLY DIRECT PRESSURE AND NOTIFY THE PHYSICIAN IMMEDIATELY INVASIVE CORONARY ARTERY PROCEDURS : PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) CORONARY ARTERY ATHERECTOMY BRACHYTHERAPY STENT SURGICAL PROCEDURES : •Coronary Artery Revascularization •Traditional Coronary Artery Bypass Graft •Cardiopulmonary Bypass COMPLICATIONS : •ACUTE PULMONARY •HEART FAILURE •CARDIOGENIC SHOCK OEDEMA •DYSRHYTHMIAS AND CARDIAC ARREST •PERICARDIAL EFFUSION •CARDIAC TAMONADE REVIEW…WATCH AND LISTEN… WITH REGARDS HELP LINE NANDU C-08867375968 ... •Traditional Coronary Artery Bypass Graft •Cardiopulmonary Bypass COMPLICATIONS : •ACUTE PULMONARY •HEART FAILURE •CARDIOGENIC SHOCK OEDEMA •DYSRHYTHMIAS AND CARDIAC ARREST •PERICARDIAL EFFUSION •CARDIAC... Coronary artery vasospasm Ventricular hypertrophy Hypoxia Coronary artery emboli CAUSES : Coronary anomalies Cocaine Aortic dissection Pediatrics Kawasaki disease, Takayasu arteritis... AND SYMPTOMS : Gastrointestinal: •Nausea and vomiting Genitourinary: •Decreased urinary output Skin: •Cool, clammy, diaphoretic and pale appearence SIGNS AND SYMPTOMS : Neurologic: •Anxiety