Management & Nursing Care
of Patient with Coronary Artery
Diseases
)Myocardial Infarction)
Dr. Walaa Nasr
Lecturer of Adult Nursing
Second year
Myocardial infarction
outlines
 Definition
 Etiology
and pathophysiology
 Clinical manifestations
 Diagnostic evaluation
 Medical management
 Nursing process
Myocardial infarction
Definition
Other names: coronary occlusion- heart
attack
 Myocardial
infarction refers to the
process by which myocardial tissue is
destroyed in regions of the heart that are
deprived of an adequate blood supply
because of a reduced coronary blood flow
(a
prolonged
lack
of
myocardial
oxygenation leading to necrosis of a
portion of the heart muscle).
Myocardial infarction
Etiology and pathopysiology
*Causes of reduced blood flow:

Narrowing of a coronary artery owing to
atherosclerosis

A complete occlusion of an artery owing to
embolus or a thrombus

Myocardial necrosis caused by acute
occlusion of a coronary artery due to
plaque
rupture or erosion with imposed
thrombosis)
Myocardial infarction
Clinical manifestations
Symptoms
 Pain is the cardinal symptom of an MI

Anxiety and fear of impending death

Nausea and vomiting

Breathlessness

Collapse/syncope
Myocardial infarction
Clinical manifestations (cont…)
Physical signs
 Signs
of sympathetic activation: pallor,
sweating, tachycardia
 Signs of vagal activation: nausea,vomiting,
bradycardia
 Signs
of impaired myocardial function:
hypotension, oligurea, cold peripheries
 Signs
of
complications:
e.g.
mitral
regurgitation, pericarditis
Myocardial infarction
Diagnostic evaluation








Electrocardiogram (ECG)
Blood test (Cardiac enzymes)
Echocardiogram
Nuclear scan
Chest radiographs
Coronary angiography
Exercise stress test.
Cardiac computerized tomography (CT) or
magnetic resonance imaging (MRI).
Myocardial infarction
Medical management

Immediate management: the first 12 hours

Analgesic (morphin sulphate) & antiemetic

Antithrombotic therapy (Antiplatlet therapy,
anticoagulants)

Anti-anginal therapy

Surgical therapy
Myocardial infarction
Assessment


Nursing process
A careful history
Description of symptoms ( chest pain,
palpitation,
dyspnea,
syncope
or
sweating). Each symptoms must be
evaluated with regard to time, duration,
precipitating & relieving factors. In
addition complete physical assessment
for:
*level of consciousness
Nursing process (cont…)
*Heart sounds
*Peripheral pulses
*Lung sound
Nursing process (cont…)
Nursing diagnosis





Chest pain related to reduced coronary blood flow.
High risk for breathing pattern ineffective related to
fluid overload
Anxiety related to fear from death
High risk for tissue perfusion alteration related to
decreased cardiac output
Health maintenance alteration
adherence to therapeutic regimen
related
to
no
Nursing process (cont…)
Patient's goals
 Report
that pain is decreased
 Breath effectively
 Experience less anxiety level
 Have
improved
tissue
perfusion
 Adhere
to the self care
program
Nursing process (cont…)

Nursing intervention
 Relief
or control of chest pain
 Alleviate respiratory difficulties
 Reduce the anxiety level
 Maintain
adequate
tissue
perfusion
 Help the patient to adhere to the
self care program