MYOCARDIAL INFARCTION (MI)
Myocardial
Infarction
is death of a segment of the myocardium due to a loss of blood supply.
(Infarction = cell necrosis as a result of loss of blood supply)
- over 90% are a result of atherosclerosis plus thrombosis
- size (severity) of MI is determined by the size and importance of the
coronary artery affected
- can range from very minor to massive
- 65 % of women - 80 % of men survive their 1st M.I.
- surviving the 1st year after an MI is very important
- the most important factor in this survival is having a pet!, quit smoking,
exercise more
- the risk of fatality increases with each subsequent M.I.
- 90% of M.I. occurs in the left ventricle because it is the main area from
which the blood is pumped
- having a parent who has or dies of a heart attack before the age of 60
increases your risk of having an M.I.
Client Picture
- Bubba - African American male, 52, Call Centre Manager, Dec 10
- 5 children, huge mortgage, smokes 2 packs a day
- rarely exercises and then overdoes it, weekend drinker
- routine BP 150/99, no meds, no diagnosis of HTN
- father and grandfather died of a heart attack
Prodromal
symptoms of M.I.
- these reflect early or preliminary signs/symptoms during progression of
thrombosis to full occlusion
- some people have none, but most have prodromal signs/symptoms for
a few minutes to a few days before the actual M.I.
S/S of SNS Activation
- cold, clammy, sweaty
- anxiety, anxious
- shaking
- rapid, shallow breathing
- pallor, cyanosis (lips, fingertips)
- rapid, ‘thready’ heartbeat (thin, weak)
- pupil dilation
- nausea, digestive disturbances (heartburn)
S/S of Reduced blood flow to the Brain
- light-headedness, dizziness, confusion, mental ‘fog’
- difficulty articulating, slurred speach
- emotional lability (more to the surface, unable to control emotions),
irritability, DENIAL
- escalating BP including blurred vision, headache etc.
Pain Pattern:
- diffuse and varied presentations of heart referral pain
 left shoulder and arm (and possibly the right)
 diffuse chest pain
 possible neck and jaw pain (usually left, sometimes right)
Therapist
Responsibility
 may centre on an old injury site (because the brain is used to
experiencing pain from that area)
 ‘heartburn-like’ s/s (again, a ‘familiar type’ of pain)
- when a client presents with s/s that raise suspicions that they may be in
the early stage of an M.I.:
 DO NOT TREAT, in any way
 do your best to get the person Emergency Medical Assistance ASAP
 call 911
 talk to them calmly, have them sit or just help them to stay comfy
until EMR is there
Actual M.I. Onset
- may be full body tonus (tension in body)
- ‘crushing’, sub-sternal pain
- acute s/s of shock (body is in a state of emergency and all non-essential
activities are shut down), including vomiting and incontinence
- possible loss of consciousness, some altered consciousness
Post M.I. Mx Tx
- if asked to massage client in the hospital, say no until you are properly
convinced there is no risk
- even if a Medical Doctor approves treatment, DO YOUR OWN
ASSESSMENT AND MAKE YOUR OWN DECISIONS
- however, a Medical Doctor’s ‘no’ is still no
- don’t assume MD knows the effects of Mx on a heart patient
- you are also responsible for your Tx of the client
Hx of M.I.
re. M.I.:
- when and circumstances, exercises? Tv?
- was it the 1st, if not, when was the first, any others?
- meds, then and now (cardiovascular and otherwise)
- severity
- complications, then and now
- surgery
- ADL’s, before and now (especially now, including exercise level)
- CHF status (anyone who has had an M.I. basically, has a weakened
heart)
Other
- compliance factors
- stress levels and current risk factors
Tx Planning
Implications for a
client with M.I. Hx
- CHF status (left vent. Heart failure is chf)
- current complications related to their M.I.
- meds: anticoagulants, antidepressants, analgesics, anti-hypertensives
etc. reduce hypertension, reduce pain, reduce anxiety, blood thinner.
- compliance factors
- angina, are they still continuing to get these? Chest pain?
Possible M.I. Complications
Massage Impact on Mx
1) Myocarditis
- usually a few weeks after the M.I.
- muscle, heart, inflammation
Nil, no Mx
2) CHF development
- CHF case Hx taking and appropriate
adaptations
3) Cardiac Dysrhythmia
- scar tissue acts as an irritable focus
- dys-rhythm
- consult with MD about the stability of the
client and are there any risks from massage
4) Mural (heart wall) Thrombosis
- a higher risk at the time of the M.I., but
may persist afterward
- consult with MD whether there is any
ongoing embolism risk
5) Mural Rupture
- may occur at the time or later with stress
due to the scar, leading to cardiac
tamponade (blood leaks out of heart into
the pericardium, puts pressure on heart
and it cant beat) inability to beat, blood is
filling the space between the heart and
pericardium.
- scar tissue rips
- internal or external heart wall
Nil
6) Valve Dysfunction
- acute valve blow-out (Papillary muscle
ruptures)
- chronic valve regurgitation (weakened
Papillary muscle)
( CHF, risk of rupture)
Ventricular Aneurysm
- medical emergency if it occurs, 911
Nil
- CHF concerns, and appropriate modifications
- 15% of people will have a ventricular aneurysm after an M.I.
- it will weaken the heart muscle, affect its ability to pump, irregular
heart beat will develop, it is most often at the same site as the M.I
- increases chance of developing a thrombus and therefore an embolus
- rare chance of rupture
- ultimate result is CCHF
Medical Treatment:
- drugs, anticoagulants, beta blockers