DEFINITION

Myocardial Infarction is a life threatening condition characterized by the formation of

localized necrotic areas within the myocardium. It is considered the end-point of
coronary heart disease (CHD) and is also known as “Heart Attack” or coronary
occlusion. Complete or nearby complete occlusion of the coronary artery (due to rupture
of atherosclerotic plaque  thrombus or embolism; vasospasm, decreased oxygen
supply, or increased demand for oxygen) profound imbalance between oxygen supply
and demand ischemiainfarction (cell death) after 15 minutes. The most common
site for infarction is in the anterior wall of the left ventricle near the apex.
Chest pain that is severe, sudden is onset, crushing, heaviness and tightness (as if an elephant is
stepping on the chest) at the substernal area radiating to arms, jaw and neck. Not relieved by rest or
nitroglycerine. Associated symptoms: dyspnea, tachypnea, crackles (pulmonary congestions), pallor,
diaphoresis, decreased urinary output (cardiogenic shock), increased PR, dizziness, restlessness, anxiety,
and feeling of impending doom or denial that something is wrong. Most common and fatal
complication: Dysrhytmias (40 to50%)

STATISTICS
LOCAL
An average of 1,591 deaths daily
This translates to 66 deaths per hour or one (1) per minute. The number of deaths from
2006 to 2016 showed an increasing trend. The increase during the ten-year period is
almost one-third, or 32.0 percent, from 441,036 in 2006 to 582,183 in 2016.
INTERNATIONAL
AHA 2019
Cardiovascular disease (CVD) remains the leading cause of death in the United
States, responsible for 840,768 deaths (635,260 cardiac) in 2016. The annual total cost
of CVD in the United States was estimated at $351.2 billion in 2014-2015, with $213.8
billion in direct cost, including 46% for inpatient care

RISK FACTORS
Heart attack risk factors include:
Age. Men age 45 or older and women age 55 or older are more likely to have a heart
attack than are younger men and women.Tobacco. This includes smoking and long-
term exposure to secondhand smoke.High blood pressure. Over time, high blood
pressure can damage arteries that feed your heart. High blood pressure that occurs with
other conditions, such as obesity, high cholesterol or diabetes, increases your risk even
more.High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein
(LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high level of
triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack.
However, a high level of high-density lipoprotein (HDL) cholesterol (the "good"
cholesterol) lowers your risk of heart attack.Obesity. Obesity is associated with high
blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes.
Losing just 10 percent of your body weight can lower this risk, however.Diabetes. Not
producing enough of a hormone secreted by your pancreas (insulin) or not responding
to insulin properly causes your body's blood sugar levels to rise, increasing your risk of
heart attack.Metabolic syndrome. This occurs when you have obesity, high blood
pressure and high blood sugar. Having metabolic syndrome makes you twice more
likely to develop heart disease than if you don't have it.Family history of heart attack. If
your siblings, parents or grandparents have had early heart attacks (by age 55 for male
relatives and by age 65 for female relatives), you might be at increased risk.Lack of
physical activity. Being inactive contributes to high blood cholesterol levels and obesity.
People who exercise regularly have better cardiovascular fitness, including lower high
blood pressure.Stress. You might respond to stress in ways that can increase your risk
of a heart attack.Illicit drug use. Using stimulant drugs, such as cocaine or
amphetamines, can trigger a spasm of your coronary arteries that can cause a heart
attack.A history of preeclampsia. This condition causes high blood pressure during
pregnancy and increases the lifetime risk of heart disease.An autoimmune
condition. Having a condition such as rheumatoid arthritis or lupus can increase your
risk of heart attack.

SIGNS AND SYMPTOMS

While the classic symptoms of a heart attack are chest pain and shortness of breath,
the symptoms can be quite varied. The most common symptoms of a heart attack
include: Pressure, Pain in the chest, back, jaw, and other areas of the upper body that
lasts more than a few minutes or that goes away and comes back, breath, Sweating,
Nausea, Vomiting, Anxiety, a cough, Dizziness, and
A fast heart rate

PREVENTIVE MEASURES
Stop smoking. If you smoke, quit. Choose good nutrition. A healthy diet is one of the
best weapons you have to fight cardiovascular disease. High blood cholesterol .Lower
high blood pressure. Be physically active every day. Aim for a healthy weight. Manage
diabetes. Reduce stress. Limit alcohol intake

MEDICAL MANAGEMENT
Once the patient reaches hospital, the major aim of treatment is to decrease the size of
the infarct. . ACE inhibitors and intravenous beta blockers are beneficial in
acutemyocardial infarction and intravenous glyceryl trinitrate probably has a role.
Calcium channel blockers and magnesium should not be used routinely.
NURSING MANAGEMENT
Contemporary approaches to the diagnosis and treatment of acute coronary syndromes
have revolutionized the role of the nurse in the coronary care unit. No longer solely the
agent of the physician's orders, today's coronary care unit nurse intimately works with
the physician and other allied health technical personnel to help stabilize patients
initially, to guide them through the early phases of therapy, to help them understand
their disease, and to educate them as to their medications. In the process, the nurse
gauges patient progress, is mindful of recurrent myocardial ischemia and alerts others
to its presence, identifies complications of thrombolytic therapy and PTCA, is alert to
potentially malignant rhythm disturbances, and finally is the advocate of patient
rehabilitation. Thus, the coronary care unit nurse plays a great role in the modern care
of the patient with a myocardial infarction and materially contributes to patient recovery.