MYOCARDIAL INFRACTION (MI)


Definition of Myocardial Infarction (MI): 

Myocardial Infarction is commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing some heart is called Myocardial Infarction.
Or,
Myocardial Infarction is defined as the myocardial tissue damage due to ischaemic necrosis occurring as a result of occlusion of coronary artery blood supply.

Risk of Myocardial Infarction (MI): 

Modifiable risk factor:

Cigarette smoking
Hypertension
Diabetic Mellitus
Dyslipidaemia
Obesity

Non-Modifiable risk factor:

Family History
Age ( Middle to old age)
Male gender

Symptoms of Myocardial Infarction (MI): 

Chest pain/ discomfort-central, Diffuse, Radiation to arms, neck and back, associated with sweating and vomiting, Compressive or burning in nature.
Breathlessness.
Palpitation.
Syncope.

Signs of Myocardial Infarction (MI): 

Dyspnoea.
BP- Hypertension/ Hypotension/Normal
Pulse- Bradycardia/Tachycardia/ Normal.
Cyanosis may be present.
Heart- Abnormal heart sound.
Lungs-Crepitations

Complication of Myocardial Infarction:

Right and left ventricular failure
Shock and peripheral circulatory failure
Respiratory failure
Cardiac arrhythmias
Cardiac arrest
Pulmonary or systemic embolism
Post myocardial infarction syndrome
Sudden death.
Arrhythmias In Myocardial Infarction
Ventricular fibrillation.
Ventricular tachycardia
Ventricular ectopics
Accelerated –idio- ventricular rhythm.
Atrial fibrillation.
Atrial tachycardia.
Heart block.

Investigation of Myocardial Infarction (MI):

ECG
Cardiac enzymes and cardiac markers.
Echocardiography.
X-Ray chest
 Blood for-Lipid profile (F), S.Urea, Creatinine, Electrolytes and Sugar (R), (F). CBC.

Management of Myocardial Infarction (MI):

1. Patient must be hospitalized in ICU/CCU.
2. Patent received on comfortable bed Propped in position.
3. Oxygen inhalation 4-6 ltr per min stat & SOS.
4. GTN spray 2 puff sublingually (S/L) stat & SOS.
5. Setup I/V line with normal saline (5-10drops/min)
6. Inj. Morphine 3-5mg IV slowly + inj. Motilon10mg IV stat & SOS.
7. Setup cardiac monitor to see the activities of heart.
8. Tab, Aspirin 75 mg – 4tab stat & 1 to2 Tabs OD PC.
9. Tab. Clopidogrel 75 mg 4tabs stat and OD.
10. Cap. Pantoprazole 20 mg 1 tab BD or Tab Ranitidine 150 mg BD.
11. Inj Streptokinase 15, 00000 dissolved with 10 ml D/W + N/S 90 ml (total volume 100 ml) IV @ 100drops per min within 01hr. It must infuse as soon as possible when ordered by Doctors. Closely monitor every after 10-15 minutes pulse, BP, Respiration, on ECG Rhythm during inj Streptokinase given.
12. If the patient comes to hospital after 12hrs of chest pain, we avoid infusing inj Streptokinase. In this condition we may start in Heparin 1000 I.U (20 ml)  I/V per hour after 5000 IU I.V bolus to be continue as per protocol for 24/72 hrs or Inj Clexane 60mg S/C BD for 3 days.
13. As per protocol- after 8 hrs of infused Inj Streptokinase, in Heparin 1000 IU per hour adjusts it as per protocol to keep APTT (60-80 indicated).
14.  Tab. Monocard 20 mg -1/2+1/2+0 or 1+1+0.
15. Tab. Clobazam 10 mg – stat & 0+0+1
16. Tab. Laxena 2tab H/S (if constipation present).
17. GTN Infusion if necessary.
18. Diet 1st day liquid, 2nd day semi solid, 3rd day solid /normal (CCU Diet)
19. Record Pulse, BP, Temp and Respiration hourly.
20. Maintain intake & output chart.
21. Visitors must be restricted                 
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Management of MI :
Bed rest, IV line, oxygen inhalation Pain relief
Aspirin, Clopidogrel
Thrombolysis if indicated Anticoagulation
Beta blocker Nitrates, statin


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