MYOCARDIAL INFARCTION

• 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.
• Most Common Site: Anterior wall of the left ventricle near the apex
• Complete or nearly complete occlusion of the coronary artery (due to rupture of
atherosclerotic plaque; thrombus or embolism; vasospasm; decrease O2 supply or increase
demand for O2) -> profound imbalance between O2 supply & demand -> ischemia ->
infarction (cell death) after 15mins.

Clinical Manifestations:
 Chest pain that is severe, sudden in onset, crushing, heaviness and tightness (as if an elephant
is stepping on the chest) @ the substernal area radiating to arms, jaw, neck, & NOT relieved
by rest or nitroglycerine.

 Associated Symptoms: dyspnea, tachypnea, crackles, pallor, diaphoresis, increase PR, WBC
& UO, restless, feelings of impending doom or denial that something is wrong.

 Most common and fatal complication: Dysrhythmias (40-50%)

 ECG changes: ST segment – T wave – Q wave. This is also the sequence in normalization,
however Q wave changes are usually permanent (only Q wave present in old MI).
o Injury > symmetric & peak T wave, at least 1mm ST segment elevation.
o Ischemia > inverted T wave & ST segment elevation.
o Infarction > abnormal or pathologic Q wave develops within 1-3 days after MI.

 Serum Enzyme Changes:

o CK-MB most reliable and increase (1-3hrs) only in cardiac damage after MI onset
o Most sensitive is Troponin I
o LDH1 > LDH2 (flipped LDH); Acute: CK-MB and Chronic: LDH

Managements:
M – orphine (Demerol)
O – xygen (humidified 2-4L/min)
N – itroglycerine (Isosorbide Dinitrate)
A – spirin (inhibits platelet aggregation & synthesis of Thromboxane A2)
T – hrombolytics (Streptokinase, Anistreplase)
A – nticoagulants (started or given before thrombolytics)
S – tool softeners (Lactulose to prevent straining)

Educating MI Patients:
1. Avoid sexual activity in FUSHIE (fatigue, unfamiliar partner, stress, heavy meals, intake of
alcohol, extreme temperature)
2. Must be able to climb two flights of stairs before resuming sexual activity.
3. Caution not to take Sildenafil (Viagra) while taking Nitroglycerine bec. both are vasodilators.
4. Sexual Tips: side lying or bottom, comfortable/familiar environment, best in mornings after
meds & less fatiguing comfortable morning foreplay.
5. Lifestyle Changes: WT & diet control, stress management, exercise, & no smoking.
6. May resume activity 5-8 weeks after uncomplicated MI.