12.29.2011

MI

Posted on 12:46 AM by know about heart

It is also known as “heart attack “.Clinically there is a pain like angina pectoris but of more severs intensity. Breathlessness, vomiting, collapse, and syncope are common. Myocardial infarction rises progressively will increase age when predispositions to Atherosclerosis are present.
Pathogenesis of MI: There is a prolonged imbalance between myocardial oxygen supply and demand leads to the death of myocardial tissue. MI occurs due to rupture or erosion of atheromatous plaque in coronary artery. Then formation of occlusive thrombus at the site of rupture of coronary artery. Thus occlusion of coronary artery occour and reduction of coronary artery supply. If coronary blood flow is decreased  ischemia of heart muscle occurs. Within 12 hours infarction of heart muscle occurs.
Features of MI:
Site: Centre of the chest.
Mode of onset: Takes several minutes or even longer to develop.
Character: Dull, constricting, choking or heavy & is usually described as squeezing, crushing, burning or aching.
Radiation: It may radiate to either or both arms, to the throat or jaw & less commonly to the back or epigastrium.
Associated symptoms: Feeling of breathlessness, autonomic symptoms such as profuse sweating, nausea, vomiting, palpitation, anxiety.
Timing/Duration: Persists for prolonged duration.
Aggravating/Exacerbating factors: It is precipitated by conditions which temporarily increase myocardial oxygen demand such as exertion, emotional excitement, cold weather, exercise after meal.
Relieving factors: Not relieved by rest or taking sublingual glyceryl-tri-nitrate (GTN).
Severity: It is usually severe & patient feels fear of death.
Anxiety: Fear of impending death.
Nausea, vomiting may present.
SIGNS:
1. Pallor
2. Sweating
3. Tachycardia
4. Vomiting
5. Hypotension
6. Raised JVP (jugular venous pressure)
7. Most patients are anxious, restless.
8. Irregular pulse
9. Diffuse apical impulse
10. Lung crepitation
11. 3rd heart sound
12. Quiet 1st heart sound
13. Fever
14. Pericardial friction rub
15. Signs of complication
      —Mitral regurgitation
     —pericarditis
INVESTIGATION:
     1. E.C.G:
                  §ST segment is elevated
                  §T wave is inverted
                  §pathological Q wave
2. Plasma biochemical marker:
     a.Plasma enzymes:
            CK MB:
                §Rise within 4 to 6 hour
                §Peaks at 12 hours
                §Returns to normal in 48 to 72 hours
Proteins:
           Troponin T and Troponin I:
                 §Rise within 4 to 6 hours
                 §Elevated up to 2 weeks
2. BLOOD:
                  §DC­-Polymorphonuclear leukocytosis
                  §ESR: Raised
                  §C –REACTIVE PROTEIN: Raised
3. Chest X-ray: Heart normal in size pulmonary edema may be present.
4. Echocardiography:
                  §To detect important complication
                  §Mural thrombus, cardiac rupture, MR, septal rupture may present.
MANAGEMENT:
IMMIDIATE MANAGEMENT:
1. Immediate hospitalization in CCU (Cardiac coronary unit)
2. Constant ECG monitoring
3. Provide facilities for defibrillation
4. High flow oxygen
5. Sublingual GTN (Tablet/spray)(Not used Systolic pressure BP<90 mm of Hg)
6. Tab.Aspirin 300mg stat if not contraindicated then 75 to 150 mg daily.
7. Analgesia-IV morphine 2 to 4 mg every 5 minute as needed.
8. Tab.Clopidogrel 300mg stat and 75ng daily
LATE MANAGEMENT:
1. Stop smoking
2. Regular exercise
3. Weight control
4. Lipid lowering
5. Stain
6. Antiplatelet therapy
7. ACEI
8. Additional therapy for control of DM and HTN



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