acute myocard infarc

AMI is the process of myocardial ischemia caused by the blockage of a coronary artery by the thrombus which has having atherosclerosis

clinical manifestation :

• precordial chest pain with or without spread to the left arm, left shoulder and neck, back
• identifay pain, constant or intermittent
• ST segmen elevation > 1mm in 2 or more leads with or without changes in Q wave
• changes in cardiac enzimeCK-MB, troponin-T, troponin-I
• peripheral cold, clammy skin, diaphoresis
• blood glucose ↑
• tightness, rapid breathing, cyanosis
• tachicardia,  blood tension  ↑
• oliguri or anuri
• nausea and vomiting

complication that my accur :

• arrhythmia (12 lead ECG or ECG monitor)
• pulmonary edema (thoracic photo)
• hypotension / cardiogenic shock
• septal or ventricular rupture
• pericarditis

management :

• total bedrest with semifowler position
• hospitalization in intensive care unit
• oxygen 2-5 Lt/minit
• liquid diet (1 day) then soft food
• thrombolytic (streptase)
• heparine, walfarine
• nytroglycerin
• aspirine
• analgesics (morphine, pethidin)
• sedative
• laxative
• beta-blocker
• ECG monitoring, monitor of vital sign and conciousness
• overcome the cause (hypertension, diabetes millitus, hyperlipidemia, gout)

pathofhisiologycal mechanism :

                                                                         Arterosklerosis

                                                                 coronary artery blockages      

                                                      Supply O2 and nutrients to the heart ↓        

                                                                Ischemia of myocardial cell

                                                                    Acute myocard infarc

myocardial tissue damage                         hypoxic/anaerobic                       pump faillure

leak of myocardial cell bocor         anaerobic metabolism    resistance in the pulmonary vein

                                              irritating substances

 CK-MB ↑             end of free nerve             lactic acid          pulmonary fluid excess       troponin-T/I ↑

                                      Talamus                    end of free nerve                    pulmonary edema

                              Chest pain          stimulation of parasympathetic and sympathetic nervous

                                                                       Adrenalin dan noradrenalin ↑

 

GI Peristaltik ↓              gastric acid ↑          kortisol&glukagon            sweat glands

Duodenal distensian/irritation     glikolisis,glukoneogenesis     peripheral cold, diaphoresis

             Vomite center                        blood glukose ↑

           Nausea, vomiting    

                                          tachicardia            vascular vasoconstriction         blodd tension ↑

                                                                              blood flow ↑↑↑

                                                                        O2 tissue perfusion ↓

                                                                              Tissue hipoxic

    metabolism ↓                                               CO2 released                     renal perfusion ↓

    energi ↓          temperature ↓                    PO2(n), PCO2 ↓                   renin angiotensin

    weakness      peripheral cold                   chinestoke             aldosteron     vasoconstriction

                        oliguri                                               dyspnea     reabsorption of Na,water