INTRODUCTION

Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow
decreases or stops to a part of the heart, causing damage to the heart muscle. The most
common symptom is chest pain or discomfort which may travel into the shoulder, arm, back,
neck, or jaw.
MI is mainly due to underlying coronary artery disease. When the coronary artery is
occluded, the myocardium is deprived of oxygen. Prolonged deprivation of oxygen supply to
the myocardium can lead to myocardial cell death and necrosis.

DEFINITION OF MYOCARDIAL INFARCTION

Myocardial infarction (MI) (i.e., heart attack) is the irreversible death (necrosis) of heart
muscle secondary to prolonged lack of oxygen supply (ischemia).

INCIDENCE:
According to a Spanish study, the crude coronary heart disease (CHD) incidence rate was
300.6/100,000 person-years for men and 47.9/100,000 person-years for women. The
incidence of MI in India is 64.37/1000 people in men aged 29-69 years, alcohol intake led to
30% lower CHD incidence.
RELATED ANATOMY AND PHYSIOLOGY
Anatomy of the Heart
The cardiovascular system can be compared to a muscular pump equipped with one-way
valves and a system of large and small plumbing tubes within which the blood travels.

Heart Structure and Functions

The modest size and weight of the heart give few hints of its incredible strength.

Weight. Approximately the size of a person’s fist, the hollow, cone-shaped heart weighs less
than a pound.

Mediastinum. Snugly enclosed within the inferior mediastinum, the medial cavity of the
thorax, the heart is flanked on each side by the lungs.

Apex. Its more pointed apex is directed toward the left hip and rests on the diaphragm,
approximately at the level of the fifth intercostal space.

Base. Its broad posterosuperior aspect, or base, from which the great vessels of the body
emerge, points toward the right shoulder and lies beneath the second rib.
Pericardium. The heart is enclosed in a double-walled sac called the pericardium and is the
outermost layer of the heart.

Fibrous pericardium. The loosely fitting superficial part of this sac is referred to as the
fibrous pericardium, which helps protect the heart and anchors it to surrounding structures
such as the diaphragm and sternum.

Serous pericardium. Deep to the fibrous pericardium is the slippery, two-layer serous
pericardium, where its parietal layer lines the interior of the fibrous pericardium.

CIRCULATION OF THE HEART

Although the heart chambers are bathed with blood almost continuously, the blood contained
in the heart does not nourish the myocardium.

Coronary arteries.

The coronary arteries branch from the base of the aorta and encircle the heart in the coronary
sulcus (atrioventricular groove) at the junction of the atria and ventricles, and these arteries
are compressed when the ventricles are contracting and fill when the heart is relaxed.

Cardiac veins.

The myocardium is drained by several cardiac veins, which empty into an enlarged vessel on
the posterior of the heart called the coronary sinus.
The typical configuration consists of two coronary arteries, arising from the left posterior and
right anterior aortic or coronary sinuses respectively, in the proximal ascending aorta. These
are the only two branches of the ascending aorta.

Left coronary artery (LMCA): The left coronary artery has a short common stem (and is
hence often referred to as the left main coronary artery), that bifurcates into the left
circumflex artery (LCx), which courses over the left atrioventricular groove, and the left
anterior descending artery (LAD), which passes towards the apex in the anterior
interventricular groove. The LAD is a continuation of the LCA main stem and supplies blood
to the anterior heart wall and the septum via the diagonal branches and septal branches.
The LAD supplies blood to the front and the left side of the heart.
The circumflex artery is responsible for blood supply to the left atrium and the posterior-
lateral aspect of the left ventricle. The circumflex curves around the left atrium to the side and
back of the LV, and divides to create the obtuse marginal branches. Some people have a
third large branch, the left intermediate artery (or ramus intermedius)
Right coronary artery (RCA): The right coronary artery courses in the right atrioventricular
groove to the inferior surface of the heart. It descends into smaller branches including the
right posterior descending artery (PDA) and acute marginal artery.
It supplies blood to the right atrium, right ventricle, SA node, and AV node.
In conjunction with the left anterior descending artery (LADA), the RCA helps supply blood
to the septum of the heart.

RISK FACTORS:
MODIFIABLE RISK FACTORS:
• Tobacco use
• High blood cholesterol or triglyceride levels
• Lack of exercise
• Obesity
• Stress
NONMODIFIABLE RISK FACTORS:
• Male > Female
• Age
>45 years for males
>55 years for females
• Family history of heart disease
• Older age
• Diabetes
• High blood pressure
CAUSES
• Coronary artery disease (atherosclerosis).
• Blood clot
• Coronary artery spasm

According to patient’s causes

MODIFIABLE RISK FACTORS:
• Tobacco use.
• Stress

NONMODIFIABLE RISK FACTORS:

• Male
• 58 years
• Fathers have heart disease
• High blood pressure
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS

CARDIOVASCULAR
➢ Chest pain -- Chest pain occurs suddenly

Mnemonics, such as SOCRATES, can be used to assess and describe patients’ chest pain
S – site of pain;
O – onset of pain;
C – character of the pain; Severe immobilizing chest pain that not relieved by rest, position
change and medications.
R – any radiation; pain radiated to nose, jaw, shoulder and upper left arm and downward 4th
and 5th fingers
A – associated factors;
T – timing of the pain- more than 15 minutes and not relieved by nitro glycerine
E – exacerbating/alleviating factors; for example, position or inspiration;
S – severity of the pain using a rating scale of 1-10 (10 being the worst pain). more than
angina.

➢ Decrease pulse rate.

➢ Bradycardia (Decrease pulse rate)
➢ Hypertension
➢ Diaphoresis –excessive sweating
➢ ECG changes – ST segment and T wave changes, also show tachycardia, bradycardia, or
dysrhythmias.
➢ Dysarrithmias
RESPIRATORY-
• Shortness of breath.
• Pulmonary oedema
• Chest heaviness
• Dyspnoea- difficulty of breathing
• Fatigue

GENITOURINARY-
• Decreased Urinary Output May Indicate Cardiogenic Shock.

GASTROINTESTINAL-
• Nausea And Vomiting

INTEGUEMENTARY
• Cool, Clammy, Diaphoretic, And Pale Appearance on Skin

(According to estimates 42% of women never experienced chest pain, while the figure was
30.7% in the case of men. This puts women as a higher risk group when it comes to painless
heart attacks. According to a leading cardiologist, 3 out of 10 people in India have a painless
heart attack mostly people who have hypertension and diabetes. The signals of discomfort are
usually too vague to cause alarm. Therefore, people who suffer from diabetes and
hypertension should be rushed to the hospital if they feel any kind of discomfort.)
According to patient
RESPIRATORY-
• Shortness of breath.
• Chest heaviness
• Fatigue

GASTROINTESTINAL-
• Nausea And Vomiting

DIAGNOSTIC EVALUATION
The mainstay of diagnosis revolves around: Cardiac biomarkers; ECG findings; and clinical
features.
Cardiac biomarkers:
Non-enzyme proteins–

➢ Troponin T & I-Troponin-test

Troponin is a protein of key importance in the functioning of skeletal and cardiac
muscle. It forms part of the contractile mechanism. Cardiac troponin is the preferred
biochemical standard for diagnosis of MI because it is the most sensitive and cardio
specific marker. Troponin is a Myocardial muscle protein released into circulation
after injury. These are highly specific indicators of MI. Troponin rises quickly within
5-6 hours but will continue to stay elevated for 2 weeks.
➢ Myoglobin- Myoglobin-lacks cardiac specificity but its presence can be detected as
early as within 1-3 hours and peaks within 12 hours after the onset of symptoms. If
the first myoglobin test results are negative the test may be repeated 3 hours later.

Enzymes-
❖ Creatine kinase (MB fraction)-CKMB
Begin to rise 3 to 12 hours after acute MI. Peak in 24 hours Return to normal in 2 to 3
days
❖ Aspartate transaminase (AST)
❖ Lactate dehydrogenase -Elevates within 8–24 hr, peaks within 72–144 hr, and may
take as long as 14 days to return to normal. An LDH1 greater than LDH2 (flipped
ratio) helps confirm/diagnose MI if not detected in acute phase.

• Physical Examination
• History collection
• Stress test
• Chest X-ray.
• Electrocardiogram (ECG)- ST elevation signifying ischemia; peaked upright or
inverted T wave indicating injury; development of Q waves signifying prolonged
ischemia or necrosis.
• Echocardiogram-May be done to determine dimensions of chambers,
septal/ventricular wall motion, ejection fraction (blood flow), and valve
configuration/function.
 • Cardiac catheterization (angiogram).

S.No Name of the PROCEDURE IMPRESSION NURSES’

investigation RESPONSIBILITY
1. Cardiac Biomarkers Troponin I test The normal range for 1.When drawing blood,
a) Troponin T & I- procedure is a troponin is between 0 the health care
Troponin-test quick, simple test and 0.4 ng/mL. Any professional should follow
using a few values greater than universal precautions.
millilitres of blood this range suggests
from the patient’s positive cardiac 2.Aseptic technique to be
vein. The test damage. followed.
timing must be
minimum 6 to 12 3.Avoid using syringes.
hours after the start Use vacuum tube blood-
of cardiac collection devices instead,
symptoms. No prior preferably those with
test preparation is needle-stick prevention
required. The features.
procedure takes
around 10 minutes
only using a rapid
test kit. A blood
sample is drawn by
a needle from a vein
in your hand/finger.

The test is done

with a blood
2. CK-MB sample. A needle is
Normal reference
used to draw blood Same as above
values for serum CK–
from a vein in arm
MB range from 3 to
or hand
5% (percentage of
total CK) or 5 to 25
IU/L.
S.No Name of the PROCEDURE IMPRESSION NURSES’
investigation RESPONSIBILITY

3. Blood for total count, The test is done WBC >12,000cu/mm Same as Above
differential count, with a blood LDL value increases
serum cholesterol, sample. A needle is HDL value decreases
LDL, HDL used to draw blood
from a vein in arm
or hand

Electrocardiogram Electrocardiography In the first hours and 1.Verify the order for the
4.
(ECG). is the process of days after the onset of ECG in the client's chart
producing an a myocardial
electrocardiogram. infarction, 2.Confirm the client's ID
It is a graph of several changes can
voltage versus time be observed on 3.Provide privacy and
of the electrical the ECG. First, large explain the procedure to
activity of the heart peaked T waves (or the client.
using electrodes hyperacute T waves),
placed on the skin. then ST elevation, 4.Emphasize that no
Electrodes (small, then negative T waves electrical current will enter
plastic patches that and finally pathologic the body. Tell the client
stick to the skin) are Q waves develop. that the test typically takes
placed at certain about 5 minutes.
spots on the chest,
arms, and legs. The 5.Wash your hands
electrodes are
connected to an 6.Place the ECG machine
ECG machine by close to the client's bed
lead wires. and plug the cord into the
The electrical wall outlet or, battery-
activity of the heart operated, ensure that it is
is then measured, functioning.
interpreted, and
printed out. No
 electricity is sent 7.Have the client lie
into the body. supine in the centre of the
bed with arms at his sides.

1.Verify the order for the ECG in the client's chart

2.Confirm the client's ID

3.Provide privacy and explain the procedure to the client.

4.Emphasize that no electrical current will enter the body. Tell the client that the test typically
takes about 5 minutes.

5.Wash your hands

6.Place the ECG machine close to the client's bed and plug the cord into the wall outlet or,
battery-operated, ensure that it is functioning.
 7.Have the client lie supine in the centre of the bed with arms at his sides.

8.Expose the arms and legs and cover the client appropriately. The arms and legs should be
relaxed to minimize muscle trembling,

9.Select flat, fleshy areas to place the limb lead electrodes. Avoid muscular and bony areas.

10.If an area is excessively hairy, clip it.

11.Clean excess oil or other substances from the skin with soap and water to enhance
electrode contact
Expose the client's chest.

12.Put a pre-gelled electrode at each electrode position.

13.Ask the client to relax and breathe normally. Tell the client to lie still and not to talk when
you record the ECG

14.When the machine finishes recording the 12-lead ECG, remove the electrodes and clean
the client's skin.

15.After disconnecting the lead wires from the electrodes, dispose of the electrodes

16.Assist the client to a comfortable position. Ensure the bed is in a low position

17.Remove any remaining equipment and wash your hands.

18.Document in your notes the test's date and time and significant responses by the client.

S. Name of the PROCEDURE IMPRESSION NURSE’S

No Investigation RESPONCIBILITY
1. Cardiac Troponin I test The normal range for 1.When drawing blood, the
Biomarkers procedure is a quick, troponin is between 0 health care professional
simple test using a few and 0.4 ng/mL. Any
 a) Troponin T & millilitres of blood from values greater than should follow universal
I-Troponin-test the patient’s vein. The this range suggests precautions.
test timing must be positive cardiac
minimum 6 to 12 hours damage. 2.Aseptic technique to be
after the start of cardiac followed.
symptoms. No prior test
preparation is required. 3.Avoid using syringes. Use
The procedure takes vacuum tube blood-
around 10 minutes only collection devices instead,
using a rapid test kit. A preferably those with
blood sample is drawn needle-stick prevention
by a needle from a vein features.
in your hand/finger.
2. CK-MB The test is done with a Normal reference
blood sample. A needle values for serum
is used to draw blood CK–MB range
from a vein in arm or from 3 to 5%
hand (percentage of total
CK) or 5 to 25 IU/L.

3. Blood for total The test is done with a WBC >12,000cu/mm Same as Above
count, differential
blood sample. A needle LDL value increases
count, serum is used to draw blood HDL value decreases
cholesterol, LDL, from a vein in arm or
HDL hand
4. Electrocardiogram Electrocardiography is In the first hours and 1.Verify the order for the
(ECG). the process of producing days after the onset ECG in the client's chart
an electrocardiogram. It of a myocardial
is a graph of voltage infarction, 2.Confirm the client's ID
versus time of the several changes can
electrical activity of the be observed on 3.Provide privacy and
heart using electrodes the ECG. First, large explain the procedure to the
placed on the skin. peaked T waves (or client.
Electrodes (small, hyperacute T waves),
plastic patches that stick then ST elevation, 4.Emphasize that no
to the skin) are placed at then negative T electrical current will enter
certain spots on the waves and finally the body. Tell the client that
chest, arms, and legs. pathologic Q waves the test typically takes about
The electrodes are develop. 5 minutes.
connected to an ECG
machine by lead wires. 5.Wash your hands
The electrical
activity of the heart is 6.Place the ECG machine
then measured, close to the client's bed and
interpreted, and printed plug the cord into the wall
outlet or, battery-operated,
out. No electricity is ensure that it is functioning.
sent into the body.
7.Have the client lie supine
in the centre of the bed with
arms at his sides.

8.Expose the arms and legs

and cover the client
appropriately. The arms and
legs should be relaxed to
minimize muscle trembling,

9.Select flat, fleshy areas to

place the limb lead
electrodes. Avoid muscular
and bony areas.

10.If an area is excessively

hairy, clip it.

11.Clean excess oil or other

substances from the skin
with soap and water to
enhance electrode contact
Expose the client's chest.

12.Put a pre-gelled
electrode at each electrode
position.

13.Ask the client to relax

and breathe normally. Tell
the client to lie still and not
to talk when you record the
ECG

14.When the machine

finishes recording the 12-
lead ECG, remove the
electrodes and clean the
client's skin.

15.After disconnecting the

lead wires from the
electrodes, dispose of the
electrodes

16.Assist the client to a

comfortable position.
 Ensure the bed is in a low
position

17.Remove any remaining

equipment and wash your
hands.

18.Document in your notes

the test's date and time and
significant responses by the
client.

3. Chest X-ray. The patient is positioned No consistent change Before Chest X-ray
on an X-ray table that in radiological 1.Remove all metallic
carefully positions the abnormality was objects.
part of the body that is found in the first
to be X-rayed--between three days after 2.No preparation is required
the X-ray machine and infarction, but Ensure the patient is not
a cassette containing thereafter a gradual pregnant or suspected to be
the X-ray film or improvement pregnant.
specialized image plate. occurred, so that
Some examinations may before discharge the 3.Assess the patient’s ability
be performed with the x-ray picture was to hold his or her breath.
patient in a sitting or nearly normal.
standing position. The commonest 4.Provide appropriate
abnormality was clothing.
upper lobe
pulmonary venous 5.Instruct patient to
congestion. cooperate during the
procedure.
After Chest X-ray
No special care
Provide comfort.
4. Echocardiogram An echocardiography, is Wall motion Before the procedure
an ultrasound of the abnormalities -Explain the procedure to
heart. It is a type of localise to the the patient.
medical imaging of the territory of the -No special preparation is
heart, using standard occluded coronary needed.
ultrasound or Doppler vessel, and may -Ensure to empty the
ultrasound. Echo can be include: bladder.
used to -absence or reduction -Encourage the patient to
--the size and thickness of systolic thickening cooperate.
of the chambers -decreased motion: -Explain the need to
--how the valves of the hypokinetic, akinetic, darkened the examination
heart are functioning dyskinetic (systolic field.
--the direction of blood bulging) and -Explain that a vasodilator
flow through the heart aneurysmal (amyl nitrate) may be given
During the procedure
 --any blood clots in the Over time, infarcted -Inform that a conductive
heart areas will appear gel is applied to the chest
--areas of damaged or thinned and fibrotic area.
weak cardiac muscle -Position the patient on his
tissue left side
--problems affecting the After the procedure
pericardium, which is -Remove the conductive gel
the fluid filled sac from the patient’s skin
around the heart -Inform the patient that the
study will be interpreted by
the physician.
-Instruct patient to resume
regular diet and activities.
5. Cardiac An angiogram is a The results show The nurse must maintain
catheterization procedure that uses X- whether there is a patient privacy and ensure
(angiogram). ray contrast to look at normal supply of confidentiality, safe
the blood vessels blood to the heart transportation of patients,
(arteries or veins) in the and any blockages. adherence to departmental
body. An abnormal result policies regarding safe
During an angiogram, a may mean that there attire, infection control, and
long slender tube called is one or more other safety practices in the
a catheter blocked arteries. If procedural area and
is inserted into a large there is a blocked throughout the patient’s
artery (generally, in the artery, doctor may care.
groin area through the choose to do an the nurse must thoroughly
femoral artery). The angioplasty during review the patient’s case,
catheter is slowly and the angiography and clinical history,
carefully threaded possibly insert an presentation, and indication
through the artery until intracoronary stent to for the procedure—working
its tip reaches the immediately improve to ensure safe conditions for
segment of vessel to be blood flow. the patient’s care.
examined by Previous history/problems
angiography. A small tolerating procedural
amount of contrast sedation—agents/amounts
material is injected into from previous experiences
the blood vessel and other related history
segment through the should be taken care of.
catheter, and X-rays are
taken. The contrast
agent enables the blood
vessels to appear on the
X-ray pictures.
6. Magnetic Allows visualization of A cardiac MRI can a. Before the procedure
resonance blood flow, cardiac help diagnose Patient may be asked not to
imaging (MRI). chambers or problems such as eat or drink anything for 4 -
intraventricular septum, coronary artery 6 hours before the scan.
valves, vascular lesions, diseases, pericardial Before the test, ask the
plaque formations, areas diseases (diseases patient if they have the
of necrosis/infarction, affecting the outside following:
and blood clots. lining of the heart),
 heart tumours, • Artificial heart
congenital heart valves
disease, • Brain aneurysm
cardiomyopathy, clips
heart valve disease, • Heart defibrillator or
and even provide pacemaker
images of the • Inner ear (cochlear)
pumping cycle. implants
• Kidney disease or
dialysis (patient may
not be able to
receive contrast)
• Recently placed
artificial joints
• Vascular stents
• Worked with sheet
metal in the past
(patient may need
tests to check for
metal pieces in their
eyes)
Because the MRI contains
strong magnets, metal
objects are not allowed into
the room with the MRI
scanner.
It is important to inform the
health care provider of any
pregnancy or suspected
pregnancy prior to the
procedure.

According to patient
Cardiac Biomarkers
a) Troponin T & I-Troponin-test
Trop T- positive
b) ECG (Electrocardiogram)

• ST Elevated MI

c)Blood for total count, differential count, serum cholesterol, LDL, HDL
▪ TC=7900/cum
▪ Dc=40
▪ Billirubin:0.40
▪ Conjugated=0.19
▪ Unconjugated=0.21
▪ SGPT=32.0
 ▪ SGOT=23.0ALP=61
▪ TP=8.15
▪ Albumin=3.90
▪ Globulin+4.25
▪ Urea14.0
▪ Creatanine+0.80
▪ Sodium=139.0
▪ Potassium=4.5

COMPLICATIONS:
➢ Heart failure
➢ Abnormal heart rhythm (arrhythmia)
➢ Cardiogenic shock
➢ Papillary muscle dysfunction
➢ Ventricular Aneurism
➢ Pericarditis
➢ Dressler Syndrome
➢ Pulmonary embolism
 MEDICAL MANAGEMENT
Various drugs can be used to treat coronary artery disease, including-
• Opiate Analgesic (For reduce pain) -Morphine sulphate
• Vasodilators (These drugs act as blood vessel dilator): • Nitrates
• Beta-Blockers (Decrease work load in heart): • Propranolol 20-40 mg
• Calcium channel blocker (They improve coronary blood flow): • Nifedipine •
Verapamil
• ACE Inhibitors. ACE inhibitors prevent the conversion of angiotensin I to
angiotensin II to decrease blood pressure and for the kidneys to secrete sodium and
fluid, decreasing the oxygen demand of the heart. Streptokinase, Urokinase
• Thrombolytics. -Thrombolytics dissolve the thrombus in the coronary artery, allowing
blood to flow through the coronary artery again, minimizing the size of the infarction
and preserving ventricular function.
• Anti coagulantant drugs: Heparin
• Antihypertensive medicines-
❖ Methyldopa - This medication is used alone or with other medications to treat
high blood pressure (hypertension). Lowering high blood pressure helps
prevent strokes, heart attacks, and kidney problems. Methyldopa works by
relaxing blood vessels so blood can flow more easily.
❖ Sodium nitroprusside- It is used for lowering the blood pressure.
❖ Amlodipine- Amlodipine is used with or without other medications to treat
high blood pressure. Lowering high blood pressure helps prevent strokes,
heart attacks, and kidney problems. Dose-10 mg,20 mg

Name of the Dose/Route Mode of action Possible Side Nursing Responsibility

drug effects
Opiate 1mg/Intravenously Morphine CNS: light- 1.Assess for mentioned
Analgesics binding to headedness, cautions and
Inj. Morphine opioid receptors dizziness, contraindications.
Sulphate blocks psychoses, anxiety, 2. Conduct pain
transmission of fear, assessment with patient
nociceptive hallucinations, to establish baseline and
signals, signals pupil constriction, evaluate effectiveness
pain-modulating impaired mental of drug therapy.
neurons in the processes 3. Perform thorough
spinal cord, and GI: nausea, physical (CNS, vital
inhibits primary vomiting, signs, bowel sounds,
afferent constipation, urine output) to
nociceptors to biliary spasm establish baseline status
the dorsal horn GU: ureteral before beginning
sensory spasm, urinary therapy, determine drug
projection cells retention, effectiveness and
hesitancy, loss of evaluate for any
libido potential adverse
Others: sweating, effects.
physical and 4. Monitor laboratory
psychological results (liver function,
dependence kidney function) to
determine need for
 Narcotic-induced possible dose
respiratory centre adjustment and identify
depression: toxic drug effects.
respiratory
depression with
apnoea, cardiac
arrest, shock
Vasodilators Intravenous Produces Postural Assess for baseline
Inj Nitro- infusion is given vascular smooth Hypotension, data.
glycerine Depending upon muscles Tachycardia,
the Blood Pressure relaxation Syncope, Nausea, Take history about pain,
causing Vomiting, Pallor, duration, activity
peripheral Sweating, Rash, performed before pain,
vasodilatation Headaches, whether taken this
resulting in Flushing, medicine earlier or not.
decreased Dizziness
resistance Check blood pressure
leading to and pulse before each
increased administration of NTG–
cardiac output blood pressure can drop
and decreased precipitously after a
BP, Coronary single dose. Hold dose
vasodilatation, if systolic BP < 90 mm
reduces Hg or more than 30 mm
myocardial Hg below baseline.
oxygen
consumption Intravenous infusion of
and reduces NTG requires special
systolic and glass bottles and IV
Diastolic BP. tubing (regular plastic
tubing will absorb 40-
80% of NTG).

Do not discontinue
NTG intravenous
infusion abruptly–it
may result in
precipitous rebound
hypertension, angina, or
coronary artery
vasospasms.

Beta Blockers PO: 100 – 200 mg Primarily blocks Bradycardia, Assess for baseline
Tab Esmolol, daily in 2 divided β1 adrenergic palpitation, cold data.
Tab Atenolol, doses receptors on the extremities,
Metoprolol, IV bolus: 5 mg myocardium Raynaud's Monitor blood pressure
Labetalol slow IVP at 5- (negative phenomenon, and apical pulse prior to
minute intervals chronotropic intermittent administration.
until total dose of and negative claudication,
15 mg inotropic agent) intensification of
 Blocks β2 AV blocks, heart Cardiac monitor should
receptors of failure be used on patients
bronchi and Dizziness, fatigue, receiving metoprolol IV
blood vessels at
insomnia boluses.
higher doses Heartburn, nausea,
headache Teach patients to report
Laryngospasms, any serious side effects
respiratory distress,
bronchospasms
Calcium Oral/Intravenous Slows SA node Headache, fatigue, Check blood pressure,
Channel Bolus and infusion automaticity dizziness, heart rate, and cardiac
Blockers (negative nervousness monitor prior to
Diltiazem, chronotropic) Bradycardia, AV administering diltiazem.
Nifedipine blocks, heart
Delays AV node failure, flushing, Assess baseline renal
conduction hypotension, (BUN, Cr) and liver
syncope, peripheral function (AST, ALT)
Reduces oedema lab tests.
myocardial Nausea, vomiting,
contractility constipation, Monitor for signs of
(negative diarrhoea, impaired heart failure (e.g.,
inotropic) taste pulmonary oedema,
weakness, dyspnoea).
Dilates coronary
arteries during Provide analgesic for
variant angina headache.

Dilates Use caution during

peripheral position changes to
arteries reducing prevent orthostatic
afterload hypotension.
ACE Inhibitors Angiotensin- Angioedema, Observe your patient
benazepril, converting persistent dry for adverse reactions.
captopril, enzyme (ACE) cough, altered
enalapril, inhibitors taste, fatigue, Monitor her vital signs
prevent the headache, regularly and her WBC
conversion of hyperkalaemia, count and serum
angiotensin I to hypotension, electrolytes, especially
angiotensin II, a photosensitivity, potassium level,
potent proteinuria, rash, periodically.
vasoconstrictor, tachycardia, and
resulting in pancytopenia. Give potassium
vasodilation, Severe hypotension supplements and
decreased may occur at toxic potassium-sparing
systemic arterial levels. diuretics cautiously
resistance, and because ACE inhibitors
decreased blood can cause potassium
pressure. In retention and
addition, ACE hyperkalaemia.
inhibitors
 decrease Warn the patient to
aldosterone avoid potassium-
production, containing salt
resulting in substitutes.
reduced sodium Warn your patient to
and water check with her health
retention; this care provider before
also helps lower taking over-the-counter
blood pressure. medications or herbal
supplements, which
may interact with her
prescribed medication.

Advise a woman of
childbearing age to
avoid pregnancy during
therapy.
Thrombolytics Intravenous: Catalyses Bleeding Do not use infusion IV
Streptokinase/ STEMI: 1.5 plasminogen to (intracranial, past line for other
Urokinase million convert into clots from medications or
international plasmin (which surgeries, arterial therapies.
units’ IV infusion degrades fibrin or venipuncture
over 1 hour (60 in clots) sites) Screen patient carefully
minutes) Works on old as Hypotension for possible
well as recent Fever (foreign contraindications prior
blood clots antigen) to fibrinolytic therapy.
Hypersensitivity
(urticaria, hives, Obtain baseline lab data
flushing, headache, for aPTT, PT, INR, Hct,
bronchospasms, Hgb, and platelets prior
anaphylaxis) to beginning
[Streptokinase has streptokinase therapy.
protein antigens
from the Avoid any invasive
Streptococcal procedures on patient
culture from which during therapy and for 2
it is isolated.] hours following
Reperfusion therapy.
dysrhythmias
(PVC's, ventricular Monitor the patient for
tachycardia, signs of bleeding every
ventricular 15 minutes during
fibrillation) therapy and hourly for
next 8 hours following
therapy.

Notify physician STAT

if signs of anaphylaxis
or allergic reaction
begin to occur.
Maintain continuous
cardiac monitoring
during therapy and at
least for the next eight
hours to watch for
reperfusion
dysrhythmias.

Reperfusion
dysrhythmias rarely
require treatment, but
appropriate
resuscitation
medications and
equipment should be at
the bedside.

Evidence of reperfusion
include 1) relief of chest
pain, 2) reperfusion
dysrhythmias, 3) return
of ST segments to
baseline in affected
leads, and 4) peaking of
serum CK-MB

Watch for neurological

alterations (like change
in mental status, level
of consciousness,
seizures,
hemiparesis/hemiplegia,
changes in pupils, etc.)
which may indicate
cerebral haemorrhage.

Do not give any

injections, draw blood
specimens (especially
not arterial), or perform
any other form of
venipuncture during
fibrinolytic therapy.

Do not use non-invasive

blood pressure
monitoring on patient
during fibrinolytic
therapy.
Antiplatelet PO: 300 mg initial Inhibits platelet Abdominal pain, Do not administer
agent dose followed by activation by dyspepsia, clopidogrel to ACS
Clopidogrel 75 mg daily ADP by diarrhoea, rash patients if CABG is
blocking ADP Bleeding: GI planned within 5 – 7
receptor sites on bleeding (melena, days
platelets peptic ulcer), GU
bleeding (blood in Platelet function and
Irreversibly urine), epistaxis bleeding time return to
blocks platelet Thrombotic baseline in 7 – 10 days.
activation for thrombocytopenic
life of platelet. purpura–rare Monitor patient for
Intracranial signs of thrombotic
bleeding thrombocytopenic
(haemorrhagic purpura (low platelet
stroke)–rare count, neuro symptoms,
renal dysfunction,
fever).

Monitor for signs and

symptoms of bleeding
(urine, stool, hematoma,
epistaxis, petechiae).

May cause elevation of

serum liver enzymes–
establish baseline
enzymes and bilirubin
levels.
Antiplatelet PO: (acute chest anti-platelet Gastrointestinal: Assess patient for signs
agent pain) 160-325 mg (blocks GI bleeding, of bleeding (petechiae,
Aspirin nonenteric coated formation of gastric irritation, ecchymosis, bloody or
preferably chewed thromboxane burning, nausea, black stools, bleeding
PO: (anti-platelet A2 reducing heartburn gums).
prophylaxis) 81 platelet Respiratory: Drink adequate fluids
mg chewable aggregation and Bronchospasms while taking aspirin.
aspirin daily vasoconstriction Haematological: Advise patient to avoid
of coronary Thrombocytopenia, alcohol when prescribed
arteries) haemolytic high doses of aspirin.
Acute Coronary anaemia, Baby aspirin is
Syndrome prolonged bleeding preferred for acute or
(ACS)– time prophylactic
suppresses Potential for acute management of heart
platelet renal failure disease.
aggregation (NSAID) Discontinue aspirin use
if ringing or buzzing in
ears or unrelieved GI
discomfort.
Not recommended for
children with influenza
or chicken pox
Anticoagulants Intravenous: bolus Facilitates Transient Protamine sulphate is
Heparin 60 units/kg antithrombin in thrombocytopenia the antidote for overly
(maximum bolus inactivating Hypersensitivity anticoagulated dose of
4,000 units for thrombin and (chills, fever, heparin. (1 gm
ACS; 5,000 units clotting factor urticaria, hives, protamine inactivates
otherwise) Xa pruritis, 100 units heparin).
Intravenous bronchospasms,
Infusion: 12 anaphylaxis) Heparin drip should be
units/kg/hour Osteoporosis, continuous. Do not
(around 1,000 hypoaldosteronism, interrupt a heparin drip
units/hour) hyperkalaemia for any other drug or IV
Subcutaneous: 1st (long-term use) therapy. Short half-life:
dose: 10,000 – Injection site If infusion is turned off,
20,000 units; reactions therapeutic effect can
subsequent doses: be lost.
8,000 – 20,000
units every 8 – 12 Only routes of
hours administration are IV or
SQ (does not absorb
PO; IM causes
hematoma)

Risk of bleeding
increases. Screen
patients for
contraindications.

To reduce risk of
haemorrhage, dosage
must be monitored
closely and adjusted
according to aPTT
levels.
Monitor with activated
partial thromboplastin
time (aPTT) which
normally is around 40
seconds.
Therapeutic goal for
aPTT is 1.5 – 2 Ï
normal level = 60 – 80
seconds).

Draw blood for aPTT

30 minutes before SQ
or intermittent doses of
heparin.

Monitor injection sites

for signs of hematoma.
 Apply direct pressure to
venipuncture sites for
longer durations (e.g., 3
minutes).
Anticoagulant Intravenous: (for Inactivate Haemorrhage, Primarily given SQ.
drugs ACS only) 30 mg clotting factor thrombocytopenia,
Enoxaparin IV bolus followed Xa, blocking the anaemia Protamine sulfate is the
by 1 mg/kg SQ conversion of antidote for enoxaparin.
BID for up to 8 prothrombin to Hypersensitivity
days thrombin (rash, urticaria), Only routes of
Subcutaneous: fever, arthralgia, administration are IV or
(for DVT and angioedema SQ (does not absorb
other uses) 30 mg PO; IM causes
SQ BID; Abnormal liver hematoma)
(pulmonary function tests
embolism) 1 Risk of bleeding
mg/kg SQ BID Neurological injury increases. Screen
for persons patients for
undergoing spinal contraindications.
canal procedures
(spinal puncture, Monitor periodically
epidural CBC for blood counts.
anaesthesia)
Assess urine and stool
for signs of blood.

Monitor injection sites

for signs of hematoma.

Apply direct pressure to

venipuncture sites for
longer durations (e.g., 3
minutes).
Low molecular weight
heparin (e.g.,
enoxaparin) is preferred
for unstable angina and
NSTEMI over
unfractionated heparin.

SURGICAL MANAGEMENT
• Angioplasty and stent placement (percutaneous coronary revascularization): PTCA, or
percutaneous transluminal coronary angioplasty, is a minimally invasive procedure
that opens blocked coronary arteries to improve blood flow to the heart muscle.
• Coronary artery bypass surgery- A coronary artery bypass graft (CABG) is a surgical
procedure used to treat coronary heart disease. It diverts blood around narrowed or
clogged parts of the major arteries to improve blood flow and oxygen supply to the
heart.
 According to patient
• Vasodilators (These drugs act as blood vessel dilator): • Nitrates
• Beta-Blockers (Decrease work load in heart): • Propranolol 20-40 mg
• Calcium channel blocker (They improve coronary blood flow): • Nifedipine •
Verapamil
• ACE Inhibitors. ACE inhibitors prevent the conversion of angiotensin I to
angiotensin II to decrease blood pressure and for the kidneys to secrete sodium and
fluid, decreasing the oxygen demand of the heart. Streptokinase
• Thrombolytics. -Thrombolytics dissolve the thrombus in the coronary artery, allowing
blood to flow through the coronary artery again, minimizing the size of the infarction
and preserving ventricular function.
• Anti coagulantant drugs: Heparin
• Antihypertensive medicines-
❖ Amlodipine- Amlodipine is used with or without other medications to treat
high blood pressure. Lowering high blood pressure helps prevent strokes,
heart attacks, and kidney problems. Dose-10 mg,20 mg
•
NURSING MANAGEMENT
The nursing management involved in MI is critical and systematic, and efficiency is needed
to implement the care for a patient with MI.

Nursing Assessment
One of the most important aspects of care of the patient with MI is the assessment.

• Assess for chest pain not relieved by rest or medications.

• Monitor vital signs, especially the blood pressure and pulse rate.
• Assess for presence of shortness of breath, dyspnoea, tachypnoea, and crackles.
• Assess for nausea and vomiting.
• Assess for decreased urinary output.
• Assess for the history of illnesses.
• Perform a precise and complete physical assessment to detect complications and
changes in the patient’s status
• Assess IV sites frequently.
• Instruct the client regarding the purpose of diagnostic medical & surgical
procedures and the pre- & post procedure expectations.
• Assist the client to identify risk factors that can be modified, and set goals that
will promote change in lifestyle to reduce the impact of risk factors.
• Instruct client regarding a low-calorie, low-sodium, low-cholesterol, low-fat diet
with a increase in dietary fiber. Stress that dietary changes are not temporary and
must be maintained for life.
• Provide community resources to client regarding exercise, smoking cessation and
stress reduction.

Nursing Priorities
• Relieve pain, anxiety.
• Reduce myocardial workload.
• Prevent/detect and assist in treatment of life-threatening dysrhythmias or
complications.
• Promote cardiac health, self-care.
•

NURSING DIAGNOSIS
➢ Impaired gas exchange related to decreased blood flow as evidenced by
breathlessness
➢ Acute pain related to disease condition as evidenced by patient verbalization
➢ Impaired physical mobility related to weakness as evidenced by patient is unable to
perform daily activity.
➢ Imbalanced nutrition less than body requirement related to less intake of food as
evidenced by weight loss
➢ Disturbed sleep pattern related to hospitalization as evidenced by patient
verbalization
➢ Anxiety related to hospitalization as evidenced by patient asking too many questions.
 ➢ Knowledge deficit related to disease process and treatment as evidenced by patient is
having many doubts

Planning and Goals

To establish a plan of care, the focus should be on the following:

• Relief of pain or ischemic signs and symptoms.

• Prevention of myocardial damage.
• Absence of respiratory dysfunction.
• Maintenance or attainment of adequate tissue perfusion.
• Reduced anxiety.
• Absence or early detection of complications.
• Chest pain absent/controlled.
• Heart rate/rhythm sufficient to sustain adequate cardiac output/tissue perfusion.
• Achievement of activity level sufficient for basic self-care.
• Anxiety reduced/managed.
• Disease process, treatment plan, and prognosis understood.
• Plan in place to meet needs after discharge.

Nursing Interventions
Nursing interventions should be anchored on the goals in the nursing care plan.

• Administer oxygen along with medication therapy to assist with relief of

symptoms.
• Encourage bed rest with the back rest elevated to help decrease chest discomfort
and dyspnoea.
• Encourage changing of positions frequently to help keep fluid from pooling in the
bases of the lungs.
• Check skin temperature and peripheral pulses frequently to monitor tissue
perfusion.
• Provide information in an honest and supportive manner.
• Monitor the patient closely for changes in cardiac rate and rhythm, heart sounds,
blood pressure, chest pain, respiratory status, urinary output, changes in skin
colour, and laboratory values.

Evaluation
After the implementation of the interventions within the time specified, the nurse should
check if:

o There is an absence of pain or ischemic signs and symptoms.

o Myocardial damage is prevented.
o Absence of respiratory dysfunction.
o Adequate tissue perfusion maintained
 o Anxiety is reduced.

NURSING CARE PLAN (DAY-1)

NURSING NURSING GOAL PLNNING INTERVENTION OUT COME

ASSESSMENT DAIGNOSIS

Subjective data: Pain related to 1.Should assess 1. Asees the pain Patient feel
Pain, chest poor oxygen Reduce the pain level. level by history comfort.
tightness, activity supply in pain level 2. Should e.g., Onset of
intolerance myocardium provide pain, durations of
Objective data: cell as comfortable pain, radiation of
Confined in bed evidence by position pain, type of pain
Verbalization, chest tightness, 3.Propt up etc.
Discomfort dyspnea position should 2.Provide comfort
feeling etc. be given position to the
4. Sorbitrate patient
should be given 3.Propt up
position should
given.
4. tab.
Nitroglycerin
5mg given.

Subjective data: Activity To achieve 1.should assess 1.Assess the Patient will
History taking intolerance optimal the patient patient general participate
related pain, onset related to level of general condition. self-care
of pain, type of insufficient activity condition.
pain, duration of oxygenation 2.Should 2.Monitor the
pain. due to monitor the cardio pulmonary
Weakness, pulmonary cardio response to
Shortness of congestion as pulmonary activity.
breath evidence by response to
Objective data: weak fatigue activity.
Dyspnea and shortness 3.Encourage 3.Encourage
Difficulty for of breath. alternate rest and alternate rest and
perform self-care activity. activity.
4.should 4.Encourage the
encourage the patient to daily
patient to daily activity.
activity.
NURSING NURSING GOAL PLANNING INTERVENTION OUTCOME
ASSESSMENT DIAGNOSIS
SUBJECTIVE Decrease Maintains 1. Respiratory 1. Respiratory Respiratory
DATE: cardiac output cardiac status should be status assessed. rate checked
Fatigue related to normal assessed 2. ABG checked and noted
Restlessness valvular function 2. ABG should and monitored 24bts/min
Anxiety incompetency be monitored 3. Comfortable
OBJECTIVE as evidence by 3. Comfortable position given to BP checked
DATA: murmur, position should patient. and noted
Abnormal heart dyspnea, be given. 4. Oxygen
sound dysarthria, 4. Oxygen demand assessed. 136/96 mm of
Dyspnea peripheral demand should 5.Moist oxygen hg
Dysarrythmia edema. be assessed given to patient
Hypotension 3lit/min.
Cold clammy skin

SUBJECTIVE Ineffective To 1. Should assess 1. Assess the Breath sound

DATA: breathing maintain the patient patient breathing is normal.
Short ness of pattern related breathing breathing pattern pattern
breath to pattern 2.Respiratory 2.Respiratory
Abnormal insufficiency states should be states checked
respiration rate. oxygenation as checked and noted
OBJECTIVE evidence by 3. Comfort 3. Comfort
DATA: dyspnea position should position given to
Dyspnea, be given. patient.
Orthopnea. 4. Oxygen 4. Oxygen
demand should demand assessed.
be assessed 5.Moist oxygen
5.Moist oxygen should be given.
should be given.

Day-2

SUBJECTIVE Dyspnea To 1. Should assess 1. Should assess Respiratory

DATA: related to improve the patient the patient rate-32brt/min
Abnormal breath impaired respiratory respiratory rate, respiratory rate,
sound (crackle, oxygen supply pattern rhythm, pattern. rhythm, pattern.
wheezes, rhonchi) in heart muscle 2. Comfort 2. Comfort
Abnormal as evidence by position should position should
respiration rate. short ness of give. give.
OBJECTIVE breath,
DATA: Restless ness,
Dyspnea, Cold clammy 3. moist oxygen 3. moist oxygen
Orthopnea. skin should give to should give to
patient. patient.
4. Oxygen 4. Oxygen
saturation should saturation should
measure by measure by pulse
pulse oximeter oximeter

SUBJECTIVE Deficit To 1. Anxiety level 1. Assess the Reduce

DATA: knowledge improve of the patients anxiety level of anxiety level.
Fear about disease related to lack the should be the patients.
process of experience knowledge assessed.
Anxiety and level of 2.Information 2.Information
Less interest information patient should be given given about
OBJECTIVE about disease about disease disease condition.
DATA: as evidence by condition.
Misinformation verbalization 3. information 3. information
Emotionally unfit should be given given to patient
about treatment about treatment
and and management.
management.
4.Information 4.Information
should be given given about life
about life style. style.
5.Mental support 5.Mental support
should be given. given to patient.

SUBJECTIVE Pain related to To reduce 1. Pain level 1. Pain level Patient look
DATA: surgical pain should be assessed by pain relax.
Verbalization incision as assessed by pain scale.
irritability evidence by scale.
verbalization 2. analgesic 2. Analgesic
should be given. given to patient.
OBJECTIVE 3. Diversional 3. Diversional
DATA: therapy shooed therapy shooed be
Pain characteristic be given. given.
Onset, quality, 4. comfort 4. comfort
severity, location, position should position should be
duration of pain be given. given.
5.Sedative 5.Sedative should
should be given. be given.
Day-3

SUBJECTIVE Risk for To reduce 1. Sign of 1. Sign of Temperature-

DATA; infection chances of infection should infection assessed 98.6-degree
Redness related to infection be assessed. and noted. Fahrenheit.
Swelling surgery, foleys 2.Vital sign 2.Vital sign
Increase catheterization, should be checked and
temperature Intravenous checked. noted.
Pain cannulization 3. Aseptic 3. Aseptic
Discharge technique for technique done
OBJECTIVE invasive for invasive
DATA: procedure procedure.
Temperatures should be done. 4.General
monitor 4.General cleanliness
Observe, drainage cleanliness maintained
site, incision site, should be 5. Antibiotic
cannulation site maintained administered to
etc. 5. Antibiotic the patient as per
should be treatment
administered. protocol.

SUBJECTIVE Deficit fluid Maintain 1. Fluid 1.Assessed fluid Intake output

DATA: volume related fluid and electrolyte electrolyte will measure
Thirst, dry to NPO for electrolyte balance should balance. and record
mucous surgery imbalance be assessed. 2.IV fluid 2 hourlies.
membranes procedure as Describe 2.IV fluid should continued as per
sunken eyeball evidence by the disease be continued. treatment.
OBJECTIVE thirst. process 3. Intake output 3. Intake output
DATA: and should be maintained.
Decrease urine treatment maintained. 4. Vital sign
output 4. Vital sign checked and
concentrated should be recorded.
urine, decreased checked and
skin turgor recorded.
SUBJECTIVE Deficit Describe 1. Assess the 1. Assess the Patient fee
DATA: knowledge the disease anxiety level of anxiety level of relax and
Fear about disease related to lack process the patients. the patients. comfort.
process of experience and 2.Information 2.Information
Anxiety and treatment should be given given about
Less interest information about disease disease condition.
OBJECTIVE about disease condition. 3. information
DATA: as evidence by 3. information given about
Misinformation verbalization should be given treatment and
Emotionally unfit about treatment management.
and 4.Information
management. given about life
4.Information style.
should be given 5.Mental support
about life style. given.
5.Mental support
should be given.

PROGNOSIS
Acute MI carries a mortality rate of 5-30%; the majority of deaths occur prior to arrival to
the hospital. With Acute MI carries a mortality rate of 5-30%; the majority of deaths occur
prior to arrival to the hospital.
Within the first year after an MI, there is an additional mortality rate of 5% to 12%.
Overall prognosis depends on the extent of heart muscle damage and ejection fraction.
Patients with preserved left ventricular function tend to have good outcomes.in the first year
after an MI, there is an additional mortality rate of 5% to 12%. Overall prognosis depends on
the extent of heart muscle damage and ejection fraction. Patients with preserved left
ventricular function tend to have good outcomes.

PREVENTION
• Quit smoking
• Control conditions such as high blood pressure, high cholesterol and diabetes
• Stay physically active
• Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole grains
• Maintain a healthy weight
• Reduce and manage stress

HEALTH EDUCATION AND DISCHARGE AND HOME CARE GUIDELINES

❖ The most effective way to increase the probability that the patient will implement a
self-care regimen after discharge is to identify the patient’s priorities.
❖ Education. This is one of the priorities that the nurse must teach the patient about
heart-healthy living.
❖ Home care. The home care nurse assists the patient with scheduling and keeping up
with the follow-up appointments and with adhering to the prescribed cardiac
rehabilitation management.
❖ Follow-up monitoring. The patient may need reminders about follow-up monitoring
including periodic laboratory testing and ECGs, as well as general health screening.
❖ Adherence. The nurse should also monitor the patient’s adherence to dietary
restrictions and prescribed medications.
❖ Assist the client to identify risk factors that can be modified, and set goals that will
promote change in lifestyle to reduce the impact of risk factors.
❖ Instruct client regarding a low-calorie, low-sodium, low-cholesterol, low-fat diet with
a increase in dietary fiber. Stress that dietary changes are not temporary and must be
maintained for life.
❖ Provide community resources to client regarding exercise, smoking cessation and
stress reduction.
 INDIFICATION DATA:

Name: Badal Majumdar

Age: 58years

Sex: Male

Ward: S.S.W.H Cardio

Bed No: CCU11

Reg No: PA No:14536

Unit No: 02

Diagnosis: Myocardial infarction

Date of Admission: 15/03/22 at 9:42 p.m.

Date of operation: Not applicable

Address: S/o Lt Jatileswar Majumdar

Tej Ganj

Natun Gang

Bardhhaman, West Bengal

History of Patient: The patient has High blood pressure

from 05 years before. She takes anti-hypertensive

medicine

Present medicine history: regularly after breakfast

Complains of the patient at the time of Admission:

 • Chest pain
• Fatigue
• Breathing difficulty

Complains after Admission:

Chest pain.
Fatigue
discomfortable
Breathing difficulty
Past medical history: The patient has history of typhoid 11 years
Ago and history of jaundice from 7 years ago.
Previous Medical History:

Any Allergy to medicines or foods: No history of allergy to medicine or foods.

Surgical History: Nothing significant.

Previous History of any operation: Nothing significant.

Any accident that needed surgery: No

Have any blood transfusion: No

Blood group: O positive

Basic physiological data:

Temperature: 99.8-degree F

Pulse: 78 b/m

Respiration: 32 b/m

Blood pressure: 156/96 mm/hg

Height: 5 feet 8 inch

Weight: 58kg

Personal History:

Marital Status: Married

Religion: Hinduism
Educational Qualification: Class-XII

Totally monthly income: Rs 22000 per month

Dietary Habit: Non-Vegetarian

Eating Pattern:
Breakfast: Puffed rice, bread, biscuit
Lunch: Rice, dal, vegetables, Fish
Dinner: Rotti, vegetables
Sleeping pattern: Time of sleep at night: 6- 7 hours
Any day time sleep: Some times
Any undesirable habit: Smoking
Family history including socioeconomic status:

• Type of family: nuclear family

• Number of family member: 04 members
• Occupation of head of the family: Business man
• Total monthly income of the family: Rs 22000 per month
• Type of House: Pucca
• Water supply: Municipality water supply
• Ventilation: Well
• Sanitary system: Good
• Education status of family member:

Sl no Name of the Relation Age Educational Income

Family member Qualification

01 Badal Majumder Self 58years Class XII Rs 22000/month

02 Jayanti Majumder Wife 52 years Graduate Nil
03 Siuli Majumder Daughter 22 years H.S. Nil

04 Sayan Majumder Son 26 years Graduate Nil

• Family medical history: There is no such genetic disorder in her family.

Physical Examination:
Central Nervous System:

• Level of consciousness: Fully conscious

• Appearance: Anxious, worried
• Co-ordination: Well, co ordinated
Reflex:
• Knee jerk: Normal
• Planter reflex: Normal
Equilibrium: well balanced
Sensation:
• Test: Normal
• Smell: Normal
• Touch: Normal
Cardiovascular System:
Heart Sound: S1 & S2 sound normal S3 audible
Heart Beats: 78 beats /min
Blood pressure: 156/ 96 mm of Hg
Respiratory System: Dyspnoea
Respiratory rate: 32 beats/ min
Any abnormal sound: Not applicable
Breathing sound: Abnormal (wheeze)
Movement of chest wall: Rapid movement of chest wall
Inspiration: Irregular (rapid)
Expiration: Irregular (rapid)
Musculoskeletal system:
Body built: Thin
Gait: Normal
Body temperature: 98.80 F
Height: 5 ft 8 inch
Weight: 58 kg

Gastrointestinal System:
 Lips: Dry
Teeth: Discoloration &dental caries are present
Gum: Normal
Tongue: Normal & moist
Abdomen: epigastric pain is present
Throat: Normal

Hair:
Colour: Black with some white
Thickness: Moderate
Any infection or infestation: Nil
Nail:
▪ Size: Normal
▪ Shape: Normal
▪ Infection: Nil
▪ Nail beds: Normal no cyanosis
Neck:
▪ Enlargement of any gland: Not present
▪ Enlargement of any lymph node: No
▪ Range of motion:
▪ Flexion: Normal
▪ Extension: Normal
▪ Rotation: Normal
▪ Any limitation of movement: Normal
Excretory System:
➢ Bowel habit: Constipation in sometimes
➢ Bladder habit: Decreased urine output
➢ Any complication at the time of voiding: Some time mild pain
➢ Any abnormal sound: Nil
Integumentary system:
➢ Colour of skin: cold and clammy skin
➢ Texture: Rough & wrinkled
➢ Temperature: Normal
➢ Any lesion: Not present
➢ Sensation: Normal
➢ Turgor: Normal
➢ Oedema: Pedal oedema present
 CASE STUDY
ON
MYOCARDIAL INFARCTION

Submitted to: Submitted by:

Madam. D. Sen Babli Dutta
Senior Lecturer M.sc 1st year Student
Govt. College of Nursing Gov t College of Nursing
B.M.C. H B.M.C.H
Purba Bardhhaman Purba Bardhhaman