.

MYOCARDIAL INFARCTION

MODIFIABLE FACTORS: Hypertension Smoking levels of triglyceride, total cholesterol & LDL DM Obesity Excessive intake of saturated fats, carbohydrates or salt Sedentary lifestyle/physical inactivity Stress/Type A personality Drug Abuse

NONMODIFIABLE FACTORS: (+) Family Hx of AMI Aging Men and Postmenopausal Women

Change in the Condition of Plaque in the Coronary Artery

Activation of Platelets Platelet Aggregation, Adhesion, & Buildup of Platelet Mass ATHEROSCLEROSIS THROMBOSIS

Release of Thromboplastin

Rest pain Claudication Fainting N/V Sweating Cool extremities

Platelet release Thromboxane A2, Serotonin, Platelet Factors 3 &4 Coagulation and Vasospasm

Enlargement of Thrombus

Ineffective tissue perfusion related to reduced coronary blood flow

Weakness/fatigue

Occlusive Thrombus

Ischemia of Tissue in Region Supplied by Artery

PALPITATIONS

O2
Coronary Blood Supply Less Than Demand CO2 levels

MYOCARDIAL CELL DEATH (NECROSIS)

Bld pH
Stimulation of Sympathetic NS

DEEP & LABORED BREATHIN G HR

O2 need

Afterload

Potential impaired gas exchange related to fluid overload

BMR

Epinephrine & Norepinephrine Production

Vasoconstriction

HTN

Decreased cardiac output related to altered myocardial contractility

ARRHYTHMIA

Blood Supply to GI Tract

DIAPHORESIS

N/V

Altered Repolarization of the Myocardium

Release of Lysosomal Enzymes Anaerobic Glycolysis Myocardial Irritability Decreased Contractility DYSRHYTHMIA Ventricular Function ANGINA Lactic Acid Production

Pain related to tissue Ischemia

Preload

CO

Blood Flow to Brain

LOSS OF CONSCIOUSNESS

Prioritized Nursing Diagnosis: Ineffective tissue perfusion related to reduced coronary blood flow Decreased cardiac output related to altered myocardial contractility Potential impaired gas exchange related to fluid overload Pain related to tissue ischemia