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  ( c) or 


  
  ( c), commonly
known as a  
 , is the interruption of blood supply to part of the heart, causing
some heart cells to die. This is most commonly due to occlusion (blockage) of
a coronary artery following the rupture of avulnerable atherosclerotic plaque, which is an
unstable collection of lipids (fatty acids) and white blood cells (especially macrophages)
in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen
shortage, if left untreated for a sufficient period of time, can cause damage or death
(Ô
Ô ) of heart muscle tissue ( Ô
).

Myocardial infarction is the leading cause of death in the United States and in
most industrialized nations throughout the world. Approximately 800,000 people in the
United States are affected and, in spite of a better awareness of manifesting symptoms,
250,000 die before presentation to a hospital. 1 The survival rate for U.S. patients
hospitalized with MI is approximately 90% to 95%. This represents a significant
improvement in survival and is related to improvements in emergency medical response
and treatment strategies.

MI can occur at any age, but its incidence rises with age. The actual incidence is
dependent on predisposing risk factors for atherosclerosis (see later). Approximately
50% of all MIs in the United States occur in people younger than 65 years. However, in
the future, as demographics shift and the mean age of the population increases, a larger
percentage of patients presenting with MI will be older than 65 years.

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After this case study, we will be able to develop our knowledge, skills and
enhance our attitude in managing the sick especially patients with acute myocardial
infarction.

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#$%&

To have a broader knowledge regarding myocardial infarction such that I will be
able to internalize in a way that there will be familiarization of its epidemiology,
predisposing factors, signs and symptoms and the pathophysiology of the disease.

To be able to improve the delivery skills and management of myocardial

infarction through effective and realistic interventions.

To be able to give significance to the exposure such that it will enable to prove
our attitudes in facing various patients having different illness.
 To be able to make the whole exposure as a cherished and unforgettable
teaching medium for higher and improved management of skills, attitude and knowledge
in handling different individuals who are sick.

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The cardiovascular system can be thought of as the transport system of the body. This
system has three main components: the heart, the blood vessel and the blood itself. The
heart is the system's pump and the blood vessels are like the delivery routes. Blood can
be thought of as a fluid which contains the oxygen and nutrients the body needs and
carries the wastes which need to be removed.

* 
The heart's job is to pump blood around the body. The heart is located in between the
two lungs. It lies left of the middle of the chest.
The heart is a muscle about the size of a fist, and is roughly cone-shaped. It is about
12cm long, 9cm across the broadest point and about 6cm thick. The pericardium is a
fibrous covering which wraps around the whole heart. It holds the heart in place but
allows it to move as it beats. The wall of the heart itself is made up of a special type of
muscle called cardiac muscle.
Chambers of the Heart

The heart has two sides, the right side and the left side. The heart has four chambers.
The left and right side each have two chambers, a top chamber and a bottom chamber.
The two top chambers are known as the left and right atria (singular: atrium). The atria
receive blood from different sources. The left atrium receives blood from the lungs and
the right atrium receives blood from the rest of the body. The bottom two chambers are
known as the left and right ventricles. The ventricles pump blood out to different parts of
the body. The right ventricle pumps blood to the lungs while the left ventricle pumps out
blood to the rest of the body. The ventricles have much thicker walls than the atria which
allows them to perform more work by pumping out blood to the whole body.



&&&
Blood Vessel are tubes which carry blood. Veins are blood vessels which carry blood
from the body back to the heart. Arteries are blood vessels which carry blood from the
heart to the body. There are also microscopic blood vessels which connect arteries and
veins together called capillaries. There are a few main blood vessels which connect to
different chambers of the heart. The aorta is the largest artery in our body. The left
ventricle pumps blood into the aorta which then carries it to the rest of the body through
smaller arteries. The pulmonary trunk is the large artery which the right ventricle pumps
into. It splits into pulmonary arteries which take the blood to the lungs. The pulmonary
veins take blood from the lungs to the left atrium. All the other veins in our body drain
into the inferior vena cava (IVC) or thesuperior vena cava (SVC). These two large veins
then take the blood from the rest of the body into the right atrium.
Valves

Valves are fibrous flaps of tissue found between the heart chambers and in the blood
vessels. They are rather like gates which prevent blood from flowing in the wrong
direction. They are found in a number of places. Valves between the atria and ventricles
are known as the right and left atrioventricular valves, otherwise known as the tricuspid
and mitral valves respectively. Valves between the ventricles and the great arteries are
known as the semilunar valves. The aortic valve is found at the base of the aorta, while
the pulmonary valve is found the base of the pulmonary trunk. There are also many
valves found in veins throughout the body. However, there are no valves found in any of
the other arteries besides the aorta and pulmonary trunk.



The object of the blood is to circulate oxygen for the growth and development of cells.
The blood is composed of red and white blood cells, platelets, lymph, plasma, and
water. The red blood cells contain hemoglobin, which is the chemical compound that
carries the oxygen. The white blood cells are part of the immune system. Platelets are
used when blood clots, to stop the bleeding. The platelets emit the blot clotting
substance, fibrinogen, into its active form, fibrin. Lymph is the interstitial fluid in the
blood. The plasma is the remaining portion of the blood, the mixture of glucose and
water in which the blood cells is suspended.

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Knowing the functions of the cardiovascular system and the parts of the body that
are part of it are critical in understanding the physiology of the human body. The
cardiovascular system is the system that keeps life pumping through you with its
complex pathways of veins, arteries, and capillaries. The heart, blood vessels, and
blood help to transport vital nutrients throughout the body as well as remove
metabolic waste. They help to protect the body and regulate body temperature.

The  % & 
&

& consists of the heart, blood vessels, and blood. This
system has three main functions:

„   of nutrients, oxygen, and hormones to cells throughout the body and
removal of metabolic wastes (carbon dioxide, nitrogenous wastes, and heat).

„ [ Ô of the body by white blood cells, antibodies, and complement proteins
that circulate in the blood and defend the body against foreign microbes and
toxins. Clotting mechanisms are also present that protect the body from blood loss
after injuries.

„ | 
Ô of body temperature, fluid pH, and water content of cells.
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Êame: J.B.

Age: 68

Sex: Male

Address: Ivisan, Capiz

Civil Status: Married

Religion: Roman Catholic

Occupation: Businessman

Date & Time Admitted: January 7, 2010

Ward: ICU B

Chief Complaint: Epigastric Pain

Impression/Admitting Diagnosis: AMI; CAD (complete RBBB)

Attending Physician: Dr. J.T.


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A. Êursing History

30 minutes prior to admission Mr. J.B. was conversing with someone when he
experienced epigastric pain which made him decide to go to the hospital.

B. Past Health Problem/Status

This is the 1st time that he was admitted in the hospital. He is suffering from Diabetes
type 2 and hypertension.

He has no known allergies.

VI. BRIEF SOCIAL, CULTURAL AÊD RELIGIOUS BACKGROUÊD

He attends mass every Sunday with his family and takes time to pray every night.

VII. CLIÊICAL IÊSPECTIOÊ

A. Vital Signs:

Upon Admission: Temp: 37 C

Pulse Rate: 122 bpm

Apical Rate: 124 bpm

BP: 140/90 mmHg

Respiratory Rate: 21

During My Care: Temp: 36.4 C

Pulse Rate: 74 bpm

Apical Rate: 78 bpm

BP: 110/60 mmHg

Respiratory Rate: 17

B. Height: Weight:

C. Physical Assessment (Cephalocaudal)

I. General Appearance (include posture, gait, overall hygiene and grooming):

Ms. MD.A is a healthy appearing man, has good posture, well groomed, and in good
spirits.

II. Skin, hair and nails: Color good. Skin dry and cool. Êails without clubbing or cyanosis.
Êo suspicious rash, petechiae or ecchymoses noted.

III. Head, Eyes, Ears, Êose, and Throat: HEEÊT: Head-Skull is normocephalic. Hair is
white with average texture. Eyes-Visual acuity 20/40 bilaterally. Sclera white; conjunctiva
pink. Pupils equally round and reactive to light and accommodations. Disc margins
sharp; no hemorrhages or exudates; no arteriolar narrowing. Ears-acuity good to
whispered voice. Tympanic membranes with good cone of light. Êose-Êasal mucosa
pink, septum midline; no sinus tenderness. Throat (or Mouth)-Oral mucosa pink;
dentition good; pharynx without exudates.

IV. Êeck and Upper Extremities: Êeck-Trachea midline. Êeck supple; thyroid isthmus
palpable, lobes not felt. Lymph Êodes-Êo cervical, axillary, epitrochlear, inguinal
adenopathy.

V. Chest, breast and axilla: Tenderness not noted, no mass found, lymphatics not
noted.

VI. Respiratory System: Thorax is symmetric with good expansion. Lungs resonant.
Breath sounds vesicular; no rales, wheezes, or rhonchi.

VII. Cardiovascular System: Carotid upstrokes are brisk, without bruits. (+) history of
hypertension with blood pressure of 140/90 upon admission.
VIII. Gastrointestinal System: Flat, Soft, Êon Tender.
IX. Genito-Urinary System: Êo mass noted
X. Musculoskeletal: Can perform active range of motion. Êo evidence of deformities or
swelling noted.

D. General Appraisal
I. Speech (quality, clarity, coherence): Speaks in a low tone voice. Coherent.
II. Language: He speaks in English, Tagalog and Illonggo.
III. Hearing: Hears well. Responds to question with immediately.
IV. Mental Status: Alert, relaxed and cooperative. Thought process of coherent. Well
oriented to person, place and time.
V. Emotional status: .

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Hematology is the branch of biology (physiology), pathology, clinical laboratory,
internal medicine, and pediatrics that is concerned with the study of blood, the blood of
forming organs, and blood diseases. Hematology includes the study of etiology,
diagnosis, treatment, prognosis, and prevention of blood diseases.
Test Result Êormal Values Significance
Date: 01/07/10
WBC count 18.3x10^9/L 4.5-11.0 › Susceptible to infection
RBC count 4.78x10^12/L 4.2-5.4 Within Êormal Range.

Hemoglobin 140g/L 120-160 Within Êormal Range.

Hematocrit 0.42vol.fr 0.37-0.47 Within Êormal Range.
Mean Corpuscular Volume 86.0cu.u 80-96 Within Êormal Range.
(MCV)
Mean Corpuscular 28.5uug 27-31 Within Êormal Range.
Hemoglobin (MCH)
Mean Corpuscular 33.0g/dL 32-36 Within Êormal Range.
Hemoglobin the
Concentration (MCHC)
RDW 12.8% 11-16 Within Êormal Range.
Êeutrophils 65.0% 50-70 Within Êormal Range.
Eosinophils 3.0% 0-3 Within Êormal Range.
Basophils 0.0% 0-1 Within Êormal Range.
Lymphocytes 11.0% 20-45 Within normal Range.
Monocytes 0.0% 0-8 Within Êormal Limits.
Platelet 118000 15000-35000 Within Êormal Limits.
Protrombin Time 14.6sec 10-15 sec Within Êormal Limits.


 

&


The serum chemistry profile is one of the most important initial tests that are
commonly performed on sick or aging patient. A blood sample is collected from the
patient. The blood is then separated into a cell layer and serum layer by spinning the
sample at high speeds in a machine called centrifuge. The serum layer is drawn off and a
variety of compounds are then measured. These measurements aid the veterinarian in
assessing the function of various organs and body systems.

Test Result Êormal Values Significance

Date: 01/09/10
Sodium 156 mmol/L 137.0 ± 145.0 Indicates fluid retention.
Magnesium 1.10 mmol/L .70 ± 1.00 Within Êormal Range.
Creatinine 85.0 mmol/L 71.0 ± 133.0 Within Êormal Range
Cholesterol 9.34 mmol/L 0.00 ± 5.20 › Elevation indicates
increase risk in
CAD
Direct HDLC .45 mmol/L 1.00 ± 1.60 Indicates risks in
CAD
LDL 7.40 1.71 ± 4.60 › Elevation indicates
risk in CAD
VLDL 1.52 0.00 ± 1.03 › Elevation indicates
increase risk in
CAD
Potassium 2.9 3.5 ± 5.10


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It is the science that deals with the properties and reactions of serums, especially
blood serum. It analyzes the contents and properties of blood serum.

Serum Specimen Result/s Êormal Value Significance

Date: 01/07/10
Troponin ± 1 Determination (+) Positive 3.13 ug/L <0.01ug/L Indicates
Myocardial
Infarction.
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M-MEDICATIOÊS

Give Ordered and scheduled meds.

E-Exercise and Activity

"
'


& Adequate rest is important to maintain progress toward full
recovery and to avoid relapse.
T-Treatment
Continue monitoring blood pressure and ECG results and comply with the medications
given prescribed by the attending physician to prevent further complications that may
occur and to have a faster recovery.

H- Home Teaching in Relation to disease, etiology and hygiene measures

O- Out Patient Follow-up

The patient will have his check-up one week after his discharge.
D-Diet

Diet as tolerated. This particular diet is only given when client can now tolerate
any food he desires that is nutritious, if this will not lead to any complications and if the
client needs further monitoring for lab test.


S- Spirituality

Continue
going to Church every Sunday and praying every night as a usual
routine.




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.

„ Sparks and Taylor Êg Diagnosis Reference Manual 7th ed.
Copyright (c) 2008 by Lippincott William and Wilkins
„ Êursing Diagnosis Handbook A guide to Planning Care 7th ed.
Betty J. Ackley and Gail B. Ladwig
Copyright (c) 2006, Mosby Inc.


IÊTERÊET

http://www.emedicine.com

http://en.wikipedia.org