Myocardial infraction

:: فهرست

تعریف-- انفارکتوس در درگیر مناطق (شناسایی درگیری) محل اساس بر

- قلب نوار تغییرات- انزیمی تغییرات

- درگیر های الیه اساس بر بندی طبقه- جهانی بندی طبقه

عوارض-- ها نشانه و عالئم

- پرستاری و درمانی مداخالت

Myocardial infarction (MI) is the irreversible necrosis of heart muscle secondary to prolonged ischemia.

:اتیولوژی-- اترواسکلروز پالک پارگی

-- میوکارد انفارکتوس شریان انسداد-- خون ) ( جریان توقف کاهش

. .ذ ویژه ارشد دروس کامل مجموعه همکاران و 118صفحه: 1393والفقاری

Hubbard, J.myocardial infarction:signs symptoms and treatment. Nursing Times;99, 4, 28–29.

استاد ی جزوه

Effects of ischemia, injury, and infarction on ECG

Ischemia causes inversion of T wave because of altered repolarization.

Cardiac muscle injury causes elevation of the ST segment and tall, symmetrical T waves.

Q or QS waves develop because of the absence of depolarization current from the necrotic tissue.

brunner & Suddarth’sxtbook of Medical-Surgical Nursing,10th edition.page 726.

brunner & Suddarth’sxtbook of Medical-Surgical Nursing,10th edition.

Note: ST segment before assessment of T waves, QT interval.the diagnosis of acute MI or ischemia is vital and depends on careful assessment of the ST segment.

The ST segment holds the key to the diagnosis.

Rapid ECG Interpretation.page 51and 33

…Page 108

(1)

Infarct Size

- Small MI: ST elevation in two or three leads

- Moderate MI: four or five leads

- Large MI: six or seven leads

- Extensive MI: eight or nine leads

Rapid ECG Interpretation.Page 120

Q WAVE MYOCARDIAL INFARCTION

Q waves of acute infarction are always associated with abnormal ST elevation.

(Pathologic Q waves are usually defined as duration >0.04 s or >25% of R-wave amplitude)

…Rapid ECG Interpretation.page 146

(2)

…page 53

T WAVE

…Page 67

(3)

Rapid ECG Interpretation.Page 67

CK-MBThe level starts to increase within a few hours and peaks within 24 hours of an MI.

Myoglobinmyoglobin level starts to increase within 1 to 3 hours and peaks within 12 hours after the onset of symptoms.

Troponinincrease in the level of troponin in the serum starts and peaks at approximately the same time as CK-MB.

ها ::::::::::::انزیم

brunner & Suddarth’sxtbook of Medical-Surgical Nursing,10th edition.page 726

brunner & Suddarth’sxtbook of Medical-Surgical Nursing,10th edition.page 727

درگیر های الیه اساس بر میوکارد انفارکتوس

--- مورال ترانس انفارکتوس

--- اندوکارد ساب انفارکتوس

--- اینترامورال انفارکتوس

. . ویژه ارشد دروس کامل مجموعه همکاران و 119صفحه: 1393ذوالفقاری

BRAUNWALD’S HEART DISEASE-A TEXTBOOK OFCARDIOVASCULAR MEDICINE.page 1069

انفارکتوس :::عوارض

1- بطنی عملکرد سو

2- بدن مایعات حجم کاهش

3- کاردیوژنیک شوک

اریتمی-4

پریکاردیت-5

هاریسون . داخلی طب ی. 2012اصول 515-512صفحه

6- راست بطن انفارکتوس

- تحتانی انفارکتوس دچار بیماران در معموال

ST elevation in V4R and V3R-

ST elevation in V4R recedes within 8 hours of onset of symptoms

هاریسون . داخلی طب ی. 2012اصول 514صفحهRapid ECG Interpretation.page 158

اولیه :::عالئمNausea and vomiting

Pain

Dizziness

Palpitations

cold perspiration

Anxious

skin pallor…….BRAUNWALD’S HEART DISEASE-A TEXTBOOK OFCARDIOVASCULAR MEDICINE.page1085

Signs and Symptoms

CardiovascularChest painPalpitationsHeart sounds may include S3, S4Increased jugular venous distention Pulse deficit

brunner & Suddarth’sxtbook of Medical-Surgical Nursing,10th edition.page 725

RespiratoryShortness of breathdyspnea tachypneacrackles Pulmonary

GastrointestinalNausea and vomiting.

GenitourinaryDecreased urinary output

brunner & Suddarth’sxtbook of Medical-Surgical Nursing,10th edition.page 725

NeurologicAnxietyRestlessnessHeadachevisual disturbancesaltered speechaltered motor functionchanges in level of consciousness

Psychological

brunner & Suddarth’sxtbook of Medical-Surgical Nursing,10th edition.page 725

Acute Coronary Syndrome Decision Tree

MANAGEMENT OF ACUTE CORONARY SYNDROMES. Cardiac Care Network.2013.page 31

-Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow from coronary thrombus and atherosclerotic plaque.-Potential impaired gas exchange related to fluid overload from left ventricular dysfunction.

NURSING DIAGNOSES

brunner & Suddarth’sxtbook of Medical-Surgical Nursing,10th edition.page 729

-Anxiety related to fear of death

-deficient knowledge about post-MI self-care-Potential altered peripheral tissue perfusion related to decreased cardiac output from left ventricular dysfunction.

brunner & Suddarth’sxtbook of Medical-Surgical Nursing,10th edition.page 729

……..

Nursing Interventions

-RELIEVING PAIN AND OTHER SIGNS AND SYMPTOMS OF ISCHEMIA-IMPROVING RESPIRATORY FUNCTION

-PROMOTING ADEQUATE TISSUE PERFUSION

-REDUCING ANXIETY

-MONITORING AND MANAGING POTENTIAL COMPLICATIONS

brunner & Suddarth’sxtbook of Medical-Surgical Nursing,10th edition.page 730