MI
Pathophysiology
Necrosis of part of the myocardium due to vessel occlusion, ischemia and anoxia
PT Evaluation
EKG:
ST segment elevation acute injury
T wave inversion (ischemia)
Pathological Q wave (necrosis)
O2 Transport
Risk Factors:
Diet, environment, lack of exercise, stress, genetics, tobacco use, diabetes, use of illegal of drugs, high blood pressure
Medical Management
Desired HR range- 97-119 bpm
ICF Model
Resting HR-75, Max HR-130
Oxygenated blood flow is blocked to heart's arteries
R. coronary:posterior section and portions of inferior section of left ventricle, Right atrium right ventricle, SA node, AV node
L. coronary: circumflex artery- lateral portion of left ventricle
Anterior descending artery- anterior/ septal portion of left ventricle
Left ventricle
Desired intensity range- (40-80%)
Diagnostic Testing
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EKG
Exercise stress test
Blood tests looking at blood enzymes (troponins)
Chest X-Ray
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Angiogram
CAD
Fatty streaks begin to form, which contain lipoproteins. Streaks form between the endothelium and internal elastic lamina
Atheroma (plaque) begins to form, decreasing oxygenated blood flow & nutrients to Myocardium --> Increased myocardial work and decreased efficiency
Atheroma creates its own network of blood vessel supply known as Angiogenesis. Calcified atheroma is made of lipids and necrotic cells
Atheroma can rupture over time, exposing thrombus and necrotic particles into circulating blood, resulting in platelet adherence and narrowing of lumen
Narrowing of artery wall leads to acute coronary symptoms such as Angina.
Myocardium receives decreased oxygen
Cells become ischemic then necrotic
Health Condition- Myocardial Infarction
Body Function/Structure- Cell death of myocardium
Activities- Decreased ability to perform ADL's
Treatment
Participation- Unemployed, takes walks with wife
Environmental/Personal Factors- Lives in condominium townhouse with wife. Has 3 children not living at home.
Cardiovascular training 3-5 days a week on preferred equipment (arm bike, treadmill, recumbent bike)
Resistance training 2-3x per week, monitoring fatigue, targeting major muscle groups
3-5 days a week
Patient is 5'9", 191 lbs BMI: 28.2 (Overweight, close to obese)
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Auscultations of heart (look for S3 sounds for heart failure) and lungs (crackles for fluid)
Ask for chest pain, nausea, anxiety, shortness of breath, pallor, sweating
Transfers
ambulation