A. DEFINITIONS
Infarct myocardium refers to the process of heart tissue damage due to blood supply so inadequate coronary blood flow decreases.
(Brunner & Sudarth, 2002)
Is miocard acute myocardial necrosis due miocard blood flow to the heart muscle affected. (Suyono, 1999)
B. Aetiology (cassowaries, 2002)
1. factors causing:
a. Supply of oxygen to reduced miocard caused by 3 factors:
- Factor of blood vessels:
? Atherosclerosis.
? Spasm
? Arteritis
- Factor circulation:
? Hypotension
? Stenosos aurta
? insufficiency
- Factor blood:
? Anemia
? Hipoksemia
? polycythemia
b. Increased cardiac output:
- Excessive activity
- Emotion
- Eating too much
- Hypertiroidisme
c. Miocard increased oxygen requirement at:
- Damage miocard
- Hypertropimiocard
- Hypertension, diastolic
2. Predisposing factors:
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a. biological risk factors that can not be changed:
- Age over 40 years
- Gender: higher incidence in males, whereas in women increases after menopause
- Heredity
- Race: higher incidence in blacks.
b. Risk factors that can be changed:
- Major:
? hyperlipidemia
? hypertension
? Smoking
? Diabetes
? Obesity
? Diets high in saturated fat, calories
- Minor:
? Physical Inaktifitas
? Type-A personality patterns (emotional, aggressive, ambitious, competitive).
? Excessive psychological stress.
C. SIGNS AND SYMPTOMS
Signs and symptoms of myocardial infarction (TRIAD) is:
1. Pain:
a. Chest pain that occurs suddenly and does not continuously subsided, usually above the lower sternal region and upper abdomen, this is the main symptom.
b. Increase the severity of pain can stay until secaara unbearable pain.
c. Pain is very ill, such as wound-stick that can spread to the shoulders and continues down to the arm (usually the left arm).
d. The pain began spontaneously (not occur after activity or emotional disorders), stayed for a few hours or days, and not relieved by rest or nitroglycerin assistance (NTG).
e. The pain may spread to the jaw and neck.
f. Pain is often accompanied by shortness of breath, pale, cold, heavy diaforesis, dizziness or head was floating and nausea vomiting.
g. Patients with diabetes mellitus will experience great pain because of neuropathy that accompanies diabetes can interfere neuroreseptor (collecting experience pain).
2. Laboratory
Cardiac enzyme Inspection:
a. CPK-MB/CPK
Isoenzim found in heart muscle increased between 4-6 hours, peak in 12-24 hours, returning to normal within 36-48 hours.
b. LDH / HBDH
Increases in the 12-24 hour time-consuming dams to return to normal
c. AST / SGOT
Increases (less real / special) occurs within 6-12 hours, culminating in 24 hours, returning to normal within 3 or 4 days
3. ECG
ECG changes that occur in the early phase of T wave height and symmetrical. After this there ST.Perubahan segment elevation that occurs then is the wave of Q / QS which indicate the presence of necrosis.
Pain scores according to White:
0 = do not experience pain
1 = pain on one side without interfering with activities
2 = more pain at one place and resulted in disruption of activities, mislnya difficulty getting out of bed, hard to bend the head and others.
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