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Acute Myocardial Infarction
"Heart Attack"
Med Today
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Pathophysiology
Sudden loss of blood supply to a portion of the heart, which creates an imbalance between myocardial oxygen supply and demand.
Etiology
Causes of Acute Myocardial Infarctions include:
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The etiology of MI varies as there are several potential causes. This may be caused by cardiac contusion, myocarditis, presence of cardiotoxic substances, hypotension, tachycardia, aortic stenosis, and pulmonary embolism can all lead to MI because the increased oxygen demand cannot be met.
Lab & Diagnostics
Labs and diagnostics include include:
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ECG
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BP Assessment
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Diagnosis: Blood test will show increased levels of CK-MB, troponin I, and troponin T.
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The ST wave will identify whether or not a heart attack occurred, and if so, which type.
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Cardiac Catheterization
Signs & Symptoms
Signs & Symptoms include:
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Chest pain unrelieved by rest
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Crushing chest pain
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Diaphoresis
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Mottled skin
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N/V
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Anxiety
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Palpitations
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ST elevation
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Shortness of breath
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Pain or tightness in jaw, neck, back or stomach
Risk Factors
Risk factors include:
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Smoking
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Overweight
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Physically inactive
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Diabetes
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Family History of Heart disease or stroke
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Hypertension
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Hypocholesteremia
Treatment
Prevention: Have a healthy, nutritious, and balanced diet, including fruits, vegetables, healthy fats, and whole grains. Reduce/limit high saturated and trans-fats. Exercise regularly, 5x per week for at least 30 minutes. Manage stress. Quit smoking. Remain at a healthy weight.
Medications: anticoagulants, antiplatelets, beta-blockers, nitrates, statins, ACE-inhibitors, ARBs (angiotensin receptor blockers).
Surgery: CABG, or coronary artery bypass graft, may be performed on those to be medium to high risk. M.O.N.A – morphine, oxygen, nitro, aspirin.
Treatment will depend on the amount of blockage and the severity of the MI. A GRACE score will determine whether the cardiac event is low, medium, or high risk. IT assesses age, heart rate, systolic BP, physical exam, serum creatinine level, cardiac arrest at admission, ST-segment deviation in ECG, elevated cardiac marker.
Nursing
Interventions
The goal is to reduce pain experienced by the patient. Severe pain due to a MI impeding blood flow was one of the causes of deaths worldwide due to ischemic heart disease. Vitals continuously monitored, NIBP, O2sat, HR, respirations should be monitored along with a 5-lead ECG to monitor heart rhythm, or even better a 12-lead if available. It is important to keep the patient well oxygenated as even during a MI, the body can utilize the extra oxygen to slow the death of myocardial cells.
Educate: The patient needs to know everything about the MI, and how to treat it afterward, including all newly prescribed medications and why they are now needed. They need to be educated mostly in factors that can reduce stress, emotional and physical, as smoking, diabetes II, and poor diet and exercise are major risk factors that are 100% changeable and will only help the patient.