Pathophysiology of Myocardial Infarction
Leaving cardiovascular complications such as angina, hypertension, and other metabolic complications may become fatal for the health of a person. Increased body weight is associated with hypertension and diabetes and eventually increases the risks of myocardial infarction (Saleh & Ambrose, 2018). The case the study-based essay is about the case of Kath Harris, who is a 65-year-old lady who is a heavy and regular smoker and has a history of a plethora of metabolic disease conditions. Recently, a diagnosis has suggested that Harris might be suffering from peptic ulcer disease. The lady is obese and has recently suffered from a traumatic injury to her head. The pathophysiology along with clinical manifestations of myocardial infarction for Kath will be discussed, followed by management and intervention of the same for Kath will be stated.
Myocardial infarction (MI) is the sudden death of the myocardial tissue. Myocardial infarction occurs from an imbalance in the supply of oxygen to the heart as per its demand. This situation arises due to the formation of plaque which ruptures with the formation of a thrombus in the coronary artery. This reduces blood supply to the myocardium resulting in loss of oxygen (Gabriel-Costa, 2018). In a clinical context, it can be said that MI arises when the ischemia induces some metabolic and ionic perturbations in the myocardia that are affected while causing rapid depression of the diastolic function. In the apoptosis and necrosis of the cells of myocardia, alterations of the mitochondria are highly involved (Smit, Coetzee & Lochner, 2020). As the heart of human beings has the very less regenerative capacity, the myocardium, which has undergone infarction, heals through the formation of a scar. The healing of the infarct is done by an inflammatory cascade where the clearance of dead cells and debris of the matrix through the infiltration of phagocytes leads to activation of inflammatory pathways, which leads to suppression of signaling cytokines as well as chemokines (Saleh & Ambrose, 2018).
The clinical manifestations as demonstrated by Kath are chest pain, nausea and a feeling of distress. Her BP was low, and her oxygen level had come down to 91%. Other vital signs were normal. During MI, adenosine gets generated, which increases the chances of coronary blood flow for the restoration of homeostasis (Yang, 2018). However, when the artery is blocked and blood supply decreases, high levels of adenosine activate cardiac neurons with the help of adenosine receptors. The resulting neural outflow results in visceral pain or discomfort, which is known as angina pectoris. Nausea during MI infarction occurs due to the infarction of the inferior wall (Jensen et al., 2022). A lowering of the blood pressure that has been noted in Kath occurs as the parasympathetic nervous system gets into overdrive due to MI. As the body tries to rest at that instance, the blood pressure gradually becomes low.
The risk factor which is responsible for the contribution of myocardial infarction of Kath, as evident from the case study, are diabetes, episodes of angina, hypertension and increased body weight. Heavy smoking is also one of the major risk factors for the occurrence of myocardial infarction (Saleh & Ambrose, 2018). For taking care of the current condition of Mrs. Harris, a sound and effective care plan consisting of diagnosis, goals and management interventions has been planned out. Among care measures, vital signs of Kath has to be checked at regular intervals, and if there is shortness of breath, then oxygen has to be supplied immediately, and urinary output has to be assessed properly (Jensen et al., 2022). A strict and well-balanced diet will be prescribed for Mrs. Harris, and she should be enforced to restrict herself from smoking.
Clinical Manifestations of Myocardial Infarction
Myocardial infarction requires immediate management of nursing along with pharmacological therapy to relieve the symptoms (Mechanic et al., 2021). The three main medications that can be given to a patient suffering from myocardial infarction include anticoagulants, beta-blockers and angiotensin-converting (ACE) enzyme inhibitors (Pietrzykowski et al., 2022). Kath presents a pain score of 6 out of 10, which is considered to be moderate to severe (Royal Perth Bentley Group, [RPBG], 2020). The pain management guidelines by the WHO suggest the nurse collect the score of pain along with subjective data. The nurse should also try to reduce fear in the mind of the patient (Berman, 2016). Non-pharmacological interventions for the management of MI include modalities of ventilation, ultrafiltration, circulatory support that is mechanical, surgical treatment as well as myocardial revascularisation (Correale et al., 2019). Kath should be advised to indulge in deep breathing as soon as she feels the pain. Apart from this, Kath has to be advised to cut off smoking from her daily habit and increase her physical activity so that weight reduction can be accomplished. Bringing improvement to the diet through the incorporation of foods that are low in saturated fats must be implemented.
Administration of oxygen along with medication therapy assists in relieving symptoms. Kath should be encouraged complete bed rest with the back elevated to a height so that it can decrease the discomfort occurring in the chest. To prevent fluids from pooling at the base of the lungs, Kath should be made to change positions quite frequently (Correale et al., 2019). Pulse and skin temperature must be checked regularly for monitoring of tissue perfusion. After implementing the interventions, the nurse should check whether myocardial damage could be prevented by performing tests like ECG and EEG (Sluchinski et al., 2022). Kath should be checked for a subsidiary of respiratory dysfunction. Last but not the least, it has to be checked whether the cardiac pain has subsided or not.
Heparin is an anticoagulant that can be prescribed for Myocardial Infarction. It is a self-injectable solution that is injected under the skin. This medicine is used as a blood thinner that helps in the prevention of blood clots from getting larger due to myocardial infarction (Tan, White & Layland, 2022). Heparin is usually administered in an intravenous manner. On administration, it binds to enzyme inhibitor anti-thrombin 3, thus causing a conformational change which results in the activation of the medicine through enhancement of the flexibility of the reactive site loop. The activated anti-thrombin will inactivate thrombin and the activated factor Xa by an anti-thrombin-dependent mechanism (van Gameren et al., 2018). Some of the common side effects of this drug include an increase in chances of bruising, elongated time for bleeding to stop, redness and sores at the site of irritation and increased enzymes in the liver on the results of liver function tests. Allergic reactions are also common during the administration of Heparin. While administering Heparin to Kath, it is important for the nurse to look out for symptoms of allergy (Tan, White & Layland, 2022). The nurse must also measure of anticoagulant effect on unfractionated heparin to adjust the dosage to maintain the levels within the targeted therapeutic range.
Risk Factors Contributing to Kath’s Condition
Captopril can be provided to Kath after MI as it is an ACE inhibitor. Captopril is an oral tablet, and it is prescribed in combination with other therapeutic drugs. This medicine works by opening the blood vessels, thus allowing blood to flow very easily (Marte, Sankar & Cassagnol, 2018). This reduces the load on the heart to pump blood. With the help of this medicine, blood pressure levels are maintained at normal, thereby improving the ability of the heart to pump blood. This medicine prevents the body from producing angiotensin 2, which is a substance narrowing the blood vessels (Hong et al., 2018). While administering Captopril to Kath, the nurse must remember to administer the dose at the same time each day. Potassium supplements have to be provided with Captopril. Moreover, Blood Urea Nitrogen has to be regularly monitored along with the levels of protein excreted through urine. The common side effects of using Captopril are dry cough, skin rashes, dizziness and alteration of taste buds.
Atenolol is an oral tablet that is a beta-blocker that needs to be administered to Kath Harris as a treatment measure for myocardial infarction. Atenolol reduced blood pressure and reduced the workload on the heart to pump blood through the body. It acts by blocking the action of certain chemicals in the body, such as epinephrine which is also known as adrenaline. It also helps in improving blood flow through the widening of arteries and veins (Rehman, Sanchez & Shah, 2020). Constipation, dizziness, shortness of breath, diarrhea and lower blood pressure than usual are some of the common side effects of administering Atenolol. The nurse must monitor sugar levels of Kath on a regular basis. Atenolol is known to mask signs of low blood sugar and hence cannot be detected easily. The nurse should also monitor apical pulse and blood pressure before the administration of this medicine (Ibrahim & Suleiman, 2019).
Conclusion
Myocardial infarction can become fatal if it is not managed and treated properly. The pathophysiology of the condition varies depending on the source or cause of the infarction. However, the nursing interventions should be designed in a manner where pain relief and relief from discomfort are achieved. Through proper administration of medicines and implementation of non-pharmacological techniques in a proper manner, Kath can be given ultimate relief from such a tedious health condition.
Reference List
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