What is Myocardial Infarction?
Kath Harris has presented herself to the healthcare facility with the sudden onset of pain in her chest. She has been diagnosed with myocardial infarction. She is 65 years old and stays alone at her house. Before the commencement of her pain, Kath was performing light housekeeping. The pathophysiology of myocardial infarction, as well as clinical signs and risk factors, will be discussed in this study. Immediate nursing care, as well as medical management of the ailment, will be covered. Three drugs that can be used to treat myocardial infarction will be discussed, as well as their indications for usage, adverse effects, mode of action, methods of administration, and nursing concerns.
A myocardial infarction (MI), also termed a “heart attack,” occurs when the supply of blood to a region of the myocardium is reduced or completely stopped. Myocardial infarction can be “quiet” and go unnoticed, or it can be a fatal occurrence that results in circulatory decline and untimely death (Reed, Rossi & Cannon, 2017). A large percentage of myocardial infarction is caused by an obstruction in one of the arteries that provide blood to the heart. Plaque which is a type of fatty material that can accumulate on the inner lining of the arteries is the most common factor for myocardial infarction. This accumulation leads to a condition known as atherosclerosis (Geovanini & Libby, 2018). The deposits of plaque within the coronary arteries of the heart can sometimes split apart or burst, causing a clot of blood to become lodged where the breach occurred. If the clot clogs the artery, the muscles of the heart will be starved of oxygen and nutrients, leading to myocardial infarction. Atherosclerotic perforation causes an inflammatory response in monocytes and macrophages, as well as the formation of thrombus and dispersion of platelets. As a result, oxygen transportation across the coronary artery is decreased, resulting in decreased oxygenation of the myocardial. The mitochondria’s incapacity to produce ATP triggers the ischemia cascade, which results in endocardial apoptosis (cell death) or myocardial infarction (Vaccarezza, Balla & Rizzo, 2018).
In the case of Kath, there are many risk factors for myocardial infarction. The first risk factor is her age. She is 65 years old and the probability of risk factors increases in women after they reach 55 years or above. She is also obese and her body mass index is 32. She also has a high level of low-density lipoprotein (LDL) in her blood, which increases her risk. This is because LDL cholesterol can attach to arterial walls and create plaque, a hard material that blocks the flow of blood in the arteries. Other potential risk factors in her case, according to the given scenario, are high blood pressure, diabetes, and smoking. She has been a cigarette smoker for almost 40 years, smoking two packets of cigarettes per day (Thygesen, et al., 2019).
She is having pain in her chest which she has rated 6 out of 10 on the pain scale. She is also feeling nauseous and her skin was pale and her peripheries were cool. Her respiratory rate has increased and is 28 bpm and she is also distressed (Anderson & Morrow, 2017).
Risk Factors for Myocardial Infarction
Nursing management in Myocardial infarction is crucial and thorough, and effectiveness is required to administer treatment for a person having a heart attack. The nursing assessment is among the most critical components of the management of a person who had a heart attack. The nurse should check for chest pain that is not eased by rest or medicines. They should keep an eye on the vital indicators of Kath, particularly her blood pressure and heart rate. the nurse should check for shortness of breath, dyspnoea, tachypnoea, and crackles. Signs of nausea and vomiting must be examined. The nurse should also look for signs of decreased urine output. They should examine Kath’s medical history. A thorough physical examination to discover problems and alterations in the condition of Kath should be conducted. The IV sites should be checked regularly (Mechanic, et al., 2021). The nursing goals here are to alleviate stress and discomfort, decrease cardiac strain, treat and prevent life-threatening dysrhythmias or consequences, and improve heart health and quality of life (Aeyels, et al., 2018). The nursing interventions must be based on the nursing management plan’s aims. To help with symptom management, the nurse should combine oxygen with prescription therapy. The nurse should facilitate bed rest with the backrest lifted to alleviate chest pains and breathlessness. The nurse should promote frequent position changes to help prevent fluid from accumulating in the lungs’ bases. They should monitor tissue perfusion by checking the temperature of the skin and peripheral pulses on a regular basis. They should give information to Kath in an open and encouraging approach. Changes in cardiac rate and rhythm, heart sounds, blood pressure, chest discomfort, respiratory status, urine output, changes in skin colour, and laboratory values should all be thoroughly monitored by the nurses (Wang, 2020).
Medical management is to reduce damage to the heart muscles, retain cardiac function, and avoid problems. Morphine in IV boluses must be administered by the nurse for Myocardial infarction to alleviate pain and anxiety. Because intravenous nitrates are significantly more successful than sublingual nitrates in treating Kath’s symptoms and the regression of ST depression, the nurse should use them. The dosage is gradually increased until the symptoms vanish, blood pressure in hypertensive people stabilizes, or unpleasant side effects such as headache and hypotension are observed. ACE inhibitors must be administered because they impede the transformation of angiotensin I to angiotensin II, which lowers blood pressure and causes the kidneys to release salt and fluid, lowering the heart’s oxygen requirement. Thrombolytics disintegrate the clot in the coronary artery, letting blood pass again into the artery, reducing the extent of the infarction, and maintaining the functional status of the ventricles. Patients with unstable angina may also benefit from PCI (Harrington, Stueben & Lenahan, 2019).
Heparin is an anticoagulant or blood thinner that inhibits blood from clotting. Heparin interacts with the enzyme inhibitor antithrombin III (AT), creating a structural shift that activates AT by increasing the mobility of its reaction domain loop. Thrombin, factor Xa, and other proteases are then inactivated by activated AT. It is injected intravenously. Heparin interacts with the enzyme inhibitor antithrombin III (AT), creating a structural shift that activates AT by increasing the mobility of its reaction domain loop. Thrombin, factor Xa, and other proteases are then inactivated by activated AT. The nurse should monitor signs of allergic reactions and bleeding (Durbin, 2021).
Nitroglycerin is a medication used to treat and control angina (chest pain) induced by coronary artery disease. Nitroglycerin works by relaxing the smooth muscle and blood vessels in the body. This increases blood and oxygen flow to the heart. As a result, the heart works less hard. This relieves chest pain. Sublingual tablets or sprays are used for administration. Some of the negative effects include headache, dizziness, lightheadedness, nausea, and flushing. If the drug is administered using patches, the nurse should be on the alert for signs of infection (Kim, et al., 2021).
Ramipril is used to treat excessive blood pressure and to enhance survival after a heart attack. Ramipril inhibits the angiotensin-converting enzyme and lowers angiotensin II production. Usually, the capsule or tablet should be entirely swallowed. Cough, dizziness, vomiting, diarrhea, and skin rashes are some of the side effects of this medication. Nurses should watch for indicators of renal dysfunction, such as fluid retention and decreased urine output (Aremu, 2020).
Conclusion
A myocardial infarction is a situation that can be very severe and can even be life-threatening if not managed properly and at right time. The cornerstone for the treatment of myocardial infarction is the timing of initiation of the symptoms.
References
Aeyels, D., Seys, D., Sinnaeve, P. R., Claeys, M. J., Gevaert, S., Schoors, D., … & Vanhaecht, K. (2018). Managing in-hospital quality improvement: An importance-performance analysis to set priorities for ST-elevation myocardial infarction care. European Journal of Cardiovascular Nursing, 17(6), 535-542.
Anderson, J. L., & Morrow, D. A. (2017). Acute myocardial infarction. New England Journal of Medicine, 376(21), 2053-2064.
Aremu, F. (2020). Ramipril, Oral Capsule. https://www.healthline.com/health/drugs/ramipril-oral-capsule
Durbin, K. (2021). Heparin Injection. https://www.drugs.com/heparin.html
Geovanini, G. R., & Libby, P. (2018). Atherosclerosis and inflammation: overview and updates. Clinical science, 132(12), 1243-1252.
Harrington, D. H., Stueben, F., & Lenahan, C. M. (2019). ST-elevation myocardial infarction and non-ST-elevation myocardial infarction: medical and surgical interventions. Critical Care Nursing Clinics, 31(1), 49-64.
Kim, K. H., Kerndt, C. C., Adnan, G., & Schaller, D. J. (2021). Nitroglycerin. In StatPearls [Internet]. StatPearls Publishing.
Mechanic, O. J., Gavin, M., Grossman, S. A., & Ziegler, K. (2021). Acute Myocardial Infarction (Nursing). In StatPearls [Internet]. StatPearls Publishing.
Reed, G. W., Rossi, J. E., & Cannon, C. P. (2017). Acute myocardial infarction. The Lancet, 389(10065), 197-210.
Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., … & Windecker, S. (2019). Fourth universal definition of myocardial infarction (2018). European heart journal, 40(3), 237-269.
Vaccarezza, M., Balla, C., & Rizzo, P. (2018). Atherosclerosis as an inflammatory disease: Doubts? No more. International Journal of cardiology. Heart & Vasculature, 19, 1.
Wang, J. (2020). Clinical efficacy of early cardiac rehabilitation nursing for patients with acute myocardial infarction after interventional therapy. Int. J. Clin. Exp. Med, 13, 7986-7992.
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