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Acute myocardial infarction is the medical

name for a heart attack. A heart attack is a


life-threatening condition that occurs when
blood flow to the heart muscle is abruptly cut
off, causing tissue damage. This is usually the
result of a blockage in one or more of
the coronary arteries. A blockage can develop
due to a buildup of plaque, a substance mostly
made of fat, cholesterol, and cellular waste
products.

Call 911 right away if you think that you or


someone you know may be having a heart
attack.
WHAT ARE THE SYMPTOMS OF
ACUTE MYOCARDIAL INFARCTION?
While the classic symptoms of a heart attack are chest
pain and shortness of breath, the symptoms can be quite
varied. The most common symptoms of a heart attack include:
• pressure or tightness in the • sweating
chest • nausea
• pain in the chest, back, jaw, • vomiting
and other areas of the upper • anxiety
body that lasts more than a • a cough
few minutes or that goes • dizziness
away and comes back • a fast heart rate
• shortness of breath
It’s important to note that not all people who have heart
attacks experience the same symptoms or the same severity of
symptoms. Chest pain is the most commonly reported
symptom among both women and men. However, women are
more likely than men to have:
• shortness of breath
• jaw pain
• upper back pain
• lightheadedness
• nausea
• vomiting
In fact, some women who have had a heart attack report that
their symptoms felt like the symptoms of the flu.
Your heart is the main organ in your cardiovascular
system, which also includes different types of blood
vessels. Some of the most important vessels are the
arteries. They take oxygen-rich blood to your body
and all of your organs. The coronary arteries take
oxygen rich blood specifically to your heart muscle.
When these arteries become blocked or narrowed
due to a buildup of plaque, the blood flow to your
heart can decrease significantly or stop completely.
This can cause a heart attack. Several factors may
lead to a blockage in the coronary arteries.
Bad cholesterol, also called low-density lipoprotein (LDL), is
one of the leading causes of a blockage in the arteries.
Cholesterol is a colorless substance that’s found in the food you
eat. Your body also makes it naturally. Not all cholesterol is
bad, but LDL cholesterol can stick to the walls of your arteries
and produce plaque. Plaque is a hard substance that blocks
blood flow in the arteries. Blood platelets, which help the blood
to cloth, may stick to the plaque and build up over time.
Saturated fats may also contribute to the buildup of plaque in
the coronary arteries. Saturated fats are found mostly in meat
and dairy products, including beef, butter, and cheese. These
fats may lead to an arterial blockage by increasing the amount
of bad cholesterol in your blood system and reducing the
amount of good cholesterol.
Another type of fat that contributes to clogged
arteries is trans fat, or hydrogenated fat. Trans fat is
usually artificially produced and can be found in a
variety of processed foods. Trans fat is typically listed
on food labels as hydrogenated oil or partially
hydrogenated oil.
 Certain factors may increase your risk
of having a heart attack.
HIGH BLOOD PRESSURE

You’re at greater risk for heart attack if you have high blood
pressure. Normal blood pressure is below 120/80 mm Hg
(millimeters of mercury) depending on your age. As the numbers
increase, so does your risk of developing heart problems. Having
high blood pressure damages your arteries and accelerates the
buildup of plaque.

HIGH CHOLESTEROL LEVELS

Having high levels of cholesterol in your blood puts you at risk for
acute myocardial infarction. You may be able to lower your
cholesterol by making changes to your diet or by taking certain
medications called statins.
HIGH TRIGLYCERIDE LEVELS
High triglyceride levels also increase your risk for having a heart attack.
Triglycerides are a type of fat that clog up your arteries. Triglycerides from
the food you eat travel through your blood until they’re stored in your
body, typically in your fat cells. However, some triglycerides may remain in
your arteries and contribute to the buildup of plaque.

DIABETES AND HIGH BLOOD SUGAR LEVELS

Diabetes is a condition that causes blood sugar, or glucose, levels to rise.


High blood sugar levels can damage blood vessels and eventually lead to
coronary artery disease. This is a serious health condition that can trigger
heart attacks in some people.
OBESITY
Your chances of having a heart attack are higher if you’re very
overweight. Obesity is associated with various conditions that increase the
risk of heart attack, including:

• Diabetes
• high blood pressure
• high cholesterol levels
• high triglyceride levels

SMOKING
Smoking tobacco products increases your risk for heart attack. It
may also lead to other cardiovascular conditions and diseases.
AGE

The risk of having a heart attack increases with age. Men are at a higher risk of a
heart attack after age 45, and women are at a higher risk of a heart attack after age
55.

FAMILY HISTORY

You’re more likely to have a heart attack if you have a family history of early heart
disease. Your risk is especially high if you have male family members who developed
heart disease before age 55 or if you have female family members who developed
heart disease before age 65.

Other factors that can increase your risk for heart attack include:

• stress
• lack of exercise
• the use of certain illegal drugs, including cocaine and amphetamines
• a history of preeclampsia, or high blood pressure during pregnancy
To determine whether you’ve had a heart attack, your doctor will listen to
your heart to check for irregularities in your heartbeat. They may measure
your blood pressure as well. Your doctor will also run a number of different
tests if they suspect that you’ve had a heart attack. An electrocardiogram
(EKG) may be done to measure your heart’s electrical activity. Blood tests
can also be used to check for proteins that are associated with heart
damage, such as troponin.

Other diagnostic tests include:

• a stress test to see how your heart responds to certain situations, such as
exercise
• an angiogram with coronary catheterization to look for areas of
blockage in your arteries
• an echocardiogram to help identify areas of your heart that aren’t
working properly
Heart attacks require immediate treatment, so most treatments begin in
the emergency room. A minimally invasive procedure called angioplasty
may be used to unblock the arteries that supply blood to the heart. During
an angioplasty, your surgeon will insert a long, thin tube called a catheter
through your artery to reach the blockage. They will then inflate a small
balloon attached to the catheter in order to reopen the artery, allowing
blood flow to resume. Your surgeon may also place a small, mesh tube
called a stent at the site of the blockage. The stent can prevent the artery
from closing again.

Your doctor may also want to perform a coronary artery bypass graft
(CABG) in some cases. In this procedure, your surgeon will reroute your
veins and arteries so the blood can flow around the blockage. A CABG is
sometimes done immediately after a heart attack. In most cases,
however, it’s performed several days after the incident so your heart has
time to heal.
A number of different medications can also be used to treat a heart
attack:

 Blood thinners, such as aspirin, are often used to break up blood clots
and improve blood flow through narrowed arteries.
 Thrombolytics are often used to dissolve clots.
 Antiplatelet drugs, such as clopidogrel, can be used to prevent new clots
from forming and existing clots from growing.
 Nitroglycerin can be used to widen your blood vessels.
 Beta-blockers lower your blood pressure and relax your heart muscle.
This can help limit the severity of damage to your heart.
 ACE inhibitors can also be used to lower blood pressure and decrease
stress on the heart.
 Pain relievers may be used to reduce any discomfort you may feel.
WHAT CAN BE EXPECTED AFTER
TREATMENT?
Your chances of recovering from a heart attack depend on how much
damage there is to your heart and how quickly you receive emergency care.
The sooner you receive treatment, the more likely you are to survive.
However, if there’s substantial damage to your heart muscle, your heart may
be unable to pump an adequate amount of blood throughout your body.
This can lead to heart failure.

Heart damage also increases your risk of developing abnormal heart rhythms,
or arrhythmias. Your risk of having another heart attack will be higher as
well.
Many people who’ve had heart attacks experience anxiety and
depression. It’s important to speak with your doctor about your
concerns during recovery. It may also be beneficial to join a support
group or to speak with a counselor about what you’re going through.

Most people are able to resume their normal activities after a heart
attack. However, you’ll need to ease back into any intense physical
activity. Your doctor will help you develop a specific plan for recovery.
You may be required to take medications or undergo a cardiac
rehabilitation program. This type of program can help you slowly
regain your strength, teach you about healthy lifestyle changes, and
guide you through treatment.
HOW CAN ACUTE MYOCARDIAL
INFARCTION BE PREVENTED?
There are many steps you can take to prevent a heart attack, even if you’ve had
one before. One way to lower your risk is to eat a heart-healthy diet. This diet
should largely consist of:

 whole grains
 vegetables
 fruits
 lean protein

You should also reduce the amount of the following in your diet:

 sugar
 saturated fat
 trans fat
 cholesterol
This is especially important for people with diabetes, high blood
pressure, and high cholesterol.

Exercising several times a week will also improve your


cardiovascular health. If you’ve had a heart attack recently,
you should speak with your doctor before starting a new
exercise plan.

It’s also important to stop smoking if you smoke. Quitting


smoking will significantly lower your risk of a heart attack and
improve both your heart and lung health. You should also
avoid being around secondhand smoke.
1. Decreased Cardiac Output
related to: changes in the frequency of heart rhythm.
2. Impaired Tissue Perfusion
related to: decrease in cardiac output.
3. Ineffective Airway Clearance
related to: accumulation of secretions.
4. Ineffective Breathing Pattern
related to: lung development is not optimal.
5. Impaired Gas Exchange
related to: pulmonary edema.
6. Acute Pain
relate to: increase in lactic acid.
7. Fluid Volume Excess
related to: retention of sodium and water.
8. Imbalanced Nutrition, Less Than Body Requirements
related to: Inadequate intake.
9. Activity Intolerance
relate to: imbalance between myocardial oxygen supply and
needs.
10. Self-Care Deficit
related to: physical weakness.
11. Anxiety
related to: ncaman death.
12. Knowledge Deficit
related to: lack of information
Nursing Interventions and Rationales:
MONA: Morphine Oxygen Nitroglycerin Aspirin (ASA)
 Initial treatment for acute coronary syndrome.
 Morphine: given if aspirin and nitroglycerine do not relieve chest pain.
Initial dose is 2-4 mg IV.
 Oxygen: helps for you to remember to check oxygenation for chest pain- if
under 94% or if patient is short of breath give 2L NC initially. Evidence
based research has left the use of oxygenation and its helpfulness in these
situations inconclusive. Oxygen can cause vasoconstriction thus worsening
the situation and decreasing blood flow. Administer oxygen when clinically
relevant.
 Nitroglycerin: This is the initial medication given, along with aspirin. This
medication dilates the blood vessels to help allow any blood flow that
might be impeded. Give 0.4 mg sublingual tab, wait 5 minutes, if the chest
pain is not relieved administer another dose. This can happen 3 times total.
Monitor a patient’s blood pressure, hold for a systolic BP of less than 90
mmHg.
 Aspirin: given to thin the blood. A total of 4 baby aspirin (81 mg each) can
be given for a total of 324 mg.
12 lead ECG If inferior wall MI- do a right sided 12 lead ECG.

• Assess a 12 lead ECG immediately on anyone complaining of chest


pain to determine if an ST elevated MI is occurring. If it is-Take the
patient to the cath lab STAT! If the ECG is a normal sinus or
otherwise non-concerning rhythm, place them on a 3 or 5 lead
cardiac monitor for frequent re-assessing.

Right sided 12 lead ECG shows the right side of the heart to assess for
right ventricular ischemia.

3 or 5 Lead monitoring

• No matter the outcome of the 12 lead ECG, placing a patient on a form of


cardiac monitoring is key. You are worried about a worsening condition such
as cardiac arrest.
Cardiac Catheterization with Percutaneous Coronary Intervention
(PCI)
A patient who has an ST elevated MI (STEMI) will be rushed to the cath lab
so they can locate the clot and place a stent to regain blood flow to the
heart.

A patient may also go to the cath lab without having a STEMI, and they
may still find a clot. Most NON-STEMI’s are treated without
catheterization.

BP Monitoring The measurement is determined by the doctor, who is


determining this based on evidence based research married with
patient factors. It can be measured by the systolic BP or the Mean
Arterial Pressure (MAP). This can also be monitored by an arterial
line.
This is important because the higher the blood pressure, the more pressure
is on a clot. It isn’t out of the question for someone to have more than one
clot, and increased pressure could break free a clot lodge itself somewhere
else either in the heart, lungs, brain, or extremity.
Heparin

This is an anticoagulant that breaks up blood clots (as well as prevents


them).
Monitor aPTT or Anti-Xa Q6H to adjust and maintain therapeutic levels.

For STEMI
Bolus: 60 units/kg (max 4,000 units)
Continuous infusion: 12 units/kg/hr
-Adjust according to your organization's nomogram (Q6H- based on results
of aPPT or Anti-Xa)

For N-STEMI
Bolus: 60-70 units/kg (max 5,000 units)
Continuous Infusion: 12-15 units/kg/hr
-Adjust according to your organization's nomogram (Q6H- based on results
of aPPT or Anti-Xa)
Monitor Cardiac Enzymes: Troponin I Creatine Kinase-MB (CKMB)

The values of these enzymes are based on your institutional laboratory


technique. If they are elevated it indicates that the cardiac muscle is stressed out
or injured.

Troponin I is an enzyme that helps the interaction of myosin and actin in the
cardiac muscle. When necrosis of the myocyte happens, the contents of the cell
eventually will be released into the bloodstream.

Troponin can become elevated 2-4 hours after in ischemic cardiac event and can
stay elevated for up to 14 days.

Creatine Kinase MB: This enzyme is found in the cardiac muscle cells and
catalyses the conversion of ATP into ADP giving your cells energy to contract.
When the cardiac muscle cells are damaged the enzyme is eventually released
into the bloodstream.

CKMB levels should be checked at admission, and then every 8 hours afterwards.
Desired Outcomes

Verbalize relief/control of chest pain within appropriate time


frame for administered medications.

Display reduced tension, relaxed manner, ease of movement.


Demonstrate use of relaxation techniques.

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