Heart Attack (Myocardial Infarction) : Elevation Myocardial Infarction (STEMI) - A Partial Myocardial Infarction (NSTEMI)

Heart Attack (Myocardial Infarction)
Definition: occurs when blood flow decreases or stops to a part of the heart, causing damage to the
heart muscle. The most common symptom is chest pain or discomfort which may travel into the
shoulder, arm, back, neck or jaw.
Causes
o A heart attack are mostly caused by a blockage of one or more of your coronary arteries
supllying your heart with blood and oxygen. Over time, a coronary artery can narrow from
the build-up of various substances, including cholesterol (atherosclerosis). This condition,
known as coronary artery disease, causes most heart attacks, which form a plaque in the
arteries that feed the heart (coronary arteries).
o The plaque eventually breaks away and forms a clot, starving the heart muscle of oxygen
and nutrients (ischemia). The interrupted blood
flow can damage or destroy part of the heart
muscle.
o You might have a complete blockage or partial. A
complete blockage means you've had an ST
elevation myocardial infarction (STEMI). A partial
blockage means you've had a non-ST elevation
myocardial infarction (NSTEMI).
o A heart attack, also called a myocardial infarction,
can be fatal, but treatment has improved
dramatically over the years. It's crucial for
emergency medical help if you think you might be
having a heart attack.
o Another cause of a heart attack is a spasm of a
coronary artery that shuts down blood flow to part
of the heart muscle. Using tobacco and illicit drugs,
such as cocaine, can cause a life-threatening spasm
Risk factors
Certain factors contribute to the unwanted build-up of fatty deposits (atherosclerosis) that
narrows arteries throughout your body. You can improve or eliminate many of these risk
factors to reduce your chances of having a first or another heart attack. Heart attack risk
factors include:
 Age
 Family history of heart attack.
 Lack of physical activity
 Stress.
 Tobacco. This includes smoking and long-term exposure to second hand smoke.
 High blood pressure. Over time, high blood pressure can damage arteries that feed
your heart. High blood pressure that occurs with other conditions, such as obesity, high
cholesterol or diabetes, increases your risk even more.
 High blood cholesterol or triglyceride levels. A high level of low-density
lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A
high level of triglycerides, a type of blood fat related to your diet, also increases your
risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol
(the "good" cholesterol) lowers your risk of heart attack.
 Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride
levels, high blood pressure and diabetes.
 Diabetes. Not producing enough of a hormone secreted by your pancreas (insulin)
or not responding to insulin properly causes your body's blood sugar levels to rise,
increasing your risk of heart attack.
 Metabolic syndrome. This occurs when you have obesity, high blood pressure and
high blood sugar. Having metabolic syndrome makes you twice as likely to develop
heart disease than if you don't have it.
 Illicit drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger
a spasm of your coronary arteries that can cause a heart attack.
 A history of preeclampsia. This condition causes high blood pressure during
pregnancy and increases the lifetime risk of heart disease.
 An autoimmune condition. Having a condition such as rheumatoid arthritis or
lupus can increase your risk of heart attack.
Symptoms
Common heart attack signs and symptoms include:
 Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms

that may spread to your neck, jaw or back
 Nausea, indigestion, heartburn or abdominal pain
 Shortness of breath
 Cold sweat
 Fatigue
 Light headaches or sudden dizziness
Treatment
Drugs used during a heart attack may include:
 Aspirin to stop blood clotting that may make the heart attack worse
 Other antiplatelet drugs, such as clopidogrel (Plavix), prasugrel (Effient), or ticagrelor
(Brilinta) to stop clotting
 Thrombolytic therapy ("clot busters") to dissolve blood clots in your heart's arteries
 Any combination of these
Other drugs given during or after a heart attack help your heart work better, widen your blood
vessels, lower your pain, and help you avoid life-threatening heart rhythms.
 Cardiac catheterization. In addition to making a picture of your arteries, cardiac

catheterization can be used for procedures (such as angiography or stent) to open
narrowed or blocked arteries.
 Bypass surgery. You might have bypass surgery in the days after a heart attack to
restore the blood supply to your heart.
Treatments don’t cure coronary artery disease. You can still have another heart attack. But
you can take steps to make it less likely.
Complications
Complications are often related to the damage done to your heart during an attack, which
can lead to:
 Abnormal heart rhythms (arrhythmias)

 Heart failure.
 Sudden cardiac arrest.
Diagnosis
 Emergency medical workers will ask you about your symptoms and do some tests.
 EKG. An EKG (also known as an electrocardiogram or ECG) can tell how much your
heart muscle has been damaged and where. It can also monitor your heart rate and
rhythm.
 Blood tests. Different levels of cardiac enzymes in your blood can indicate heart
muscle damage. These enzymes are usually inside the cells of your heart. When those
cells are injured, their contents -- including the enzymes -- spill into your bloodstream.
By measuring the levels of these enzymes, your doctor can find out the size of the heart
attack and when it started. Tests can also measure troponin levels. Troponins are
proteins inside heart cells that are released when the cells are damaged by the lack of
blood supply to your heart.
 Echocardiography. This imaging test can be used during and after a heart attack to
learn how your heart is pumping and what areas aren’t pumping the way they should.
The "echo" can also tell whether any parts of your heart (valves, septum, etc.) have
been injured in the heart attack.
 Cardiac catheterization. You might need cardiac catheterization, also called cardiac
catheterization, during the first hours of a heart attack if medications aren’t helping the
ischemia or symptoms. The cardiac catheterization can give an image of the blocked
artery and help your doctor decide on a treatment.
Nursing intervention
The midwife advices the patient or client to change their life style and habits like; stop smoking,
lower your cholesterol, Control your diabetes and blood pressure, Follow an exercise plan, keep
a healthy body weight, control stress

Heart Attack (Myocardial Infarction) : Elevation Myocardial Infarction (STEMI) - A Partial Myocardial Infarction (NSTEMI)

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Heart Attack (Myocardial Infarction)

 Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms

 Cardiac catheterization. In addition to making a picture of your arteries, cardiac

 Abnormal heart rhythms (arrhythmias)

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