NCM 112

(Care for Clients with Problems in Oxygenation, Fluid & Electrolyte, Infectious
Inflammatory & Immunologic Response, Cellular Aberrations, Acute and Chronic)

SGL #3

MYOCARDIAL INFARCTION

- Myocardial infarction (MI), colloquially known as "heart attack," is caused by decreased or

complete cessation of blood flow to a portion of the myocardium. Myocardial infarction may
be"silent," and go undetected, or it could be a catastrophic event leading to hemodynamic
deterioration and sudden death.
- A heart attack occurs when the flow of blood to the heart is severely reduced or blocked. The
blockage is usually due to a buildup of fat, cholesterol and other substances in the heart
(coronary) arteries. The fatty, cholesterol-containing deposits are called plaques. The process of
plaque buildup is called atherosclerosis.

The three types of heart attacks are:

● ST segment elevation myocardial infarction (STEMI)

● non-ST segment elevation myocardial infarction (NSTEMI)
● coronary artery spasm, or unstable angina (CAS)

STEMI - occurs when a ruptured plaque blocks a major artery completely.

NSTEMI - caused by a block in a minor artery or a partial obstruction in a major artery.

CAS - It is chest tightness or pain caused by tightening of a heart artery. Coronary artery spasm is a long-
term (chronic) condition.

- is also known as a coronary spasm, unstable angina, or silent heart attack. The symptoms,
which can be the same as a STEMI heart attack, may be mistaken for muscle pain,
indigestion, and more. It occurs when one of the heart’s arteries tightens so much that
blood flow stops or becomes drastically reduced

SIGNS & SYMPTOMS

- Some heart attacks strike suddenly. But many people have warning signs and symptoms hours,
days or weeks in advance. Chest pain or pressure (angina) that keeps happening and doesn't go
away with rest may be an early warning sign. Angina is caused by a temporary decrease in blood
flow to the heart.
NCM 112
(Care for Clients with Problems in Oxygenation, Fluid & Electrolyte, Infectious
Inflammatory & Immunologic Response, Cellular Aberrations, Acute and Chronic)

SGL #3

- 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 chest

● pain in the chest, back, jaw, and other areas of the upper body that lasts more than a few minutes
or that goes away and comes back
● shortness of breath
● sweating
● nausea
● vomiting
● anxiety
● feeling like you’re going to faint
● a fast heart rate
● sense of impending doom

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
a bit more likely than men to have more of the “atypical” symptoms, such as:

● shortness of breath
● jaw pain
● upper back pain
● lightheadedness
NCM 112
(Care for Clients with Problems in Oxygenation, Fluid & Electrolyte, Infectious
Inflammatory & Immunologic Response, Cellular Aberrations, Acute and Chronic)

SGL #3

● nausea
● vomiting

In fact, some women who have had a heart attack report that their symptoms felt like the symptoms of the
flu.

CAUSES/RISK FACTORS

A major trigger for heart problems can be the fat content of food. People who eat a lot of processed and
fried foods, as well as some meat and dairy foods that contain unhealthy saturated and trans saturated fats,
are at a higher risk for heart disease. Obesity can increase this risk.

In addition to your diet, the following factors can also increase your risk of heart problems.

● High blood pressure.

● High blood sugar levels.
● Smoking.
● 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.)
● Sex.
● Family history.
● Stress.
● Physical inactivity.
● Drug use.
● Preeclampsia.

ASSESSMENT/DIAGNOSTIC FINDINGS
NCM 112
(Care for Clients with Problems in Oxygenation, Fluid & Electrolyte, Infectious
Inflammatory & Immunologic Response, Cellular Aberrations, Acute and Chronic)

SGL #3

Some Immediate tests to conduct when a patient is feeling unwell and have signs of myocardial
infarction is checking blood pressure, pulse and temperature.

Other confirmatory are follows:

● Electrocardiogram (ECG or EKG). This first test done to diagnose a heart attack records
electrical signals as they travel through the heart. Sticky patches (electrodes) are attached to the
chest and sometimes the arms and legs. Signals are recorded as waves displayed on a monitor or
printed on paper. An ECG can show if you are having or have had a heart attack.

● Blood Test. Certain heart proteins slowly leak into the blood after heart damage from a heart
attack. Blood tests can be done to check for these proteins (cardiac markers).
- The most common protein measurement is called cardiac troponin. Your troponin level
will be measured through a series of blood tests done over the course of a few days. This
will allow damage to your heart to be assessed, and also help determine how well you are
responding to treatment.

● Chest X-ray. A chest X-ray shows the condition and size of the heart and lungs.

● 2D Echocardiogram. Echocardiography is an accurate noninvasive test that enables detection of

evidence of myocardial dysfunction caused by ischemia or necrosis . Evaluation of wall motion
while a patient is experiencing chest pain can be useful when the ECG is nondiagnostic.
● Coronary catheterization (angiogram). A long, thin tube (catheter) is inserted into an artery,
usually in the leg, and guided to the heart. Coronary angiograms can show blocked or narrowed
blood vessels in the heart. A coronary angiogram is a procedure that uses X-ray imaging to see
your heart's blood vessels.
● Cardiac CT or MRI. These tests create images of the heart and chest. Cardiac CT scans use X-
rays. Cardiac MRI uses a magnetic field and radio waves to create images of your heart. Each test
can be used to diagnose heart problems. They can help show the severity of heart damage. MRI is
the most accurate test for identifying MIs and for delineating the size and depth of wall-thickness
involvement
● Myocardial perfusion is an imaging test. It's also called a nuclear stress test. It is done to show
how well blood flows through the heart muscle. It also shows how well the heart muscle is
pumping. For example, after a heart attack, it may be done to find areas of damaged heart muscle.
This test may be done during rest and while you exercise.

THERAPEUTIC/NURSING MANAGEMENT
NCM 112
(Care for Clients with Problems in Oxygenation, Fluid & Electrolyte, Infectious
Inflammatory & Immunologic Response, Cellular Aberrations, Acute and Chronic)

SGL #3

PHARMACOLOGICAL MANAGEMENT

1. Anticoagulant. It prevents formation of blood clots that may cause a heart attack or stroke. It
helps keep blood moving through a narrowed artery.
2. Clot busters (thrombolytics or fibrinolytics). These drugs help break up any blood clots that
are blocking blood flow to the heart. The earlier a thrombolytic drug is given after a heart attack,
the less the heart is damaged and the greater the chance of survival.
3. Nitroglycerin (Vasodilator). This medication widens the blood vessels. It helps improve blood
flow to the heart. Nitroglycerin is used to treat sudden chest pain (angina). It's given as a pill
under the tongue, as a pill to swallow or as an injection.
4. Morphine (opiate (narcotic) analgesics). This medicine is given to relieve chest pain that
doesn't go away with nitroglycerin.
5. Beta blockers. These medications slow the heartbeat and decrease blood pressure. Beta blockers
can limit the amount of heart muscle damage and prevent future heart attacks. They are given to
most people who are having a heart attack.
6. ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart.
7. Statins. These drugs help lower unhealthy cholesterol levels. Too much bad (low-density
lipoprotein, or LDL) cholesterol can clog arteries.
8. Angiotensin receptor blockers (ARBs), also known as angiotensin II receptor antagonists, are
used to treat high blood pressure and heart failure. They are also used for chronic kidney disease
and prescribed following a heart attack.

NON-PHARMACOLOGICAL MANAGEMENT

1. Exercise. Regular exercise helps improve heart health. As a general goal, aim for at least 30
minutes of moderate or vigorous physical activity five or more days a week. For a client who has
a heart problem, elderly and has other underlying diseases need extra care on doing physical
activity and may rely on the suggested activities by the health care worker.
2. Eat a heart-healthy diet. Avoid or limit foods with a lot of saturated fat, trans fats, salt and
sugar. Choose whole grains, fruits, vegetables, and lean proteins, such as fish and beans.
3. Maintain a healthy weight. Too much weight strains the heart. Being overweight increases the
risk of high cholesterol, high blood pressure and diabetes. To achieve this follow a strict diet and
exercise.
4. Get regular health checkups. Some of the major risk factors for a heart attack — high blood
cholesterol, high blood pressure and diabetes — don't cause early symptoms. Make sure to
regularly visit your physician for check-up and for early diagnosis of possible diseases and early
treatment and management.
5. Manage blood pressure, cholesterol and blood sugar. Ask your provider how often you need
to have your blood pressure, blood sugar and cholesterol levels checked. Make sure to take the
prescribed medication regularly and on time.
NCM 112
(Care for Clients with Problems in Oxygenation, Fluid & Electrolyte, Infectious
Inflammatory & Immunologic Response, Cellular Aberrations, Acute and Chronic)

SGL #3

6. Control stress. Find ways to help reduce emotional stress. Getting more exercise, practicing
mindfulness and connecting with others in support groups are some ways to ease stress.