Overview of CVD Infarction:

Cardiovascular Disease (CVD) Infarction, often referred to as myocardial infarction

(MI) or heart attack, occurs when blood flow to a part of the heart is blocked for a
prolonged period, leading to tissue damage or cell death due to lack of oxygen. It is a
serious medical emergency that requires prompt treatment to prevent further
complications and potential death.

Introduction:

CVD infarction typically results from the buildup of fatty deposits, cholesterol, and
other substances within the arteries, causing atherosclerosis. When a plaque
ruptures, it can trigger the formation of a blood clot, which may completely obstruct
blood flow to a portion of the heart muscle. This interruption in blood flow leads to
ischemia (lack of oxygen), which, if not promptly restored, can cause irreversible
damage to the heart tissue. 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.

An estimated 17.9 million people died from CVDs in 2019, representing 32% of all
global deaths. Of these deaths, 85% were due to heart attack and stroke.

The blockage is caused by a buildup of plaque in the arteries (atherosclerosis). Plaque

is made up of deposits, cholesterol, and other substances. When a plaque breaks
(ruptures), a blood clot quickly forms. The blood clot is the actual cause of the heart
attack.

If the blood and oxygen supply is cut off, muscle cells of the heart begin to suffer
damage and start to die. Irreversible damage begins within 30 minutes of blockage.
The result is heart muscle affected by the lack of oxygen no longer works as it should.

Symptoms:

The symptoms of CVD infarction can vary from person to person but commonly
include:

- Chest pain or discomfort (often described as pressure, squeezing, fullness, or pain)

- Pain or discomfort in other areas of the upper body, including the arms, back, neck,
jaw, or stomach
- Shortness of breath

- Nausea

- Lightheadedness or dizziness

- Cold sweat

The chest pain is usually retrosternal and is sometimes described as the sensation of
pressure or heaviness. The pain often radiates to the left shoulder, neck, or arms with
no obvious precipitating factors, and it may be intermittent or persistent. The pain
usually lasts for more than 20 minutes.

Etiology

Myocardial infarction is closely associated with coronary artery disease. The

following modifiable risk factors for coronary artery disease:

1. Smoking — Smoking can increase the risk of CVD by damaging the arteries.
It also affects blood flow through the arteries and can make blockages more
common. Smokers are twice as likely to have a heart attack.

2. Abnormal lipid profile/blood apolipoprotein (raised ApoB/ApoA1) — High

levels of the “bad” cholesterol (LDL cholesterol) can add to the build-up of
plaque in the arteries.

3. Hypertension — High blood pressure can overload the heart and arteries and
speed up atherosclerosis.

4. Diabetes mellitus

5. Abdominal obesity (waist/hip ratio) (greater than 0.90 for males and greater
than 0.85 for females)

6. Psychosocial factors such as depression, loss of the locus of control, global

stress, financial stress, and life events including marital separation, job loss,
and family conflicts

7. Lack of daily consumption of fruits or vegetables

8. Lack of physical activity

9. Alcohol consumption (weaker association, protective)

Management:

Immediate management of CVD infarction involves:

1. Emergency Medical Care: Calling emergency services (911 in the United States) is
crucial. Paramedics can provide life-saving interventions en route to the hospital.

2. Aspirin Administration: Chewing an aspirin (if not allergic) can help prevent
further blood clot formation.

3. Oxygen Therapy: Providing supplemental oxygen can help improve oxygen delivery
to the heart.

4. Pain Management: Medications such as nitroglycerin may be administered to

alleviate chest pain.

Upon arrival at the hospital, management includes:

1. Diagnostic Tests: Electrocardiogram (ECG), blood tests (troponin levels), and

imaging studies (such as angiography) help confirm the diagnosis and assess the
extent of damage.

2. Reperfusion Therapy: This involves restoring blood flow to the affected area of the
heart. It may be achieved through medication (thrombolytics) or procedures such as
percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)
— During the surgery, the surgeon makes a bypass by grafting a piece of a vein above
and below the blocked area of a coronary artery. This lets blood flow around the
blockage. The surgeon usually takes veins from a leg, but he or she may also use
arteries from the chest or an arm.

3. Coronary angioplasty: With this procedure, a balloon is used to create a bigger

opening in the vessel to increase blood flow. This is often followed by inserting a stent
into the coronary artery to help keep the vessel open. Although angioplasty is done
in other blood vessels elsewhere in the body, percutaneous coronary intervention
(PCI) refers to angioplasty in the coronary arteries. This lets more blood flow into the
heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA).
Medications:

Long-term management typically involves medications to:

1. Reduce Blood Clotting: Antiplatelet drugs (e.g., aspirin, clopidogrel) and

anticoagulants (e.g., heparin, warfarin) help prevent further clot formation. —
thrombolytics

Purpose: Antiplatelet medications are prescribed to prevent blood clot formation

within the arteries. Aspirin inhibits the aggregation of platelets, reducing the risk of
further clotting. Clopidogrel works similarly by inhibiting platelet activation and
aggregation.

Why Given: These medications are crucial in the acute and long-term management
of CVD infarction to prevent recurrent thrombotic events. By inhibiting platelet
activity, they help maintain blood flow through narrowed or partially blocked
arteries, reducing the risk of additional ischemic damage to the heart muscle.

Purpose Anticoagulants are prescribed to prevent the formation of blood clots within
the bloodstream. Heparin works by inhibiting the activity of certain clotting factors,
while warfarin interferes with the production of clotting factors in the liver.

Why Given: These medications are used in the acute phase of CVD infarction to
prevent the extension of existing blood clots and the formation of new clots. They help
maintain patency in the coronary arteries and reduce the risk of complications such
as stroke and pulmonary embolism.

2. Lower Cholesterol: Statins (e.g., atorvastatin, simvastatin) are commonly

prescribed to lower cholesterol levels and reduce the risk of future cardiovascular
events.

Purpose: Statins are lipid-lowering medications that primarily act by inhibiting the
enzymes HMG-CoA reductase, which plays a key role in cholesterol synthesis in the
liver. By lowering cholesterol levels, statins help reduce the formation of
atherosclerotic plaques and stabilize existing plaques.

Why Given: Statins are prescribed for long-term management to lower LDL
cholesterol levels and reduce the risk of cardiovascular events, including recurrent
CVD infarction. Additionally, they have been shown to have anti-inflammatory and
plaque-stabilizing effects, contributing to their cardioprotective benefits.
3. Control Blood Pressure: Medications such as ACE inhibitors, beta-blockers, and
calcium channel blockers help control blood pressure and reduce strain on the heart.

Purpose: Beta-blockers inhibit the effects of adrenaline on the heart by blocking beta-
adrenergic receptors. This results in decreased heart rate, blood pressure, and
myocardial oxygen demand, thereby reducing the workload on the heart.

Why Given: Beta-blockers are commonly prescribed after CVD infarction to reduce
the risk of recurrent ischemic events, manage symptoms such as chest pain, and
improve overall cardiac function. They also help prevent arrhythmias and reduce the
risk of sudden cardiac death.

Purpose: ACE inhibitors block the conversion of angiotensin I to angiotensin II, a

potent vasoconstrictor, leading to vasodilation and reduced blood pressure. They also
decrease aldosterone secretion, which helps decrease fluid retention and cardiac
workload.

Why Given: ACE inhibitors are indicated for patients with CVD infarction to improve
cardiac function, reduce myocardial remodeling, and lower blood pressure. They are
particularly beneficial in individuals with left ventricular dysfunction and heart
failure, as they can slow disease progression and improve outcomes.

4. Manage Symptoms: Medications may be prescribed to alleviate symptoms and

improve heart function, such as beta-blockers for chest pain and heart failure.

In addition to medication, lifestyle modifications such as adopting a heart-healthy

diet, regular exercise, smoking cessation, and stress management are essential
components of long-term management and prevention of CVD infarction. Regular
follow-up with healthcare providers is crucial to monitor progress and adjust
treatment as needed.

Nursing Responsibilities

1. Conduct a thorough assessment of the patient's vital signs, cardiac status, and
symptoms. Monitor for signs of chest pain, shortness of breath, cyanosis, altered level
of consciousness, and other symptoms indicating worsening cardiac function.

2. Assist with the administration of medications as prescribed by the healthcare

provider. Ensure proper dosage, route, and timing of medications such as
antiplatelets, anticoagulants, statins, beta-blockers, and ACE inhibitors. Educate the
patient about the purpose, potential side effects, and importance of medication
adherence.

3. Continuously monitor the patient's cardiac rhythm, oxygen saturation, blood

pressure, and pain level. Stay alert for any signs of deterioration or complications,
such as arrhythmias, hypotension, or heart failure. Report any abnormalities
promptly to the registered nurse or healthcare provider.