Myocardial infarction

Definition
•  acute myocardial infarction (AMI) commonly
known as heart attack happens when there is
marked reduction or loss of blood flow
through one or more of the coronary arteries,
resulting in cardiac muscle ischemia and
necrosis.
 Predisposing factors
• Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack
than are younger men and women.
• 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 a heart attack
• Metabolic syndrome. This syndrome 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.
• Family history of heart attacks. If your siblings, parents or grandparents have had early heart
attacks (by age 55 for males and by age 65 for females), you might be at increased risk.
• 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 a heart attack.
• High blood pressure. Over time, high blood pressure can damage arteries that lead to your
heart. High blood pressure that occurs with other conditions, such as obesity, high cholesterol
or diabetes, increases your risk even more.
 Precipitating factors
• Tobacco. This includes smoking and long-term exposure to secondhand
smoke.
• Obesity. Obesity is linked with high blood cholesterol levels, high
triglyceride levels, high blood pressure and diabetes. Losing just 10% of
your body weight can lower this risk.
• Lack of physical activity. Being inactive contributes to high blood
cholesterol levels and obesity. People who exercise regularly have
better heart health, including lower blood pressure.
• Stress. You might respond to stress in ways that can increase your risk
of a heart attack.
• 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.
 Signs and Symptoms
• 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
 Diagnostic test
• History taking
• ECG tracing
• Trop I test
 Nursing diagnosis
• Acute pain related to tissue ischemia
– Monitor and document characteristics of pain,
notify verbal and non verbal cues.
• Risk for decreased cardiac output related
reduced preload
– Evaluate quality of pulses on both pulses points
decrease cardiac output results in diminished or
weak pulses. Irregularities suggest dysrthmias
which may require evaluation and monitoring.
• Risk for ineffective tissue perfusion related to
reduction of blood flow
– Watch out for sudden changes and continued
alterations in mentation changes.
 Medical interventions
• Bypass surgery: Treats blocked heart arteries by
creating new passages for blood to flow to your
heart muscle.
• Cardiomyoplasty: An experimental procedure
in which skeletal muscles are taken from a
patient’s back or abdomen.
• Heart transplant: Removes a diseased heart
and replaces it with a donated healthy human
heart.
 Medication
• Angiotensin-converting enzyme (ACE) inhibitor: Expands blood vessels and
decreases resistance by lowering levels of angiotensin II. Allows blood to flow more
easily and makes the heart’s work easier or more efficient.
• Angiotensin II receptor blocker: Rather than lowering levels of angiotensin II (as ACE
inhibitors do) angiotensin II receptor blockers prevent this chemical from having any
effects on the heart and blood vessels. This keeps blood pressure from rising.
• Angiotensin receptor neprilysin inhibitor: Neprilysin is an enzyme that breaks down
natural substances in the body that open narrowed arteries. By inhibiting neprilysin,
those natural substances can have their normal effect. That improves artery opening
and blood flow, reduces sodium (salt) retention and decreases strain on the heart.
• Beta blocker: Decreases the heart rate and cardiac output, which lowers blood
pressure and makes the heart beat more slowly, with less force.
• Combined alpha and beta blocker: Combined alpha and beta blockers are used as an
IV drip for those patients experiencing a hypertensive crisis. They may be prescribed
for outpatient high blood pressure use if the patient is at risk for heart failure.