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Myocardial Infarction With History Of Stable

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What Is The Myocardial Infarction With History Of Stable?




Myocardial infarction occurs as a result of blockages in one or more coronary arteries. The blockages occur as a result of the building up of different substances in blood vessels. A coronary artery can narrow from the buildup of various substances, including low density lipoprotein (bad cholesterol), saturated fats, hydrogenated fats produced artificially and blood clots (Levine et al, 2016). Platelets in blood stick to plaque which builds up blockages as a result of bad cholesterol deposition on the walls of blood vessels. The coronary arteries supply oxygenated blood to the heart and therefore any blockages within these particular vessels reduce the amount of blood flowing to the heart muscles. In acute myocardial infarction, the blockages can completely stop the supply of blood to the heart causing a heart attack.


Risk factors

The first risk factor to myocardial infarction is high blood pressure. Individuals with high blood pressure above 120/80mmHg have higher chances of experiencing heart attacks (Hazinski et al, 2015). This is because the high pressure destroys the arteries and increases the plaque buildup leading to heart attacks.  High cholesterol intake and presence in blood is another contributing factor to acute myocardial infarction. Individuals thus need to take statins to reduce cholesterol build up or reduce its intake through proper diet (Charakida, 2013). Thirdly a high triglyceride amount in blood is another risk as they are fat types which clog up the arteries leading to heart attacks. High blood glucose levels and diabetes are also risky to myocardial infarctions (Amsterdam et al, 2014). The high sugar presence in blood leads to the destruction of arteries among other blood vessels contributing to coronary artery disease which triggers heart attacks in different individuals. Further, obesity which is associated diabetes and all the above risk factors is a contributing factor to acute myocardial infarction. Other risk factors include smoking tobacco, age of an individual above 45 years for men and 55 years for women, lack of exercise and family history of the disease.

Impact on Patient and Family

One of the impacts of myocardial infarction on patients and family includes the high cost of treating and managing the disease. Financial resources that could be used to run family issues will be diverted to clearing hospital bills (Torio, 2013). Secondly, an individual patient may be unable to report back to their former workplaces due to the medical condition and therefore limit the financial sources of the family. The family members including children turn into caregivers so as to nurse their parent or family member (Hazinski et al, 2015). Patients with heart disease suffer often from depression and anxiety and the family has to handle this change in the emotional state of their family member.


Common Signs and Symptoms for Myocardial Infarction



1.      Fast heart rate

The first heart rate occurs as a response by the Sino-atrial nerves’ sympathetic system when the body is under stress. This system triggers faster heart beats in order to restore sufficient flow of oxygenated blood around all the cardiac muscles (Levine et al, 2016). The fast heart rate is also intended to boost the pumping of blood from the heart to the vital organs including the brain and the lungs.

2.      Shortness of breath

This is caused by different factors including the lowered oxygen levels within the blood, dysrhythmia, anxiety and the failure of the heart. The respiratory center in the medulla oblongata of the brain works hand in hand with the Sino-atrial nerves on the heart to control the heart rate and with extension, the breathing rate (Hazinski et al, 2015).  During a heart attack, the heart’s pumping function is impaired and cannot effectively respond to the stimulation of the sympathetic and parasympathetic impulses in order to alter its rate. It may even undergo dysrhythmia due to death of its cells and thus lead to dyspnea in victims.

3.      Dizziness

Feeling dizzy is caused by insufficient levels of oxygen reaching the brain cells (Miller, 2013). In the case of heart attack, the coronary arteries that supply cardiac muscles with nutrients and oxygen narrow up or completely get blocked and this limits its pumping effect of oxygenated blood to the brain (Amsterdam et al, 2014). This eventually leads to dizziness among the victims.

4.      Fatigue and anxiety

Heart attack victims present with fatigue within the chest and sometimes cannot carry out simple exercises. This is caused by the lack of sufficient amounts of oxygen and nutrients within the muscles and cells within this particular region due to the narrowing and blockages along the coronary arteries serving the heart and limiting its pumping effect (Charakida, 2013). Anxiety is a natural emotional response among acute myocardial infraction victims especially those with a history of coronary heart disease as in this particular case. The patient remains anxious and would want to know the progress in their management.

5.      Pressure, tightness in chest; chest, back, jaw and upper body pains lasting in several minutes. The pain can go away and come back.


The radiating pain from the heart region to the back, the jaw and two arms is caused by the inadequate supply of blood to the heart muscles (Anderson, 2014). This condition is referred medically as angina and also involves pains in the shoulders.

Common Classes of Drugs for Myocardial Infarction & Their Physiological Effect


Thrombolytic drugs refer to a class of drugs used to treat acute myocardial infarction among other heart diseases. They can as well be referred to as clot-busters as their physiological effect includes dissolving blood clots along blood vessels including the coronary arteries supplying nutrients and oxygen to the heart muscles (Amsterdam et al, 2014). Blood clots are formed as a result of the accumulation of blood plates around plaques within blood vessels. The plaque develops as a result of the deposition of low-density lipoprotein on the walls of the arteries, which may also build up further with the addition of hydrogenated and saturated fats. This plaque blocks the arteries partially and/or completely and thus prevents the flow of blood to the cardiac muscles. As a result, the patient suffers a heart attack. Thrombolytic are thus important as they dissolve the blood platelet composition of the plaque and thus unblocking the arteries (Hazinski et al, 2015).  They can be administered along with cholesterol dissolvers. An example of thrombolytic class of drugs includes aspirin, which is commonly used as first aid medication for a heart attack. It reduces blood clotting and thus maintaining the flow of blood in narrow arteries on the heart muscles. While Aspiring is a first aid remedy for acute myocardial infarction among other heart attack types, hospital management of the patient must be based on the determination of patient aspirin intolerance.


Beta blockers

Beta blockers are a class of medications that are also given in the emergency management of acute myocardial infarction. Beta blockers are particularly used in relaxing the cardiac muscles and thus easing the pressure within the ventricles (Charakida, 2013). They also lead to a slower heartbeat while decreasing the levels of blood pressure. In essence, beta blockers ease the heart’s pumping function.  This medication further reduces the chances of potential heart muscle damage. In doing so, beta blockers prevent the recurrence myocardial infarction. Beta blockers are also referred to as adrenergic blocking agents and can be used in the management of both migraines and hypertension. Physiologically, beta blockers act as blocking agents that bar the effect of the epinephrine hormone in the body. They thus slow down the heart beat and even enable the opening up of blood vessels, leading to a smooth blood flow.

Nursing Strategies

The nursing care strategies for this particular patient in the first 24 hours of post admission include mainly: restoring oxygen demand and supply balance in order to prevent ischemia: relieving pain and: preventing and treating the complication to reinstate blood flow. Therefore as the first step the nurse needs to monitor the oxygen saturation continuously through pulse oximetry.  The nurse should ensure that the patient remains confined to their beds in order to reduce all the oxygen need of the now damaged myocardium (Amsterdam et al, 2014). Secondly, there is need to administer antiplatelet drugs to prevent clotting in blood vessels. In particular, the patient can be started on a dose of specifically 300mg of aspirin if the patient is not aspirin intolerant to unblock the arteries in case they have blood clots according to Moran et al (2014).   Another important management intervention for this emergency includes reducing the cardiac pain. Therefore, the patient needs to be put on vasodilators such as Nitrates in doses of 0.4gm as a sublingual tablet. Vasodilation reduces the ventricular preload by reducing the amount of the venous blood returning to the heart (Charakida, 2013). The pain and shock can be managed by administering strong pain killers such as morphine. This can ease the patient’s breathing and anxiety as the patient undergoes oxygen therapy. The patient should also be put on anti-emetics to stop nausea among other signs and symptoms. Another important post admission emergency intervention includes initiating a continuous monitoring of the cardiac functions in order to look out for dysrhythmia and manage the condition (Anderson, 2014). Under this there is need to provide a reperfusion treatment in order to restore the flow of blood within the cardiovascular system. In this regard, the nursing interventions focus on reducing any further damage on the cardiac muscles while preserving the pumping functionality of the heart.


Once the patient starts stabilizing but within the first 24 hours, there is need for the nurse to provide psychological support which is a vital component to nursing care for such patients. This is because patients suffering from acute myocardial infarction often present with anxiety and/or fear while admitted in coronary care units. The nurse therefore encourages the patient on their healing process while providing any crucial information regarding their health condition, medical procedures, and patient family among others (Hodis, 2014). In this case study, the patient also presented with mitral valve stenosis which is associated with pulmonary congestion.  The patient therefore can be given diuretics to treat pulmonary congestion while ventricular preload can be decreased to desired levels using nitrates. This ventricular rate caused by mitral stenosis can also be treated by the beta blockers and calcium channel blocking therapy. There is need to return the heart to a sinus rhythm in order to also prevent mitral valve stenosis (Anderson, 2014). The nurse can therefore start the patient immediately on an anti-coagulation therapy. In such an acute case though, it is important to use electrical cardioversion to treat mitral valve stenosis. These approaches must however be done step while ensuring the safety of the patient so as to effectively treat the delicate physiological state that he is in



Levine, Glenn N.; Bates, Eric R.; Blankenship, James C.; Bailey, Steven R.; Bittl, John A.; Cercek, Bojan; Chambers, Charles E.; Ellis, Stephen G.; Guyton, Robert A. (2016-03-15). "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction". Circulation. 133 (11): 1135–1147.

Hazinski, MF; Nolan, JP; Aickin, R; Bhanji, F; Billi, JE; Callaway, CW; Castren, M (October 2015). "Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations". Circulation (Review). 132 (16 (Supplement 1)): S2-39. 

Amsterdam, E. A.; Wenger, N. K.; Brindis, R. G.; Casey, D. E.; Ganiats, T. G.; Holmes, D. R.; Jaffe, A. S.; Jneid, H.; Kelly, R. F.; Kontos, M. C.; Levine, G. N.; Liebson, P. R.; Mukherjee, D.; Peterson, E. D.; Sabatine, M. S.; Smalling, R. W.; Zieman, S. J. (23 September 2014). "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 130 (Online first): e344–e426. 

Charakida M, Tousoulis D (2013). "Infections and atheromatous plaque: current therapeutic implications.". Current pharmaceutical design. 19 (9): 1638–50. 

Anderson, L; Taylor, RS (12 December 2014). "Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews.". The Cochrane database of systematic reviews. 12: CD011273. 

Elmariah, Sammy; Mauri, Laura; Doros, Gheorghe; Galper, Benjamin Z; O'Neill, Kelly E; Steg, Philippe Gabriel; Kereiakes, Dean J; Yeh, Robert W (November 2014). "Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis". The Lancet. 385: 792–798.

Lassen JF, Bøtker HE, Terkelsen CJ (Jan 2013). "Timely and optimal treatment of patients with STEMI". Nature Reviews Cardiology. 1. 10 (1): 41–8. 

Matthys, F; De Backer, T; De Backer, G; Stichele, RV (March 2014). "Review of guidelines on primary prevention of cardiovascular disease with aspirin: how much evidence is needed to turn a tanker?". European journal of preventive cardiology. 21 (3): 354–65.

Miller, J. D. (2013). Cardiovascular calcification: Orbicular origins. Nature Materials 12, 476-478

Moran, AE; Forouzanfar, MH; Roth, GA; Mensah, GA; Ezzati, M; Flaxman, A; Murray, CJ; Naghavi, M (8 April 2014). "The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study.". Circulation. 129 (14): 1493–501. 

Torio, Celeste (August 2013). "National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011". HCUP.

Hodis, Howard (July 2014). "Hormone replacement therapy and the association with coronary heart disease and overall mortality: Clinical application of the timing hypothesis". The Journal of Steroid Biochemistry and Molecular Biology. 142: 68–75. 


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