Myocardial infarction is the other name of heart attack and is an identified cardiac emergency (Malik, Khan, Safdar & Taseer, 2013). The disorder occurs when there is a diminution in the flow of blood to a part of the heart, leading to damage to the heart myogenic muscles which results into tissue damage. The blockage results from formation of plaque. There is blockage of more than one or one coronary artery. The heart condition has its primary symptom as chest pains or discomfort. Normally the pain spreads to other parts like shoulders, jaws, neck or back. The attack is mostly on the left side of the body and takes a few minutes to go away. One could mistake the condition for acid reflux (GERD). Some of the accompanying symptoms are shortness of breath, nausea, weakness, increased heart rate feeling exhausted, cold sweating, coughing, and dizziness (Bruyninckx, Aertgeerts, Bruyninckx, & Buntinx, 2008; Malik et al., 2013).
This case study will look into Mrs Harris (Kath) who is a 65 year old overweight lady with a recent development of acute Myocardial infarction. Her chest pains do not just last for a few minutes but 2 hours. Kath has had a medical history of head trauma, peptic ulcers, uneven angina, high blood pressure, and T2DM. Above that she is has been a cigarrete addict for 4 decades. She also presents some wanting pathological results.
The outline of the study will answer four questions. The first is a question of the current statistics of incidence and prevalence of heart attack in Australia. Secondly her clinical manifestation of acute myocardial infarction explaining the physiological rationale for each manifestation and the management (plan of care). The risk factors for Kath to heart attack will be identified explaining a complex plan on how the showing symptoms can be modified. Lastly, before conclusion will be the identification of the issues affiliated to thrombotic therapy from the case scenario of Kath.
Statistics; Prevalence and Incidence of Myocardial Infarction in Australia
According to (Australian Bureau of Statistics, 2017) in 2016, there were 8011 lives claimed by myocardial infarction. This amounts to 22 deaths every day (Australian Bureau of Statistics, 2017). From 2014 to 2015, there were >54, 000 hospitalised cases of the same (Australian Institute of Health and Welfare 2015). The prevalence of Australia is that there are over 400,000 Australians who have experienced heart attacks (National Heart Foundation, 2017). About 100, 000 of the citizens have the heart attack before reaching age 65 (Australian Bureau of Statistics. Australian Health Survey, 2015.). As at 2017, about 34 % knew, in person, someone with heart attack (Heart Foundation, 2018).
Clinical Manifestation of Acute Myocardial Infarction
As already mentioned, radiating chest, arm, shoulder, neck or back pains together with nausea, sweating, shortness of breath, and a feeling of weakness among others are the identified signs and symptoms of myocardial infarction. However only a few present in Mrs Harris.
One of the heart attack manifestation in Kath is Chest pains. It is reported that Mrs Harris experiences chest pains for 2 hours. According to Malik et al. (2013), in order to correctly diagnose AMI (Acute Myocardial infarction), one should perform an integrated chest assessment of the history of the patient referring to chest pain among other factors. Chest pain is the most persistent presenting complaint for AMI. The classic presentation of inadequate supply of blood (ischemia) is a manifested in form of a hefty chest pressure or squeezing that comes with a burning effect characterized with shortness of breath (“Warning Signs of a Heart Attack: Shortness of Breath and Others”, 2018). . The intensity of the chest pains build up in a few minutes goes away and comes back and it starts with psychological stress. However, only a few percentage of all reported cases of chest pains are associated with acute myocardial infarction (15-25 %). The emergency department (ED) normally has challenges in differentiating the acute myocardial infarction from the non-cardiac syndrome.
Another clinical presentation is indigestion (Cleveland Clinic, 2018). Kath has been reported to have a recent history of indigestion. Indigestion results from the discomfort from the pressure imposed upon the chest and it extends to the epigastrium where it influences indigestion (bloating). Medications against the acute indigestions using anti acids prove no help (Sharma, 2015). According to Nia et al. (2011) women show significant symptoms of indigestion as compared to men, and it is therefore not a coincidence that Kath manifests the condition. Despite the fact that indigestion is associated with heart attack, not all cases of indigestion should be presumed to be heart attack symptoms. However as it shows with Kath, indigestion is a manifestation.
A study of Kath’s Lipids shows that she is having high levels total lipids, triglycerides, total cholesterol and LDL cholesterol. All the aforementioned lipids are above the normal range. High triglyceride level for example, has been associated with heart attacks. The triglyceride fats clog on the arteries building up plaque that cause blockage. The same case with the LDL cholesterol that sticks on the walls of the arteries. A person with a heart attack will manifest these symptoms.
Kath’s glucose is so high (11.2); she has a history of T1DM. High BP would have caused damages to Mrs Harris blood vessels to lead coronary artery disease. That eventually would have triggered her myocardial Infarction.
Management of Mrs Harris’ Care
Kath’s heart attack requires emergency treatment in the ED, otherwise, she is could lose her life very easily. The first consideration is unblocking the blocked arteries. One way of doing that is by use of the invasive procedure-angioplasty (National Heart, Lung, And Blood Institute, NIH (US), 2014). The ED team should insert (unblocking tubes) catheters to reach to the blocked artery and unblock them. A small inflated balloon should then be attached to the unblocking tube to open the artery once more and thus resuming to normal blood flow. The management tea may also consider using the stent mesh tube that will prevent the blockage from reoccurring.
Another option by the doctors is performing a coronary artery bypass graft (CABG) whereby the surgeons reroute the blocked veins and arteries to allow for blood flow around the blockage (“Coronary Artery Bypass Grafting | National Heart, Lung, and Blood Institute (NHLBI)”, 2014).
The medical team can also consider using blood thinners for Mrs Harris such as aspirin. Aspirin breaks down the blood clot and improves blood flow within the narrowed arteries (Ramlaul & Vosper, 2013). Mrs Harris should be given the aspirin (150-300 mg) to swallow in the earliest time possible. Others anti-clots options are thrombolytic and antiplatelet drugs like clopidogrel. These substances dissolve the clots and inhibit the formation of new clots.
Pain management is also important at this stage considering that Mrs Harris has been in suffering chest pains for 2 hours. This can be facilitated by use of effective pain killers like aspirin.
Fibrinolytic therapy is an identified backbone of treatment and thus will be very useful for Kath (Bhatt, 2015). The treatment is given to liquefy the thrombus in the artery to reinstate flow. Mrs Harris should therefore be given either of streptokinase or tissue plasminogen activator (tPA) which hare common in Australia. Streptokinase is given intravenously and it produces generalised total fibrinolysis. tPA produces local fibrinolysis.
Heparin is another option for Kath. It is an antithrombin agent that can be administered hypodermically and intravenously.
It is also advisable that Kath’s glucose be managed by use of insulin while Kath is still in the emergency room.
Risk Factors and Modification
Kath has many risk factors to heart attack that should be modified to prevent reoccurrence of the heart attack. However, the selected four for this case study are;
Obesity: Mrs Harris is reported to be overweight. Obesity is an identified risk factor for many cardiovascular disease morbidity and mortality. The high body mass index increases chances of heart attack (Akil & Ahmad, 2011). A BMI of above 30 indicates obesity as with Kath. An overweight person has stored significant amounts of LDL cholesterols which causes blockage of arteries. The modification for this risk factor is a long-term procedure that will see Kath engage in physical activities like running to lose some weight. She can also be advised to enrol with a trainer on fitness and also a nutritionist to manage and advice on her dieting.
Smoking; Tobacco products puts one at a risk of heart attack by affecting the heart and blood vessels. The resulting effect is development of atherosclerosis which manifest itself with waxy plaque substances building up in the arteries to cause blockage (NHLBI, 2013). Mrs Harris is addicted to cigarettes smoking 2 packets on daily basis for 40 years now. Smoking is an addiction and stopping from an addiction is not easy. The modification for this risk is only through rehabilitation considering the fact that Kath has been addicted for close to 4 decades.
Head Trauma; It has been established that traumatic brain injury leads to myocardial infarction (Cuisinier et al., 2016). Head injuries lead extreme rise in BP that consequently leads to straining the heart leading to heart attacks. Nothing much can be done for this risk factor other than continued treatment for the head trauma. Kath should be advised to stick to her prescribed dosages in order for her to recover from TBI.
High triglyceride and Cholesterol Levels; Mrs. Harrier’s levels of cholesterol and triglyceride exceed the normal levels. That predisposes her to heart attack as they both facilitate the blockage of arteries (“Acute Myocardial Infarction: Causes, Symptoms, and Treatment”, 2018). The management of these risk factors is a matter of dieting, a nutritionist can be of great help for Kath. She should be advised to limit her eating behaviors of foods high in cholesterol and triglyceride. Engaging in simple physical activities will also help Mrs Harris lessen the levels of these lipids (fats)
Problems Associated with Fibrinolytic Therapy
The clinical risks associated with intravenous thrombolytic therapy are critical and understanding them is a boost for the care plan for select patients. Therefore there are factors that’s should be considered when applying this intervention on Mrs Harris considering her history ailment of hypertension, unstable Angina and T2DM. The risks attached to the use of this therapy method that can be applicable in Kath’s case scenario are; myocardial rapture, hypotension, systemic hemorrhage, and immunologic complications. All these identified risks can be summarized into one; bleeding complications (Bundhun, Janoo, & Chen, 2016). It is therefore clear that use of fibrinolytic therapy can put Kath at a risk of profuse bleeding and a potential loss of life. Kath could have lost blood in the accident a few months ago that led to her head trauma. More loss of blood would be fatal for her.
In conclusion, Kath can be debarred from the 8011 annual deaths that occur from heart attacks in Australia. Her manifestation of 2-hours acute chest Pains, high LDL cholesterol and other lipids levels and indigestion are strong points to support that indeed Mrs Harris has myocardial infarction. Kath requires special treatment as she has other medical histories of serious diseases like another heart related disease (hypertension) diabetes and Angina. Being of an advancing age she will be more vulnerable to heart attacks if she does not lose some weight or stay away from risk factors like smoking cigarettes. Finally, fibrinolytic therapy is not advisable for Kath because of her many health issues.
Acute Myocardial Infarction: Causes, Symptoms, and Treatment. (2018). Healthline. Retrieved 2 October 2018, from https://www.healthline.com/health/acute-myocardial-infarction#risk-factors
Akil, L., & Ahmad, H. A. (2011). Relationships between obesity and cardiovascular diseases in four southern states and Colorado. Journal of health care for the poor and underserved, 22(4 Suppl), 61. doi: 10.1353/hpu.2011.0166
Australian Bureau of Statistics 2017, Causes of Death 2016, ABS cat. no. 3303.0, September
Australian Bureau of Statistics. Australian Health Survey 2014/2015.
Australian Institute of Health and Welfare 2015. Australian hospital statistics 2014–15. Health services series no. 54. Cat. no. HSE 145. Canberra: AIHW.
Bhatt, D. L. (2015). Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease E-Book. Elsevier Health Sciences.
Bruyninckx, R., Aertgeerts, B., Bruyninckx, P., & Buntinx, F. (2008). Signs and symptoms in diagnosing acute myocardial infarction and acute coronary syndrome: a diagnostic meta-analysis. Br J Gen Pract, 58(547), e1-e8. doi: 10.3399/bjgp08X277014
Bundhun, P. K., Janoo, G., & Chen, M. H. (2016). Bleeding events associated with fibrinolytic therapy and primary percutaneous coronary intervention in patients with STEMI: A systematic review and meta-analysis of randomized controlled trials. Medicine, 95(23). doi: 10.1097/MD.0000000000003877
Cleveland Clinic (2018). Heart Attack (Myocardial Infarction) Symptoms | Cleveland Clinic. Retrieved 2 October 2018, from https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction/symptoms
Coronary Artery Bypass Grafting | National Heart, Lung, and Blood Institute (NHLBI). (2014). Nhlbi.nih.gov. Retrieved 2 October 2018, from https://www.nhlbi.nih.gov/health-topics/coronary-artery-bypass-grafting
Cuisinier, A., Maufrais, C., Payen, J. F., Nottin, S., Walther, G., & Bouzat, P. (2016). Myocardial function at the early phase of traumatic brain injury: a prospective controlled study. Scandinavian journal of trauma, resuscitation and emergency medicine, 24(1), 129.
Heart Foundation (2018). Heart attack fact sheet. The Heart Foundation. Retrieved 2 October 2018, from https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/heart-attack-fact-sheet
Malik, M. A., Khan, S. A., Safdar, S., & Taseer, I. U. H. (2013). Chest Pain as a presenting complaint in patients with acute myocardial infarction (AMI). Pakistan journal of medical sciences, 29(2), 565.
National Heart Foundation, 2017. HeartWatch Survey, customised data, April 2018.
National Heart, Lung, And Blood Institute, NIH (US) (2014). Coronary Angioplasty. Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0062935/
NHLBI. (2013) Smoking and Your Heart | National Heart, Lung, and Blood Institute. Nhlbi.nih.gov. Retrieved 2 October 2018, from https://www.nhlbi.nih.gov/health-topics/smoking-and-your-heart
Nia, S. H. S., Haghdoost, A. A., Nazari, R., Rezaie, R., Sa'atsaz, S., Andi, S. J. S., & Chan, Y. H. (2011). Difference in clinical symptoms of myocardial infarction between men and women. Iranian Journal of Critical Care Nursing Spring, 4(1), 33-38. Retrieved 2 October 2018 from https://pdfs.semanticscholar.org/673f/00a9eaee616ff5e5ac799dbb2fbb18fbda23.pdf
Ramlaul, A., & Vosper, M. (2013). Patient Centered Care in Medical Imaging and Radiotherapy E-Book. Elsevier Health Sciences.
Sharma, R. (2015). Clinical methods in cardiology (p. 54). JP Medical Ltd.
Warning Signs of a Heart Attack: Shortness of Breath and Others. (2018). Healthline. Retrieved 2 October 2018, from https://www.healthline.com/health/heart-disease/warning-signs-heart-attack