Heart attack / Myocardial infarction

What is a heart attack?

A heart attack (called a myocardial infarction) is the death of a portion of heart muscle in an area where there is sudden loss of blood supply.

Orderly movement (transmission) of electrical signals in the heart is important for the regular beating (pumping) of the heart. Death of the heart muscle often causes chest pain and may cause electrical instability of the heart muscle tissue, resulting in a rapid and disorganised heartbeat (ventricular fibrillation). A heart undergoing ventricular fibrillation simply quivers, and cannot pump or deliver oxygenated blood to the brain. Permanent brain damage and death can occur unless oxygenated blood flow is quickly resumed.

How do you get a heart attack?

A heart attack is usually caused by a complete blockage of a coronary artery by a blood clot forming. This occurs when there is advanced coronary artery disease in which the blood vessel, containing fatty deposits, is damaged. This encourages a blood clot to form on the damaged surface inside the artery.

A coronary artery is an artery that supplies blood (along with essential nutrients) to the heart muscle. Chest pain or pressure is a common symptom of heart attack, but can also be a symptom of many other conditions. Cardiac chest pain is often vague, or dull, and may be described as a pressure or constricting band-like sensation, squeezing, heaviness, or other discomfort.

How serious is a heart attack?

A heart attack is potentially very serious. It can lead to a chronic disabling condition because it can cause heart failure, or it can lead to full recovery. In some, it is rapidly fatal mainly because if the hearts rhythm is disturbed, permanent brain damage and death can occur unless blood flow is quickly resumed.

How long does a heart attack last?

A heart attack itself may last several minutes when the symptoms are present. However, because of the damage it causes and the way the heart tries to cope with it, in those people who survive a heart attack, the consequences last a lot longer. This may mean there is a risk of more abnormal heartbeats (arrhythmias) for several hours or days following. For some patients there can be further risk several months later because they may go on to develop heart failure or other problems. This is why special care and medicines are needed for a long time, to reduce the chances of this happening.

Following recovery from a heart attack there is damage to the heart muscle, which takes some time to repair. The repair to the heart muscle is not always complete and scarring is usually present. There is always a chance of a recurrence due to the continued presence of diseased coronary arteries that caused the heart attack. There is also the risk of heart failure developing over a period of weeks as the heart reacts to the injury it has sustained. For these reasons it is necessary for patients to be monitored carefully and to receive the appropriate treatment to reduce the risk of further disease progression and other heart attacks.

How is a heart attack treated?

Medical treatment is aimed to open the blocked artery and restore blood flow to the affected area of heart muscle (doctors call this reperfusion). Treatment is also aimed at preventing further damage and the chance of repeat heart attacks in the future.

Once the artery is open, the heart attack is generally halted and the patient becomes pain free. The patient is most likely to make a good recovery if reperfusion can be established in the first 4-6 hours of a heart attack. Anti-platelet medicines, for example aspirin, reduce the tendency of platelets (a type of blood cell) in the blood to clump and clot. These medicines help to prevent the arteries from becoming blocked again. Nitroglycerin, a vasodilator (blood vessel dilator), widens the blood vessel by relaxing the muscular wall of the blood vessel. ACE (angiotensin converting enzyme) inhibitors, another type of vasodilator, improve the heart muscle healing process. They do this by blocking the production of a hormone (chemical signal carried in the blood) called angiotensin II.

Beta-blocking agents interfere with the nerves controlling the heart by blocking the action of a chemical they release called noradrenaline. They also block a hormone (chemical carried in the blood) called adrenaline. This makes the heart beat more slowly and less forcibly, which decreases the amount of muscle damage and can help to prevent serious arrhythmias.

After a heart attack, many other recommendations may be made including changes in diet, lifestyle, stopping smoking and so on. The aim of these is to try to reduce the chance of having another heart attack. If specific conditions are discovered that have contributed to the heart attack, like high cholesterol or high blood pressure for example, then specific treatments might be needed for these. Any medical information on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. Click here for more important information.

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Nursing Intervention for Myocardial Infarction

Home > Nursing Intervention for Myocardial Infarction > Nursing Intervention for Myocardial Infarction

Nursing Intervention for Myocardial Infarction

Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium). wikipedia Nursing Diagnosis for Myocardial Infarction Acute Pain related to tissue ischemic, secondary to clogged arteries. Marked by :

Chest pain with or without spread Facial grimacing Nervous Delirium Changes in pulse, blood pressure.

Goal : Pain reduced / no pain Expected Outcome :

Chest pain is reduced, eg from scale 3 to 2, or from 2 to 1 Facial expression relaxed / calm, not tense

Not anxious Pulse 60-100 x / min Blood pressure 120/80 mmHg

Nursing Intervention for Myocardial Infarction

Observation of the characteristics, location, time, and the course of chest pain. Instruct the client to stop activity and rest during an attack. Help the client to do relaxation techniques, eg deep breathing, distraction behavior, visualization, or imagination guidance. Maintain oxygenation with bicanul example (2-4 lt / min) Monitor vital signs (pulse and blood pressure) every two hours. Collaboration with the health team in providing analgesic.

Nursing Diagnosis for Myocardial Infarction Risk for Decreased Cardiac Output related to changes in power factors, reduction miocard characteristics. Goal : Cardiac Output: improved / stable. Expected Outcome

No edema No dysrhythmias Normal urine output Vital Signs within normal limits

Nursing Intervention for Myocardial Infarction

Maintain bed rest during the acute phase Assess and report any signs of decreased cardiac output, blood pressure Monitor urine output Assess and monitor vital signs every hour Assess and monitor ECG every day Give oxygen as needed Auscultation of respiratory and heart every hour as indicated Keep parenteral fluids and medications appropriate advice. Provide appropriate food diet. Avoid Valsalva maneuver, straining (use laxan).

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