Case Study of ST-Elevated Myocardial Infarction

A case study of a patient with ST-elevated myocardial infarction
Risk factors and health promotion
Myocardial infarction is a condition of the cardiovascular system where the flow of blood to
the heart is abruptly cut short (Nabel, & Braunwald, 2012). The blood vessel that supplies blood
to the heart is the coronary artery. When this vessel is blocked or narrowed the heart fails to get
enough blood and therefore the cardiac muscle gets deprived of nutrients together with oxygen.
Vital heart tissues together with the cardiac muscle tissues therefore die. Since anaerobic
respiration takes place in the heart muscles, lactic acid is formed which cause the acute pain of
scale of 10/10 radiating to the back and shoulders (McCarthy, 2013). This is, therefore, a life-
threatening condition. There are several factors that greatly contribute to this heart condition.
One major factor in Mr. Papa’s is the lack of adequate exercise. His occupation has made
him exercise a little since he spends most time in the office. Lack of physical exercise can lead to
fat deposition along the walls of the blood vessels leading to a condition called atherosclerosis in
the coronary artery (Bastien, et.al, 2014). Atherosclerosis refers to the deposition of fats along
the blood vessels walls. This will eventually cause narrowing of coronary artery hence increase
the chances of formation of thrombus within the lumen of blood vessels. This thrombus causes
blockage in the coronary artery. Another major contributing factor, in this case, is smoking. Mr.
Papa reports that he smokes about 15 cigarettes per day. Smoking increases heart rate and blood
pressure in the human cardiovascular system which results in the augmentation of myocardial
oxygen demand. Also, smoking causes a reduction in the dimension of the coronary arteries and
coronary blood flow. Smoking, therefore, induces vasoconstriction of coronary arteries (Leone,
2012) and therefore reduces blood flow in both the right and left coronary arterial systems
equally. Another contributing factor is the advanced age. Studies show that men are at risk of,
myocardial infarction after the age of 45 years while women are at risk of AMI at the after the
age of 55 years. Therefore, Mr. Papa, at the age of 55 years is exactly within the age bracket
where the risk of development of myocardial infarction is very high.
This condition requires immediate concerns, one being their safety and comfort. I will first
ensure intravenous access for the effective administration of life-saving emergency drugs then
followed by immediate transfer to resuscitation areas for close supervision and ready

resuscitation in case need arises. Therefore, to increase the comfort of the patient, I will
administer analgesics which help to relieve pain (Hui, & Bruera, 2014) and, in this matter, the
drug of choice is the morphine 2.5-5 mg administered intravenously since it is not only a
powerful analgesic but also has anxiolytic effect, a vital factor in the case of thrombus formed.
Also, oxygen is administered to improve oxygen saturation in the body hence eliminate
hypoxemia, then antiemetic to reduce nausea and vomiting and also nitrates to improve cardiac
activity and reduce oxygen demand. Also, remember to administer junior aspirin which aids in
thrombolysis. The patient is supposed to avoid strenuous exercise because this may exacerbate
oxygen demand. He also should avoid heavy work, eat a lot of fruits and avoid fatty foods. He
should also avoid since this can elevate blood pressure. I will then refer the patient to the
coronary unit where he will be done angiography, ECG and blood test to check on cardiac
markers (Bodor, 2016).
Pathophysiology
ST-elevated myocardial infarction is a heart condition that develops as a result of an
imbalance between the supply oxygen to the heart and the demand of oxygen by the muscles and
tissues of heart. In this matter, specifically is that oxygen supply is less than oxygen demand
leading to the damage of the myocardial (necrosis) and specifically secondary to blockage of
coronary arteries which supply the heart. The condition is actually due to a rupture of a plaque
which is a substance mostly made of fat, cholesterol and cellular waste products. A tissue factor
which implies to a substance found within the necrotic core of the plaque gets exposed when a
fibrous cap which covers the plaque gets disrupted and leads to the rupture of the plaque (Moore,
Sheedy, & Fisher, 2013). When this tissue factor gets exposed to the blood flow, it triggers
clotting cascade and this leads to thrombosis formation, mostly at the site where coronary
arteries are stenosed. Most of the plaques are vulnerable and hence easily break up while some
are strong and do not easily rapture. The blood supply is cut short and the cardiac tissues get
deprived of oxygen and other necessary nutrients hence die off. Sometimes anaerobic respiration
may take place in the cardiac muscle due to the inadequate supply of oxygen. Such leads to the
formation of lactic acid which causes acute pain in the chest up to a scale of ten out of ten. The
difference between ST-elevated sand non-ST elevated myocardial infarction is that the ST-
elevated myocardial infarction is caused by complete occlusion of the coronary artery while the

non-ST elevated myocardial infarction is as a result of incomplete but severe blockage of the
coronary artery (Park, et.al, 2013). therefore, ST-elevated myocardial infarction requires
emergent and immediate medical intervention including catheterization since it is a lifesaving
intervention while the non-ST elevated myocardial infarction is not such much emergent. Also, a
point to note is that on Electrocardiogram, ST wave is not elevated on non-ST elevated
myocardial infarction while on ST-elevated myocardial infarction ECG shows elevated ST
waves. Therefore, guide on the form of immediate management to be offered. Now the case of
Mr. Papa is ST-elevated MI. therefore he needs emergency treatment since the coronary artery is
completely blocked. He requires angioplasty with stent insertion.
Homeostatic mechanisms
i) Clamminess of the skin
Clamminess refers to the dampness and coldness of the skin (Das, & Maiti, 2013). The
myocardial infarction is a condition that causes blood arrest from getting into the cardiac muscle
and therefore can lead to cardiac arrest. The heart muscle functioning capacity is weakened and
therefore is greatly reduced leading to cardiogenic shock if no intervention is done immediately.
Therefore Mr. Papa is having an impending cardiogenic shock. The heart is unable to pump
blood as usual due to decrease function of the cardiac muscle. Cardiac output greatly reduces and
the blood is shunted to vital organs like the brain, kidneys, and liver. Peripheral blood circulation
is restricted. Tissue perfusion is reduced too since the blood flow to tissues is inadequate. Since
the skin is not a vital organ, the blood supply to the skin greatly reduces and therefore becomes a
dump and cold, clammy. Blood supply to tissues including the skin normally brings with it
warmth and
ii) Radiation of pain to shoulders and left arm
In the case of myocardial infarction, pain is often felt at the sites away from the location or
point of the pain stimulus. The main complication of myocardial infarction is angina pectoris,
where the pain is felt in the chest and radiating to the back, neck and shoulders. The pain felt
away from the site of injury is therefore called referred pain. Referred pain is slightly different
from the radiating pain. Therefore, in the case of myocardial infarction, it can be either referred
or radiating. The mechanism of this radiating pain is that the general visceral pain fibers follow