Clinical Case of Acute Myocardial Infarction

This article presents a clinical case study of a patient with acute myocardial infarction, discussing the pathophysiology of the disease and identifying suitable nursing care plans, interventions, and diagnosis. It also explores the patient's medical history and risk factors. Read more at Desklib.

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CLINICAL CASE OF ACUTE MYOCARDIAL INFARCTION
By,
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University
City and State
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Mrs. X is a 66 year old female with a diagnosis of acute myocardial infarction. Prior to arrival in
the emergency department, she was experiencing a severe chest pain that radiated to the back and
the arms. She was also experiencing shortness of breath (dyspnea), chest tightness and increased
sweating. She has a two day history of persistent cough, nausea and vomiting. She had
previously sought over the counter medication for her cough and was given a cough syrup. She
has a 3 months history of primary hypertension and a 3 year history of osteoarthritis. The joint
pains and stiffness caused by inflammation has been managed over the years by corticosteroids
such as prednisolone and she has been monitoring her progress on the same. She lives alone on
the third floor of an apartment without a lift. On arrival to the ER, an angioplasty was performed
on her in attempt to unblock the blocked coronary arteries that supply blood to the heart. She was
then admitted to the wards for further monitoring.
Acute myocardial infarction occurs when the blood supply to the heart is cut off thereby leading
to damage of the heart muscle. Myocardial infarction also referred to as a heart attack occurs
when there is blockage of vessels that supply blood to the heart muscle (Smits et al, 2017). These
vessels are referred to as coronary arteries and form a very delicate part of the heart. There are
several factors that can lead to blockage of coronary arteries. The blockage is as a result of
formation of a hard sticky substance referred to as plaque. Plaque is formed from accumulation
of several substances. These include cholesterol, fat and cellular waste products.
The heart muscle also called the myocardium is a delicate smooth muscle that requires
nourishment and oxygen supply just like any muscle in the body. Because of partial or full
blockage of the coronary arteries, there is limited oxygenation of the muscle and waste products
accumulate within the muscle leading to tissue damage and therefore inefficiency of the heart
muscle to function properly. Hypoxic conditions of the heart muscle may eventually lead to heart

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failure if the condition is not managed (Cung et al, 2015). Mrs. X suffers from an acute
myocardial infarction which was stabilized on admission. The aim of this discussion is to
critically analyze Mrs. X case study and explain the pathophysiology of the disease in details and
identify nursing care plans, interventions and diagnosis that were suitable following admission.
There are several considerations that must be taken by the attending nurse as far as acute
myocardial infarction is concerned. The patient’s history as far as cardiac related diseases are
concerned is of importance in understanding the physiology behind the disease and in
development of a care plan. This is because acute myocardial infarction is related to several heart
diseases and this information is important to understand the possible causes of the attack. The
discovery of risk factors is important in better diagnosis as well as treatment plan (Anderson &
Morrow, 2017). The subjective data is important before developing a good care plan. The patient
may for example complain of chest, arm and back pains. Shortness of breath is a common sign
associated with acute myocardial infarction. The aim of the nursing care plan should revolve
around relieving chest pains, reducing cardiac workload, stabilizing heart rhythm and preserving
the myocardial tissue.
Since a care plan aims at achieving the best outcome for the patient, consideration of other
complications affecting the patient should be considered. Mrs. X for example had a history of
primary hypertension and longstanding osteoarthritis. The arthritic pain had exacerbated over the
past few months hence the need for monitoring and treatment plan to alleviate the condition.
According to Hofmann et al. 2017, hypertension is one of the risk factors associated with acute
myocardial infarction. Since Mrs. X was suffering from primary hypertension, it would be an
important contributor to the development of the myocardial infarction. There is therefore need to

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include the hypertensive condition in the nursing care plan so as to prevent future recurrence of
the condition.
According to the clinical reasoning cycle by Levett-Jones, the first phase is consideration of facts
from the patient or situation at hand. Mrs. X history of primary hypertension was therefore an
important consideration in explaining the experience of the patient. Information revolving around
prior exacerbation of her condition would be a crucial fact with regard to her condition. For
example, she lives on the third floor of an apartment without any lift. Shortness of breath could
be exacerbated whenever she climbs the staircase to her apartment and query of such information
would help monitor improvement once the condition is fully managed. The fact that she has no
extended family is an important consideration before establishing a care plan as it helps the care
team provide the moral support needed to the patient hence establishing a comprehensive care
process.
Acute myocardial infarction like any other disease has its pathophysiology. It is caused when
coronary arteries are clogged by a hard sticky substance called plaque. Plaque is normally as a
result of accumulation of cell waste products and cholesterol in the arteries. Due to blockage, the
myocardium is deprived of important nutrients. Oxygen supply to the heart muscle is also cut off
and infarcts develop within the heart muscle. Infarcts are areas of limited blood and oxygen
supply. Increased deprivation of oxygen to the heart muscle leads to necrosis which refers to
tissue death (Thiele et al, 2017). Necrosis is characterized by tissue scarring as a result of dead
cells. The heart therefore becomes inefficient in its performance. The pumping power of the
heart is affected when infarction occurs and this has serious consequences as it might result to
heart failure and death if not managed.

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Nursing assessments conducted on an acute myocardial infarction patient are of importance in
understanding the disease and the priority in which they are to be performed varies depending on
the emergency state. One of the priority nursing assessments of importance in such a case is
performing an electrocardiogram. After considering information of the patient in accordance to
the stipulated clinical reasoning cycle, an electrocardiogram to assess the patient would be of
importance. An electrocardiogram is a useful assessment tool as it helps identify parts of the
heart that are not functioning properly due to infarction (Kwong et al, 2018). It helps identify the
coronary arteries that are blocked and leading to a heart attack. This assessment is also useful in
identifying the extent of damage to the heart as a result of the infarction. This assessment is a
priority as it assists the medical team perform procedures targeting the blocked arteries so as to
alleviate the condition. An electrocardiogram for example can aid in the performance of an
angioplasty that targets to unblock the blocked coronary arteries.
Another nursing assessment to explain the physiological aspect of the disease would be checking
the patient’s heart rate and blood pressure. Individuals suffering from an acute myocardial
infarction tend to have an abnormally paced heart rhythm (Barnes et al, 2015). It is important to
monitor the heart rhythm and detect the extent and severity of the infarction. The more severe the
infarction is, the more possibility of detecting increased and abnormal heart rate. Hypertension is
a common risk factor associated with an acute myocardial infarction. It is therefore important to
assess and monitor the blood pressure levels of the patient from time to time. Mrs X has a history
of primary hypertension.
It is necessary to monitor the blood pressure levels of the patient and manage her with anti-
hypertensives. Increased blood pressure can lead to a severe form of acute myocardial infarction.
As stated by Cannon et al. 2015, this is because the pressure of blood within the vessels can push

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thrombi and clots within the vessels up to the coronary vessels where they are dislodged causing
blockage of the vessels and leading to a heart attack. Hypertensive conditions may also lead to
rapture of the coronary vessels hence leading to deficient blood supply to the myocardium. The
systolic and diastolic pressures should therefore be measured and managed if in excess so as to
avoid further damage to the coronary levels and the heart muscle as a whole.
Another important assessment determinant of the physiology of the disease is blood withdrawal
to test for cardiac enzymes and proteins associated with cardiac damage. There are certain
enzymes associated with cardiac muscle damage and injury. These enzymes include creatine
phosphokinase (CPK) and creatine kinase (CK) (Shibata, 2015). They are referred to as cardiac
biomarkers and are released into the blood when myocardial necrosis occurs. Their levels are
therefore elevated in myocardial infarction and they indicate damage to the heart muscle. Other
cardiac biomarkers include myoglobin and troponin. According to Bonaca et al. 2015, both
troponin I and troponin T are relevant in myocardial infarction. This is therefore another priority
assessment as it helps capture information concerning the extent of cardiac muscle damage as a
result of the infarction. In the past, lactate dehydrogenase was also used as a cardiac biomarker
but is non-specific since it does not always indicate cardiac damage.
The patient’s experience as a result of the disease and the development of a nursing diagnosis is
important in identifying problems and complications caused by the disease and managing them
effectively. In Mrs. X case, acute pain is one of the nursing diagnosis that is relevant to her
condition. The chest pains experienced by the patient could be as a result of accumulation of
lactic acid due to tissue ischemia and coronary vessels occlusion (Templin et al, 2015). It is
important to identify any radiation of the pain as stated by the patient in order to understand how
to manage the pain better. Patients with an acute myocardial infarction for example experience

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arm and back pains in addition to the unpleasant chest pains. The characteristic of the pain is
important as many cardiac problems present with different characteristics. A patient suffering
from the condition might for example complain of a dull crushing pain in the chest associated
with chest tightness. Administration of oxygen to combat the ischemic heart conditions is an
important treatment plan (Sandoval et al, 2017). The nurse should also administer analgesics
such as morphine and meperidine to provide relieve from pain.
Another important nursing diagnosis in Mrs. X case is limited cardiac tissue perfusion. This
results mainly from inefficient blood supply to the heart muscle as a result of blockage of the
coronary vessels. The cut off blood supply leads to insufficient oxygen supply to the
myocardium and hence the myocardium activity is negatively affected. The implications of
inadequate myocardial perfusion include the fact that the heart can no longer effectively pump
blood to the rest of the body tissues resulting into peripheral tissue necrosis as well (Mathur et al,
2017). Increased recurrence of an acute myocardial infarction can lead to a complete heart failure
and the perfusion of vital organs in the body is affected. The nurse can alleviate the condition by
placing the patient under oxygen therapy. The therapy involves administration of oxygen levels
of about 2 liters per minute so as to increase the oxygen saturation to levels above 95 percent.
Another nursing diagnosis that is relevant to Mrs. X and acute myocardial patients in general is
decreased cardiac output. Cardiac output arises from stroke volume and peripheral resistance.
The frequency of the heart rhythm is normally affected by the myocardial infarction (Sharma and
Bhat, 2018). Since the blood supply to the heart is normally interrupted, the heart muscle cannot
function properly and its rhythm is affected. The frequency of the heart to pump blood to the rest
of the body is significantly decreased by the condition hence a low cardiac output since the

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stroke volume becomes less. This leads to decreased tissue perfusion in organs. The nurse can
manage the effect by administering antidysrythmic drugs and supplement oxygen supply.
In conclusion, myocardial infarction is a medical condition that requires immediate attention so
as to manage it and prevent severe consequences. It is an emergency case that if left untreated
could lead to worsening and an eventual heart failure. This is because the heart is damaged and
can no longer function optimally in pumping blood to the rest of the body. The incidence of
myocardial infarction increases with age. It is therefore more likely to occur to people above 65
years of age as compared to the younger population. Patients who have experienced an incidence
of a heart attack have various perceptions concerning the disease. There is a high rate of
depression linked to those who have suffered from acute myocardial infarction in their lifetime.
This is associated with hopelessness and fear of death. It is therefore important for a
comprehensive patient education about the disease to encourage and give hope to those who
suffer from the disease.

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