Clinical Case of Acute Myocardial Infarction

Acute myocardial infarction 1
CLINICAL CASE OF ACUTE MYOCARDIAL INFARCTION
By,
Course
Tutor
University
City and State
Date

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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.