Clinical Case Study of Myocardial Infarction

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Clinical case study of myocardial infarction 1
CASE STUDY OF MYOCARDIAL INFARCTION
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Clinical case study of myocardial infarction 2
Introduction
Acute myocardial infarction is also commonly referred to as a heart attack. It is an emergency
condition that results from blood supply cut off to the heart muscle thereby leading to tissue
damage. The heart muscle also known as myocardium in medical terms. Blood supply to the
heart muscle is usually supplied by arteries called coronary arteries. The myocardium is a
smooth muscle which is very delicate and like any other muscle requires nourishment and
oxygen supply so as to function properly. Blockage of the coronary arteries either partially or
fully can therefore affect negatively its function in pumping blood to the rest of the body leading
to serious complications (Ibanez et al., 2017).. Blockage of coronary arteries leading to
myocardial infarction can develop due to a substance called plaque. The plaque is composed of
various products ranging from cholesterol, fat to cellular waste products. This plaque builds up
over time until one or more of these arteries is blocked hence an abrupt cut off of blood supply to
the heart muscle. There are various risk factors that predispose one to a myocardial infarction
which should be prevented as much as possible. Acute myocardial infarction is quite common
among the aged due to less activity hence buildup of fat and plaque in the arteries (Subbaiyan et
al., 2018). The classical symptoms of acute myocardial infarction are chest pains and shortness
of breath though they can be quite varied in their presentation.
Case study
Mr. Eric Johnson is 60 year old man with a diagnosis of acute myocardial infarction. He is a
known diabetic for the past 2 years. He is a heavy smoker and smokes at least 2 packets of
cigarette per day for the past 3 years. On arrival to the A and E, he presented with chest and back
pains, shortness of breath and profuse sweating. He has a three day history of persistent dry
cough, nausea and vomiting and had not sought medical attention since then. He has however

Clinical case study of myocardial infarction 3
made an attempt to seek over the counter cough syrups such as delsym in an attempt to suppress
the cough. An angioplasty procedure was performed immediately on him on arrival to unblock
the clogged coronary arteries. In the procedure a stent was placed to prevent blockage of the
arteries again. He was admitted to the wards for further management.
Comprehensive patient assessment
A verbal consent of the patient was obtained and a comprehensive assessment was done on the
patient. The patient had a three day history of persistent dry cough, nausea and back pains that
came and went after some time. He experienced shortness of breath on little exertion. He had no
previous history of a heart disease but his grandfather had passed away due to coronary heart
disease and his father had a history of right heart failure which was managed in its early stages.
The patient appeared to be restless and anxious on inspection. He had an increased breathing rate
and his pulse was higher than normal (110 beats per minute). There were no signs of wheezing or
respiratory distress. He had dual cardiac heart sounds and had tachycardia. On abdominal
inspection, it was soft and non-tender. He however had truncal obesity and his abdominal
muscles moved with respiration. He was on insulin therapy for his diabetic condition. The vitals
taken showed that his blood pressure was 132/84, a heart rate of 110beats/min, a temperature of
37.9 degrees, Spo2 of 98% on room air.
There are a wide number of etiologies linked to an acute myocardial infarction. Cabello et al.
(2016) states that the main predisposing factors include history of a previous heart attack or a
family history of an early cardiac disease. One is likely to have an acute myocardial infarction if
his/her male family members of have developed a heart disease before the age of 55 years or if
the female family members have developed the same disease before the age of 65 years. A
history of diabetes is also a significant predisposing factor to a heart attack. This is a condition

Clinical case study of myocardial infarction 4
that causes blood sugar levels to rise higher than normal. High blood sugar causes significant
damage to coronary arteries leading to coronary artery disease that leads to a myocardial
infarction. High blood pressure also referred to as hypertension also predisposes to one to a heart
attack. According to Cung et al. (2015), social behaviors such as smoking tobacco are linked to
heart attacks and other cardiovascular diseases. Mr. Eric is a diabetic patient as well as a heavy
smoker which might have predisposed him to the condition. Age is also a factor that cannot be
disregarded in this case.
As stated by Mehta et al. (2016), men are at a higher risk of suffering from myocardial
infarction and other heart related conditions after the age of 45. Mr. Eric is 60 years of age which
makes him vulnerable. This can be easily explained by the fact that older people have less
physical activity hence the possibility of buildup of plaque over time. High cholesterol and
triglycerides increase the risk of one suffering from the condition as they clog blood vessels
especially the coronary arteries preventing blood supply to the heart muscle (Ouweneel et al,
2017). Stress and lack of exercise are also leading factors to the attack. The pathophysiology of
the condition begins when the coronary arteries become blocked for a given duration of time and
affects a certain portion of the heart muscle (1 cm or more). About 80% of acute myocardial
infarcts are as a result of coronary atherosclerosis. This results from narrowing of the arteries as
a result of accumulation of plaque. The plaque is caused by accumulation of bad cholesterol also
referred to as low density lipoprotein (LDL), saturated fats and Trans fat (Heusch & Gersh,
2016).
Plaque is a hard sticky substance that blocks blood flow in the arteries. Thrombus formation
from blood clots also facilitates in clogging of the coronary vessels leading to a myocardial
infarction (Fisher et al., 2015). Blood platelets attach on the already preformed plaque and form

Clinical case study of myocardial infarction 5
clots which contribute to more blockage. The heart muscle undergoes necrosis after deprivation
of blood supply for some time. Lack or limited supply of blood to the heart muscle deprives it of
oxygen (hypoxia) and nutrients hence leading to necrosis (Anderson & Morrow, 2017). Acute
myocardial infarction is as a result of regional myocardial necrosis. Apart from coronary
atherosclerosis, the attack may result from coronary spasm, embolism and thrombosis in non-
atherosclerotic cases. Factors that influence the severity of the condition include the area covered
by resulting necrosis that is correspondent to the length of the vessel occluded, duration between
the occlusion and reperfusion and availability of collateral vessel circulation.
Since it was the first episode of myocardial infarction for Mr. Eric, immediate medical attention
was sought hence leading to management of the condition. Early detection of myocardial
infarction is critical since prevention of recurrence of such an attack is possible and can be
applied. According to Thiele et al. (2017), primary prevention strategies include reduction of the
risk factors associated with the disease in disease free subjects. The aim of primary intervention
is to protect those whom are at risk of contracting the disease from getting sick. It aims at
improving lifestyle habits by avoiding unhealthy eating of high cholesterol foodstuff and
adequate exercise hence preventing risk factors. Secondary prevention on the other hand aims at
preventing recurrence of myocardial infarction (O’donoghue et al., 2016). In the case study of
Mr. Eric for instance, secondary preventive measures were put in place to avoid the attack from
occurring again. These include rehabilitating the patient from tobacco addiction and advice on
healthy eating to avoid another attack.
Myocardial infarction is characterized by severe sharp chest pains, chest tightness and pressure.
A person with a diagnosis of the same experiences back pains, jaw pains and pain of other parts
of the upper body that lasts for a few minutes and comes and goes away (Hofmann et al, 2017).

Clinical case study of myocardial infarction 6
Other symptoms include nausea, vomiting, sweating, anxiety, coughing, dizziness and a fast
heart rate. The diagnostic measures that were taken to arrive at myocardial infarction include an
auscultation was done whereby the patient had irregular heartbeats. An electrocardiogram was
also conducted to measure the hearts electrical activity. It showed the classical indications of a
myocardial infarction using the test which include paced heart rhythm, early repolarization, left
bundle branch block, and a ventricular aneurysm. Blood tests were also conducted whereby
proteins that are linked to cardiovascular disease and heart damage such as troponin where
detected. An angiogram with cauterization of the coronary arteries was done to look for the
blocked sites and a stent was inserted on detection of this areas to avoid a repetition of blockage.
An echocardiogram is another important diagnostic measure that cannot be disregarded when it
comes to suspected myocardial infarction. As explained by Li et al. (2015), it is a useful
procedure to detect parts of the heart that are not function which in this case have necrosis and
infarcted due to blood supply cut off. A stress test is usually performed in well asserted and alert
patients to detect how the heart responds to stress activities such as exercise. As echoed by Reed
et al. (2017), people suffering from myocardial infarction or at risk of the same tend to have an
abnormally paced heart rhythm. The nursing implications associated with these diagnostic
measures are that the nurse should always be available for monitoring the patient’s progress and
ensuring that the patient complies with the medication schedule. In cases of admission, the
nursing care provider should provide the patient with a care plan that ensures the patient is
propped up when need arises and that the patient is under directly observed therapy (Kwong et
al., 2018). Medications that were recommended for Mr. Eric include thrombolytics such as
alteplast, antiplatelet drugs that prevent clot formation in vessels for example clopidogrel and a
beta blocker agent such as atenolol.

Clinical case study of myocardial infarction 7
Patient’s experience
The patient was shocked on realization of his diagnosis. He could not believe that he was
suffering from a heart attack and felt as if the world was ending on his end. He first reacted by
saying that it can’t be true and that the doctors might have not investigated well since he has not
had heart problems in the past. However, he later believed the diagnosis and sought more
information about it. He perceived the diagnosis as a very serious condition that was life
threatening and had limited expectations as to live for long. He cried as a form of copying
mechanism but stopped as soon as he was assured that it can be managed and prevented from
recurring. On realization, he was depressed and immediately informed his wife of the diagnosis
in an alarmed manner. The patient had lost hope in life and had many thoughts on the news of his
diagnosis. He could think about physical limitations, loss of employment due to the condition
and feared of sudden death making him leave a lot of projects that he wanted to accomplish in
life. The world had stopped for a minute in his life and depression had sunk in.
The patient did not have complete awareness of his condition and what might have caused it. He
decided to seek more information concerning the disease and its implications from his health
practitioner. The disease process was fully explained to him including the possibility of a family
history of the disease in his family, the risky behavior of smoking tobacco in relation to the
disease and the fact that unhealthy lifestyle would have catalyzed the occurrence of the disease.
After full awareness of his condition including possible causes he agreed to comply with
whatever medication he would be prescribed. There was assurance from his health care provider
that he would be able to prevent recurrence of the disease and this really helped reduce his cause
of alarm and fear for his life. He agreed to seek rehabilitative initiatives so as to stop tobacco
smoking and help reduce risks of another episode. He also decided to seek healthy foodstuff and

Clinical case study of myocardial infarction 8
lifestyle as advised by the doctor. He was under keen observation in the care facility to ensure
that he improves by careful compliance to the medication prescribed. The medication process
gave the patient hope as he came to the knowledge that it can be treated and therefore not
terminal if risk factors are avoided.
The family was shocked on realization of his condition but offered moral support to Mr. Eric and
hence helping in the recovery process. Though initially the patient felt alone and hopeless, he
later coped with the situation after experiencing a lot of support from his wife, children and
relatives. The patients decision about treatment came from himself as he agreed to follow keenly
all the medication that would be prescribed to him. His family helped ensure that he sought more
counselling and assurance from counselling centers so as to help him cope with depression.
Acoording to Scarano et al. (2018), family members are the immediate social structure that offer
moral support in the healing process. He received a lot of external support from his friends and
family by their assurance of hope and this helped him cope and come to terms with his diagnosis.
The rehabilitation center also provided a lot of care and helped him quit smoking and live a
healthy lifestyle by eating fruits and vegetables as opposed to fatty foods that lead to cholesterol
build up, engaging the patient in exercises that help prevent buildup of plaque in the arteries
hence reducing a number of risks associated with the disease. Since he was a known diabetic
patient, compliance to insulin treatment and avoidance of sugary meals also helped prevent
recurrence of the heart disease.
Conclusion
In conclusion, acute myocardial infarction is a condition that can be prevented by healthy
lifestyle and behavior. As supported by Westman et al. (2016), the risk factors associated with
the condition including high cholesterol and triglyceride levels, hypertension and unhealthy diet

Clinical case study of myocardial infarction 9
can be prevented by lifestyle changes. Healthy diet initiatives that can be taken to prevent the
condition include a diet that is rich in fruits, vegetables, whole grain and lean protein. Unhealthy
diet such as sugary food, high fat protein rich foods and cholesterol rich meals should be avoided
as they predispose someone to myocardial infarction caused by plaque accumulation in coronary
vessels (Sager et al., 2015). Engaging in exercises from time to time also helps reduce the risk of
cardiovascular problems. Myocardial infarction is manageable but chances of surviving from the
disease depend on how prompt once receives care after an attack and how large the infarct is in
the heart muscle. Immediate response to an attack increases the chances of survival as medical
procedures performed help unblock the blocked vessels and reperfusion takes place. According
to Han et al. (2015), if there is a solid damage to the heart muscle due to lack of blood supply,
the myocardium may be unable to pump enough blood to body organs leading to heart failure in
which the heart muscle becomes ineffective and is quite a life threatening condition. Damage of
the heart muscle as a result of prolonged cut off of blood supply may predispose one to other
risky heart conditions such as arrhythmias and the risk of subsequent heart attacks becomes
higher. Many people that are affected by this condition undergo a phase of depression and
therefore it is the duty of all of us to ensure we give them the support and assurance they need in
the healing process (De Couto et al., 2015). It is highly recommended that individuals with a
history of acute myocardial infarction seek cardiac rehabilitation programs that enable them cope
with the condition and prevent risks associated with the disease.

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