Clinical Case Study of Myocardial Infarction

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

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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

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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