Myocardial infarction

Myocardial infarction is the technical name for a heart attack. A heart attack occurs when an artery leading to the heart becomes completely blocked and the heart doesnt get enough blood or oxygen, causing cells in that area of the heart to die (called an infarct). Signs and Symptoms:

Squeezing pain, heaviness, tightness, pressure in center of chest Pain that spreads to your back, left arm, jaw, neck Shortness of breath Dizziness, weakness Nausea, vomiting Irregular heartbeat Sweating Feeling of doom

Women may experience different symptoms than men. In women, along with chest pain, symptoms can include:

Heartburn or pain in the abdomen Unusual fatigue Clammy skin

Causes: Heart attacks happen when an artery supplying your heart with blood becomes blocked. Without blood, the heart doesnt get enough oxygen and cells in the heart start to die. The most common cause of blocked arteries is atherosclerosis. No one knows the exact cause of atherosclerosis, but most researchers believe it begins with an injury to the innermost layer of the artery, known as the endothelium. The following factors are thought to contribute to the damage:

High blood pressure Elevated LDL ("bad") cholesterol An accumulation of homocysteine (an amino acid produced by the human body, thought to be a risk factor for heart disease, stroke, osteoporosis, diabetes, and dementia) Smoking

Diabetes Inflammation

Once the artery is damaged, blood cells called platelets build up there to try and repair the injury. Over time, fats, cholesterol, and other substances also build up at the site, which thickens and hardens the artery wall. The amount of blood that flows through the artery is decreased, and oxygen supply to organs also decreases. Blood clots may also form, blocking the artery. Rarely, a spasm in a coronary artery (one that supplies blood to the heart) stops blood flow and can cause a heart attack.

Pathophysiology

Diagnostic exam:

Electrocardiogram (ECG) -- the first test done to check for a heart attack. You may be hooked up to a monitor even as the doctor is asking you questions. An ECG measures electrical activity of your heart. Blood tests -- Your doctor may look for certain enzymes that are released into your blood when you have a heart attack.

Other tests include:

Chest x-ray Echocardiogram (uses sound waves to take a picture of your heart) Coronary catheterization or angiogram (uses a liquid dye inserted through a catheter to see whether your arteries are blocked) Stress test (involves walking on a treadmill while hooked up to an ECG machine to see how your heart responds to exercise)

Treatment
Lifestyle

Making lifestyle changes can improve many of your risk factors for heart disease, including high cholesterol, high blood pressure, extra weight, high homocysteine, and elevated C-reactive protein. Cardiac rehabilitation programs generally involve teaching you about diet, physical activity, and relaxation techniques. To keep your risk factors low, you will need to follow the healthy habits taught in cardiac rehab, such as exercise and eating properly, for the rest of your life.
Medications

When you arrive at the hospital, you will likely be given one or more medications to help your body cope with, or ward off, damage from the heart attack, including:

Aspirin - helps stop blood from clotting. You may be given aspirin in the ambulance or as soon as you get to the hospital. Aspirin should be continued indefinitely at a dose of 81 mg per day.

Nitroglycerin - helps dilate (widen) blood vessels. You may be given nitroglycerin in the ambulance or as soon as you get to the hospital. Pain reliever - helps relieve pain and is often given intravenously (IV). Thrombolytic -a work to break up clots. A They are most effective when taken within 2 hours of the heart attack, and are not given after 12 hours have elapsed. These drugs may be given with other anticoagulants (blood thinners). Anticoagulants (blood thinners) -- make your blood less likely to form clots. Heparin is often given by injection while you are in the hospital.

Preventive Care: You can reduce your risk of heart attack by:

Stopping smoking. Getting aerobic exercise (such as walking, biking, or swimming) for at least 30 minutes 5 days per week. If you haven't exercised much in the past, walking is a great way to start. If you have any heart risk factors, you should get an okay from your health care provider that you're healthy enough to begin an exercise program. Reducing stress and learning stress-reduction techniques such as deep breathing and meditation. Yoga and tai chi -- two forms of exercise that emphasize stretching, breathing, and meditating -- can also help you reduce your stress level. Eating a diet low in saturated fat and rich in fruits, vegetables, and whole grains. Losing weight or maintaining a proper weight.

If you have high cholesterol, diabetes, or high blood pressure, follow your doctors instructions to keep these risk factors under control. You may need medications in addition to lifestyle changes. If you don't have heart disease yet or have not had a heart attack despite these risk factors, aggressive control can help prevent a heart attack. And, if you already have heart disease, aggressive control of these risk factors can prevent further heart attacks or other problems related to heart disease. Nursing intervention Administer analgesics as ordered. Organize patient care and activities to allow periods of uninterrupted rest. Provide a clear liquid diet until nausea subsides. Provide stool softener to prevent straining during defecation. Assist with range of motion exercises. Provide emotional support, and help reduce stress and anxiety.

Assess and record the patients severity, location, type, and duration of pain. Check his blood pressure after giving nitroglycerin, especially during first dose. Thoroughly explain the medication and treatment regimen. Review dietary restriction with the patient. Advise the patient about appropriate responses to new or recurrent symptoms. Stress the need to stop smoking.