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PROGNOSIS

Myocardial infarction, also known as MI, refers to the process by which areas of myocardial cells in the heart are permanently destroyed. Like unstable angina, MI is usually caused by reduced blood flow in a coronary artery due to atherosclerosis and occlusion of an artery by an embolus or thrombus. Other causes of an MI include vasospasm (sudden constriction or narrowing) of a coronary artery; decreased oxygen supply (eg, from acute blood loss, anemia, or low blood pressure); and increased demand for oxygen (eg, from a rapid heart rate, thyrotoxicosis, or ingestion of cocaine). In each case, a profound imbalance exists between myocardial oxygen supply and demand. (Bare & Smeltzer, 2009).

Acute myocardial infarction is associated with a 30% mortality rate; half of the deaths occur prior to arrival at the hospital. An additional 5-10% of survivors die within the first year after their myocardial infarction. Approximately half of all patients with a myocardial infarction are rehospitalized within 1 year of their index event.

Survivors of a first, acute myocardial infarction (MI) face a substantial risk of further cardiovascular events, including death, recurrent myocardial infarction, heart failure, arrhythmias, angina, and stroke. Patients (and family members) often ask what their future holds; thus, information regarding prognosis after MI is necessary for patient care. (http://www.uptodate.com/contents/prognosis-after-myocardial-infarction)

According to an article by Dr.

Zafari, M, et.al, prognosis of clients with

myocardial infarction is highly variable and depends largely on the extent of the infarct, the residual left ventricular function, and whether the patient underwent

revascularization.

Furthermore, she and her associates stated that better prognosis is associated with factors namely successful early reperfusion, preserved left ventricular function and short-term and long-term treatment with beta blockers, aspirin and ACE inhibitors.

Meanwhile, poor prognosis is associated with increasing age, diabetes, previous vascular disease, elevated thrombolysis, delayed or unsuccessful reperfusion, poorly preserved left ventricular function, evidence of congestive heart failure, elevated B-type natriuretic peptide levels, elevated high censitive C-reactive protein, and secretoryassociated phospholipase A2 activity. In addition, continued and uncontrolled hyperglycemia and psychological depression can also pull down the clients prognosis. (http://emedicine.medscape.com/article/155919-overview#aw2aab6b2b7aa)

On the other hand, Wilson, P. and his associate physicians stated in their article published in http://www.uptodate.com/contents/risk-factors-for-adverse-outcomes-afternon-st-elevation-acute-coronary-syndromes?source=see_link that the prognosis after myocardial infarction may vary widely between individuals, according to the presence or absence of risk factors before the MI. One of the biggest factors that affect the

prognosis is on the number of coronary heart disease risk factors such as hypertension, smoking, dyslipidemia, diabetes, family history of premature CHD and atherosclerosis.

According to a discussion seen in http://www.sparkpeople.com/resource/ health_a-z_detail.asp?AZ=221&Page=8 written by the Faculty of Harvard Medical school, survival from myocardial infarction has improved dramatically over the last two decades. However, some people experience sudden death and never make it to the hospital. For most people that do reach the hospital soon after the onset of symptoms, the prognosis is very good. Many people leave the hospital feeling well with limited heart damage. With the information gathered from different reliant references, the group gave the client a poor prognosis. The factors took into consideration of the made prognosis are as follows:

As observed in the health history and laboratory and diagnostic results of the client, his chances of fully recovering from the said disease has decreased.

His health history reveals that the client is hypertensive. Furthermore, on the year 2012, client was admitted to a local hospital due to difficulty of moving his ___ side. He was then diagnosed with cerebrovascular accident. Furthermore, he is also

currently diagnosed with hypertensive cardiovascular disease (HCVD).

Meanwhile, results from his laboratory and diagnostic tests also reveal abnormalities that further exacerbate his condition and dragging his prognosis down. For one, it was revealed that his blood glucose was elevated. Moreover, his HDL cholesterol was decreased. HDL is important because it functions as a transporter of cholesterol n the blood and high levels are associated with a decreased risk of atherosclerosis and coronary heart disease. Also, his triglycerides levels deviation from the normal range was high. Thus, this further makes his prognosis poor because too many triglycerides in ones body puts him in a higher risk of further exacerbation of his cardiovascular disease. Most importantly, the clients heart function has somehow failed due to the enlargement of the left ventricle and dilation of the left atrium as revealed in the echocardiography report and radiologic findings, respectively.

Even though client was immediately brought to the hospital upon feeling the symptoms that led to the admission to the health care facility, the factors that were stated above that were all based from related literature further supported the groups conclusion in lieu of the clients prognosis poor.