...Myocardial Infarction Mr. X., aged 55 years, arrives at the emergency department with severe chest pain. He appears very anxious, and his facial skin is cool and clammy. His blood pressure is 90/60, and his pulse around 90, weak, and irregular. He is given oxygen, and intravenous line is opened, and leads for ECG are attached. Blood is taken for determination of serum enzymes and electrolytes. Tentative diagnosis is myocardial infarction involving the left ventricle. His wife arrives and, in response to questions, indicates that her husband is a heavy cigarette smoker, prefers a diet of fried foods and meat (he is obese), and had complained periodically of indigestion, with brief episodes of epigastric pain. He also seemed to be more fatigued at night recently but was very busy at work. He was fearful of heart disease because his father had died of a heart attack. He had also noticed more fatigue and intermittent leg pain when playing golf recently. Generalized atherosclerosis is suspected. 1. List the high-risk factors for atherosclerosis in this patient’s history. The high-risk factors for the atherosclerosis in the patient’s history include smoking, obesity, and a diet high in cholesterol and animal fat. Other factors include past history of heart disease and heart attack 2. Describe how atherosclerosis caused myocardial infarction. Atherosclerosis caused myocardial infarction by causing a build up of plaque occurring in five different phases over...
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...Myocardial Infarction Cardiovascular disease is the leading cause of death in the United States; approximately 500,000-700,000 deaths related to the coronary artery occur each year. Approximately 1.5 million cases of myocardial infarction occur annually in the United States. Myocardial infarction, commonly known as a heart attack, is the irreversible necrosis of heart muscle secondary to prolonged ischemia. This usually results from an imbalance in oxygen supply and demand, which is most often caused by plaque rupture with thrombus formation in a coronary vessel, resulting in an acute reduction of blood supply to a portion of the myocardium. Patients with typical myocardial infarction may have the following prodromal symptoms: Intense sharp chest pain, radiation of chest pain up to neck, shoulder, jaw and down left arm, ventricular tachycardia, atrial fibrillation or flutter, Coughing, wheezing, Fever, Fatigue, chest discomfort, and Malaise. Atherosclerosis is the disease primarily responsible almost 90% of myocardial infarctions that result from an acute thrombus that obstructs an atherosclerotic coronary artery. Plaque rupture and erosion are considered to be the major triggers for coronary thrombosis. Following plaque erosion or rupture, platelet activation and aggregation, coagulation pathway activation, and endothelial vasoconstriction occur, leading to coronary thrombosis and occlusion. The damage in the myocardium is essentially the result of a tissue response that...
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...The leading cause of death in the United States is heart disease, which is often manifested as a myocardial infarction (MI). One of the most damaging types of myocardial infarctions is a STsegment elevation MI (STEMI) which indicates a block of blood flow to the entire thickness of the myocardial wall. In the treatment of STEMIs, quick reperfusion has the potential to save cardiac muscle. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) reperfusion guidelines recommend a door-to-balloon time (DTBT) of less than 90 minutes for all STEMI patients presenting to percutaneous coronary intervention (PCI) capable hospitals and less than 120 minutes for those same patients presenting to non-PCI hospitals (1). The DTBT of...
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...com/content/12/2/R36 Research Vol 12 No 2 Open Access Detecting myocardial infarction in critical illness using screening troponin measurements and ECG recordings Wendy Lim1, Paula Holinski1, PJ Devereaux1,2, Andrea Tkaczyk2, Ellen McDonald2, France Clarke2, Ismael Qushmaq3, Irene Terrenato4, Holger Schunemann2,4, Mark Crowther1 and Deborah Cook1,2 1Department 2Department of Medicine, McMaster University, Canada of Clinical Epidemiology and Biostatistics, McMaster University, Canada 3Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia 4Department of Epidemiology, Italian National Cancer Institute Regina Elena, Rome, Italy Corresponding author: Deborah Cook, debcook@mcmaster.ca Received: 6 Dec 2007 Revisions received: 22 Jan 2008 Accepted: 4 Mar 2008 Published: 4 Mar 2008 Critical Care 2008, 12:R36 (doi:10.1186/cc6815) This article is online at: http://ccforum.com/content/12/2/R36 © 2008 Lim et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction To use screening cardiac troponin (cTn) measurements and electrocardiograms (ECGs) to determine the incidence of elevated cTn and of myocardial infarction (MI) in patients admitted to the intensive care unit (ICU),...
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...Cardiac – Coronary Artery Disease/Acute Myocardial Infarction Topic: Cardiac – Coronary Artery Disease/Acute Myocardial Infarction 1 Cardiac – Coronary Artery Disease/Acute Myocardial Infarction Table of Contents Introduction...................................................................................................................3 Patient’s profile..............................................................................................................4 Pathophysiology...............................................................................................................................5 Clinical manifestations...................................................................................................................6 Short of breath and ‘light headed’...................................................................................................6 Nauseous and uncomfortable feeling...............................................................................................6 Crushing substernal chest pain .......................................................................................................6 Modifiable and Non-modifiable risk factors.................................................................7 Laboratory tests results and ECG findings................................................................................7 ECG (Electrocardiogram)....................................................................
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...For the purpose of this assignment the author will discuss the pathophysiology of a myocardial infarction and will give an in-depth discussion of one central aspect of care and in this assignment the author has chosen the management of anxiety. Due to word restrictions a brief mention will be given to the other aspects of care. Ischaemia is a term which is used to describe the deficiency in blood supply to any part of the body. In ischaemic heart disease there is a deficiency in the blood supply to the heart muscle which can be caused by an obstruction to, or even a narrowing of the coronary arteries. This in turn reduces the supply of nutrients and oxygen to the heart muscle. Without an optimum oxygen supply the heart muscle is unable to function efficiently.(Boersma et al 2003) There are three ways in which an infarction may develop. 1) The narrowing and hardening of arteries is caused by degenerative changes and also the build up of cholesterol and other fatty deposits which occur in the vessel wall. Plaques which then develop and subsequently become ‘calcified or fibrotic’ is through a process known as atherosclerosis. The atherosclerotic plaque slowly builds up in the inner lining of a coronary artery. The presence of the plaques causes the linings of the artery walls to become roughened and this in turn reduces the size of the lumen and eventually occludes it. As circulation slows down there is a strong possibility of thrombus formation. Should a coronary artery become...
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...1. Describe nursing care of the post angioplasty patient. A coronary angioplasty is a procedure to open an area of the arterial blockage in the heart that has become narrowed. This allows better blood flow through the artery and to the heart muscle. It is often done with a catheter that has an inflatable small sausage-shaped balloon at its tip. Coronary angioplasty is being increasingly used as a treatment for coronary artery disease; the proper evaluation and management of patients after the procedure are important issues. Although coronary angioplasty is a complex technical procedure, the methods routinely used to evaluate its results have many limitations. The management of the patient during the first 24 hours after angioplasty should focus on the prevention, detection, and if necessary treatment of acute vessel closure. Assessment: When the patient returns from the cardiac catheterization laboratory, the stability of the patient should be established initially. This will include, but is not limited to, EKG, vital signs, oxygenation level, urine output, cardiac, respiratory, pulmonary, gastrointestinal, and gentle urinary assessment. Particular attention must be paid to the peripheral vascular assessment of the lower extremities. Often the patient may return from the cardiac catheterization laboratory with a sheath in place. If this is the case, the institutional procedures for caring for sheaths should be applied. Some institutions, may allow the nurse to remove that...
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...Back Ground: Despite impressive strides in diagnosis and management of acute myocardial infarction in the past three decades, acute myocardial infarction continues to be a major health problem. About 50% of death from acute myocardial infarction occur within 1hr of the event and are attributable to arrhythmias most often ventricular fibrillation. Ischaemic injury can produce conduction blocks at any level of the atrioventricular or Intraventricular conduction systems. Such conduction block can occur in the atrioventricular node producing various grades of AV block. Conduction block can occur in either main bundle branch producing right or left bundle branch block or in the anterior and posterior fascicle of left bundle branch, producing left anterior &left posterior...
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...Beta Blockers After Myocardial Infarction Clinical Scenario The acute care nurse practitioner on the cardiology service treats a 67 year-old-male admitted after recovering from an acute ST-Elevation Myocardial Infarction (STEMI). His risk factors include obesity, Type II diabetes mellitus, and family history. Upon exam the patient asks why he has not been started on a beta blocker yet. He explains further that when his brother had a “heart attack” in 2005, he was immediately placed on a beta blocker because the cardiologist reported how beta blockers reduce mortality after myocardial infarction (MI). The patient wants to know if a beta blocker would reduce his chance of mortality? Using the Patient-Intervention-Comparator-Outcome (PICO) format we formulated the following question. In a 67-year-old male with multiple co-morbidities with MI (P), does treatment with a beta blocker (I), compared with no beta blocker or placebo (O), reduce mortality rate (O)? Risk Factors, Incidence and Prevalence of Disease * US incidence rates of cardiovascular disease, including MI, are seen in men more than women (Alexander et al., 2007). This trend is also true in Utah ("Impact of heart," 2007). * The incidence rates of cardiovascular disease increase with age (Alexander et al., 2007). * Risk factors for cardiovascular disease include not eating enough fruits and vegetables, lack of physical exercise, smoking cigarettes and the co-morbidities of diabetes, hypertension, hyperlipidemia...
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...intake. The genomic effect of aldosterone increases renal sodium transport, but the administration of large doses of aldosterone to normal individuals does not cause edema, relating to the phenomenon of "aldosterone escape"; however, in edematous disorders including cardiac failure, cirrhosis, and nephrotic syndrome, impaired aldosterone escape leads to renal sodium retention and edema formation. There is now considerable evidence for the nongenomic effects of aldosterone in several important diseases. Thus, low dosages of mineralocorticoid antagonists, with little or no effect on urinary sodium excretion, have been shown to afford a beneficial effect on morbidity and mortality in patients with advanced cardiac failure and after acute myocardial infarction. Three-drug-resistant hypertension has also been found to respond to spironolactone in modest dosages. The combination of an angiotensin converting enzyme inhibitor (ACEI) with spironolactone to treat such resistant hypertension may be more effective than adding an angiotensin receptor blocker to an ACEI. The role of spironolactone has also been shown to decrease albuminuria in chronic kidney disease including diabetic nephropathy in the presence of maximal dosages of ACEI. The effect of aldosterone in metabolic...
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...Women and Heart Disease Coppin State University Abstract Heart disease is a leading cause of death for women and men worldwide. Women are more vulnerable to myocardial infarction because of the size of their coronary arteries. They have unique risk factors such as a high level of cholesterol, hypertension, and smoking that cause heart disease, which leads to the high mortality rate. To reduce the high mortality rate among women, nurses must play their roles as educators because they interact frequently with patient, moreso than any other health care workers. Nurses must educate their patients on how to prevent the risk factors of heart disease. In order to reduce the high mortality rate due to MI in women, the Obama administration implemented the Patient Protection and Affordable Care Act (PPACA), popularly called t "Obama Care". This policy has mandated that insurance companies cover important preventive care at no cost, which will help eliminate the expensive bills that would have been incurred. As a future nurse, I would address the issue of heart disease by providing qualitative education and creating awareness of the causes and preventive measures of heart diseases. Keywords: Affordable Care Act, Heart Disease, Myocardial Infarction, "Obama Care", and Women's Health. Introduction Although both men and women have increased mortality rates due to heart disease in the United States, women have the higher rate and carry a heavier cardiovascular burden...
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...Respodent: LUCITA R. VILLAREAL Nature of the case: Civil case PART III Facts of the case: Respondent is the widow of Zacarias F. Villareal, a technical education and skills development supervisor in the Technical Education and Skills Development Authority at the time of his death on October 20, 2002 due to myocardial infarction. Respondent filed with petitioner a claim for death benefits under PD 626, as amended. Petitioner denied the claim on the ground that the cause of death was not work-connected. The ECC upheld petitioner. On appeal, however, the CA reversed petitioner and the ECC and held that myocardial infarction, a cardiovascular disease, was a compensable occupational disease. Thus, this petition. Is respondent entitled to compensation for her husband’s death? Yes, she is. Under PD 626, the beneficiaries of an employee are entitled to death benefits under the system if the cause of death of the employee is a sickness listed as an occupational disease by the ECC or any other illness caused by employment, subject to proof that the risk of contracting the same is increased by the working conditions. The CA correctly ruled that myocardial infarction was considered as an occupational disease because it was included under the classification “cardiovascular disease,” a compensable occupational disease under ECC Resolution No. 432 (dated July 20, 1977) subject to substantial evidence proving any of the following conditions: (a) If the heart...
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...Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study Summary Background Although more than 80% of the global burden of cardiovascular disease occurs in low-income and middle-income countries, knowledge of the importance of risk factors is largely derived from developed countries. Therefore, the effect of such factors on risk of coronary heart disease in most regions of the world is unknown. Methods We established a standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent. 15152 cases and 14820 controls were enrolled. The relation of smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins (Apo), and psychosocial factors to myocardial infarction are reported here. Odds ratios and their 99% CIs for the association of risk factors to myocardial infarction and their population attributable risks (PAR) were calculated. Findings Smoking (odds ratio 2·87 for current vs never, PAR 35·7% for current and former vs never), raised ApoB/ApoA1 ratio (3·25 for top vs lowest quintile, PAR 49·2% for top four quintiles vs lowest quintile), history of hypertension (1·91, PAR 17·9%), diabetes (2·37, PAR 9·9%), abdominal obesity (1·12 for top vs lowest tertile and 1·62 for middle vs lowest tertile, PAR 20·1% for top two tertiles vs lowest tertile), psychosocial...
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... one fact that cannot be denied is that stem cell research has led to many life saving discoveries in various sectors of scientific research. In regards to the ethical dilemma of stem cells, recent developments in induced pluripotent stem cells (iPSCs) have made it possible to explore the applications of stem cells while avoiding the ethical problems associated with embryonic stem cell research (Seki & Fekuda, 2015). One intriguing area in stem cell research is the potential applications for them in the treatment of cardiac diseases. Studies have explored the potential uses for stem cells for the treatment of heart disease (Yamakawa & Ieda, 2015). Additionally, stem cells have been explored for the treatment of heart failure and myocardial infarction (Rasmussen, et al., 2013). Stem cells and how they may be used for the treatment of various cardiac diseases is an exciting topic and has the potential to change future approaches to the treatment. This paper will examine the applications and significance of stem cells in relation to these common cardiac pathologies. Heart disease is one of the leading causes of death in developed countries and currently there are few effective treatment options available (Yamakawa & Ieda, 2015). This it is important to research and make state of the art treatments available to address this issue. The use of stem cells may become an option for treatment of coronary artery disease (CAD). One approach has involved the use of endothelial progenitor...
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...Myocardial Infarction Mortality 1.0 Introduction In the UK, about 838,000 men and 394,000 women have had a myocardial infarction (MI) at some point in their lives, (NICE clinical guideline 48, 2007). The latest statistics from the British Heart Foundation state that approximately 227,000 people suffer from an acute MI (heart attack) each year (British Heart Foundation Statistics Website). To put this figure in to perspective this equates to one person every 2 minutes. Mortality is at approximately 30% which is 68,100 deaths in the UK per year. The National Service Framework (NSF) for Coronary Heart disease (CHD) is a 10-year programme published by the Department of Health in 2000 and has set key standards for the prevention and treatment of CHD. Access to the right treatment for those who suffer from an AMI, is essential to reduce morbidity and mortality and improve clinical outcomes. People with diabetes mellitus constitute a group of patients who have a higher risk of having an MI and also a poorer prognosis post infarction. The higher death and complication rates appear to be multifactorial but a significant finding in the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Trial showed to reduce one year mortality by 30% (Malberg et al., 1995). It’s recommended 1.1 Primary Objective To determine the relationship between HbA1c and prognosis of patients in East Lancashire having a myocardial infarction. 1.2 Secondary Objectives To assess...
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