7 Myocardial Infarction (Heart Attack) Nursing Care Plans

Myocardial Infarction (Heart Attack) Nursing Care Plans,Myocardial infarction (MI) or acute myocardial infarction (AMI) commonly known as heart attack happens when there is marked reduction or loss of blood flow through one or more of the coronary arteries, resulting in cardiac muscle ischemia and necrosis.

Myocardial infarction is a part of a broader category of disease known as acute coronary syndrome, results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries.

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In cardiovascular diseases, the leading cause of death in the United States and western Europe usually results from the cardiac damage or complications of MI. Mortality is high when treatment is delayed and almost one-half of sudden deaths due to an MI occur before hospitalization, within one hour of the onset of symptoms. The prognosis improves if vigorous treatment begins immediately.

Acute myocardial infarction is the medical name for a heart attack. A heart attack is a life-threatening condition that occurs when blood flow to the heart muscle is abruptly cut off, causing tissue damage. This is usually the result of a blockage in one or more of the coronary arteries. A blockage can develop due to a buildup of plaque, a substance mostly made of fat, cholesterol, and cellular waste products.

What are the symptoms of acute myocardial infarction?

While the classic symptoms of a heart attack are chest pain and shortness of breath, the symptoms can be quite varied. The most common symptoms of a heart attack include:

  • Pressure or tightness in the chest
  • Pain in the chest, back, jaw, and other areas of the upper body that lasts more than a few minutes or that goes away and comes back
  • Shortness of breath
  • Sweating
  • Nausea
  • Vomiting
  • Anxiety
  • A cough
  • Dizziness
  • A fast heart rate

It’s important to note that not all people who have heart attacks experience the same symptoms or the same severity of symptoms. Chest pain is the most commonly reported symptom among both women and men. However, women are more likely than men to have:

  • Shortness of breath
  • Jaw pain
  • Upper back pain
  • Lightheadedness
  • Nausea
  • Vomiting

In fact, some women who have had a heart attack report that their symptoms felt like the symptoms of the flu.

What causes acute myocardial infarction?

Your heart is the main organ in your cardiovascular system, which also includes different types of blood vessels. Some of the most important vessels are the arteries. They take oxygen-rich blood to your body and all of your organs. The coronary arteries take oxygen rich blood specifically to your heart muscle. When these arteries become blocked or narrowed due to a buildup of plaque, the blood flow to your heart can decrease significantly or stop completely. This can cause a heart attack. Several factors may lead to a blockage in the coronary arteries.

Bad cholesterol

Bad cholesterol, also called low-density lipoprotein (LDL), is one of the leading causes of a blockage in the arteries. Cholesterol is a colorless substance that’s found in the food you eat. Your body also makes it naturally. Not all cholesterol is bad, but LDL cholesterol can stick to the walls of your arteries and produce plaque. Plaque is a hard substance that blocks blood flow in the arteries. Blood platelets, which help the blood to clot, may stick to the plaque and build up over time.

Saturated fats

Saturated fats may also contribute to the buildup of plaque in the coronary arteries. Saturated fats are found mostly in meat and dairy products, including beef, butter, and cheese. These fats may lead to an arterial blockage by increasing the amount of bad cholesterol in your blood system and reducing the amount of good cholesterol.

Tran’s fat

Another type of fat that contributes to clogged arteries is trans-fat or hydrogenated fat. Tran’s fat is usually artificially produced and can be found in a variety of processed foods. Tran’s fat is typically listed on food labels as hydrogenated oil or partially hydrogenated oil.

Who is at risk for acute myocardial infarction?

Certain factors may increase your risk of having a heart attack.

High blood pressure

You’re at greater risk for heart attack if you have high blood pressure. Normal blood pressure is below 120/80 mm Hg (millimeters of mercury) depending on your age. As the numbers increase, so does your risk of developing heart problems. Having high blood pressure damages your arteries and accelerates the buildup of plaque.

High cholesterol levels

Having high levels of cholesterol in your blood puts you at risk for acute myocardial infarction. You may be able to lower your cholesterol by making changes to your diet or by taking certain medications called statins.

High triglyceride levels

High triglyceride levels also increase your risk for having a heart attack. Triglycerides are a type of fat that clog up your arteries. Triglycerides from the food you eat travel through your blood until they’re stored in your body, typically in your fat cells. However, some triglycerides may remain in your arteries and contribute to the buildup of plaque.

Diabetes and high blood sugar levels

Diabetes is a condition that causes blood sugar, or glucose, levels to rise. High blood sugar levels can damage blood vessels and eventually lead to coronary artery disease. This is a serious health condition that can trigger heart attacks in some people.

Obesity

Your chances of having a heart attack are higher if you’re very overweight. Obesity is associated with various conditions that increase the risk of heart attack, including:

  • Diabetes
  • High blood pressure
  • High cholesterol levels
  • High triglyceride levels

Smoking

Smoking tobacco products increases your risk for heart attack. It may also lead to other cardiovascular conditions and diseases.

Age

The risk of having a heart attack increases with age. Men are at a higher risk of a heart attack after age 45, and women are at a higher risk of a heart attack after age 55.

Family history

You’re more likely to have a heart attack if you have a family history of early heart disease. Your risk is especially high if you have male family members who developed heart disease before age 55 or if you have female family members who developed heart disease before age 65.

Other factors that can increase your risk for heart attack include:

  • Stress
  • Lack of exercise
  • The use of certain illegal drugs, including cocaine and amphetamines
  • A history of preeclampsia, or high blood pressure during pregnancy

How is acute myocardial infarction diagnosed?

To determine whether you’ve had a heart attack, your doctor will listen to your heart to check for irregularities in your heartbeat. They may measure your blood pressure as well. Your doctor will also run a number of different tests if they suspect that you’ve had a heart attack. An electrocardiogram (EKG) may be done to measure your heart’s electrical activity. Blood tests can also be used to check for proteins that are associated with heart damage, such as troponin.

Other diagnostic tests include:

  • A stress test to see how your heart responds to certain situations, such as exercise
  • An angiogram with coronary catheterization to look for areas of blockage in your arteries
  • An echocardiogram to help identify areas of your heart that aren’t working properly

How is acute myocardial infarction treated?

Heart attacks require immediate treatment, so most treatments begin in the emergency room. A minimally invasive procedure called angioplasty may be used to unblock the arteries that supply blood to the heart. During an angioplasty, your surgeon will insert a long, thin tube called a catheter through your artery to reach the blockage. They will then inflate a small balloon attached to the catheter in order to reopen the artery, allowing blood flow to resume. Your surgeon may also place a small, mesh tube called a stent at the site of the blockage. The stent can prevent the artery from closing again.

Your doctor may also want to perform a coronary artery bypass graft (CABG) in some cases. In this procedure, your surgeon will reroute your veins and arteries so the blood can flow around the blockage. A CABG is sometimes done immediately after a heart attack. In most cases, however, it’s performed several days after the incident so your heart has time to heal.A number of different medications can also be used to treat a heart attack:

Blood thinners, such as aspirin, are often used to break up blood clots and improve blood flow through narrowed arteries.

Thrombolytic are often used to dissolve clots.

Antiplatelet drugs, such as clopidogrel, can be used to prevent new clots from forming and existing clots from growing.

Nitroglycerin can be used to widen your blood vessels.

Beta-blockers lower your blood pressure and relax your heart muscle. This can help limit the severity of damage to your heart.

ACE inhibitors can also be used to lower blood pressure and decrease stress on the heart.

Pain relievers may be used to reduce any discomfort you may feel.

What can be expected after treatment?

Your chances of recovering from a heart attack depend on how much damage there is to your heart and how quickly you receive emergency care. The sooner you receive treatment, the more likely you are to survive. However, if there’s substantial damage to your heart muscle, your heart may be unable to pump an adequate amount of blood throughout your body. This can lead to heart failure.

Heart damage also increases your risk of developing abnormal heart rhythms, or arrhythmias. Your risk of having another heart attack will be higher as well.

Many people who’ve had heart attacks experience anxiety and depression. It’s important to speak with your doctor about your concerns during recovery. It may also be beneficial to join a support group or to speak with a counselor about what you’re going through.

Most people are able to resume their normal activities after a heart attack. However, you’ll need to ease back into any intense physical activity. Your doctor will help you develop a specific plan for recovery. You may be required to take medications or undergo a cardiac rehabilitation program. This type of program can help you slowly regain your strength, teach you about healthy lifestyle changes, and guide you through treatment.

How can acute myocardial infarction be prevented?

There are many steps you can take to prevent a heart attack, even if you’ve had one before.

One way to lower your risk is to eat a heart-healthy diet. This diet should largely consist of:

  • Whole grains
  • Vegetables
  • Fruits
  • Lean protein

You should also reduce the amount of the following in your diet:

  • Sugar
  • Saturated fat
  • Tran’s fat
  • Cholesterol

This is especially important for people with diabetes, high blood pressure, and high cholesterol.

Exercising several times a week will also improve your cardiovascular health. If you’ve had a heart attack recently, you should speak with your doctor before starting a new exercise plan.It’s also important to stop smoking if you smoke. Quitting smoking will significantly lower your risk of a heart attack and improve both your heart and lung health. You should also avoid being around secondhand smoke.

Nursing Care Plans

The goals of treatment for myocardial infarction are to relieve chest pain, stabilize heart rhythm, reduce cardiac workload, revascularize the coronary artery, and preserve myocardial tissue.

Here are seven (7) nursing diagnosis for myocardial infarction (heart attack) nursing care plans (NCP):

  1. Acute Pain
  2. Activity Intolerance
  3. Fear/Anxiety
  4. Risk for Decreased Cardiac Output
  5. Risk for Ineffective Tissue Perfusion
  6. Risk for Excess Fluid Volume
  7. Deficient Knowledge
  8. Other Possible Nursing Care Plans

Acute Pain

Nursing Diagnosis

May be related to

  • Tissue ischemia (coronary artery occlusion)

Possibly evidenced by

  • Reports of chest pain with/without radiation
  • Facial grimacing
  • Restlessness, changes in level of consciousness
  • Changes in pulse, BP

Desired Outcomes

  • Verbalize relief/control of chest pain within appropriate time frame for administered medications.
  • Display reduced tension, relaxed manner, ease of movement.
  • Demonstrate use of relaxation techniques.

Nursing Interventions

Rationale

Monitor and document characteristic of pain, noting verbal reports, nonverbal cues (moaning, crying, grimacing, restlessness, diaphoresis, clutching of chest) and BP or heart rate changes. Variation of appearance and behavior of patients in pain may present a challenge in assessment. Most patients with an acute MI appear ill, distracted, and focused on pain. Verbal history and deeper investigation of precipitating factors should be postponed until pain is relieved. Respirations may be increased as a result of pain and associated anxiety; release of stress-induced catecholamines increases heart rate and BP.
Obtain full description of pain from patient including location, intensity (using scale of 0–10), duration, characteristics (dull, crushing, described as “like an elephant in my chest”), and radiation. Assist patient to quantify pain by comparing it to other experiences. Pain is a subjective experience and must be described by patient. Provides baseline for comparison to aid in determining effectiveness of therapy, resolution and progression of problem.
Review history of previous angina, anginal equivalent, or MI pain. Discuss family history if pertinent. Delay in reporting pain hinders pain relief and may require increased dosage of medication to achieve relief. In addition, severe pain may induce shock by stimulating the sympathetic nervous system, thereby creating further damage and interfering with diagnostics and relief of pain.
Instruct patient to report pain immediately. Provide quiet environment, calm activities, and comfort measures. Approach patient calmly and confidently. Decreases external stimuli, which may aggravate anxiety and cardiac strain, limit coping abilities and adjustment to current situation.
Instruct patient to do relaxation techniques: deep and slow breathing, distraction behaviors, visualization, guided imagery. Assist as needed. Helpful in decreasing perception and response to pain. Provides a sense of having some control over the situation, increase in positive attitude.
Check vital signs before and after narcotic medication. Hypotension and respiratory depression can occur as a result of narcotic administration. These problems may increase myocardial damage in presence of ventricular insufficiency.
Administer supplemental oxygen by means of nasal cannula or face mask, as indicated. Increases amount of oxygen available for myocardial uptake and thereby may relieve discomfort associated with tissue ischemia.

Administer medications as indicated: 

  • Antianginals: nitroglycerin (Nitro-Bid, Nitrostat, Nitro-Dur), isosorbide dinitrate (Isordil), mononitrate (Imdur)
Nitrates are useful for pain control by coronary vasodilating effects, which increase coronary blood flow and myocardial perfusion. Peripheral vasodilation effects reduce the volume of blood returning to the heart (preload), thereby decreasing myocardial workload and oxygen demand.
  • Beta-blockers: atenolol (Tenormin), pindolol(Visken), propranolol (Inderal), nadolol (Corgard), metoprolol (Lopressor)
Important second-line agents for pain control through effect of blocking sympathetic stimulation, thereby reducing heart rate, systolic BP, and myocardial oxygen demand.May be given alone or with nitrates. Note: beta-blockers may be contraindicated if myocardial contractility is severely impaired, because negative inotropic properties can further reduce contractility.
  • Analgesics: morphine, meperidine (Demerol)
Although intravenous (IV) morphine is the usual drug of choice, other injectable narcotics may be used in acute-phase and/or recurrent chest pain unrelieved by nitroglycerin to reduce severe pain, provide sedation, and decrease myocardial workload. IM injections should be avoided, if possible, because they can alter the CPK diagnostic indicator and are not well absorbed in underperfused tissue.