Myocardial infarction (MI) is commonly referred to as a “heart attack”. Myocardial ischemia is inadequate perfusion to the myocardium that occurs from a partial or complete blockage of blood and oxygen to the heart muscle. The most common cause of a heart attack is coronary artery disease.
In an emergency, as the cells lose oxygen, ischemia (reduced blood flow) sets in. If the supply and demand of myocardial oxygen are out of balance, it can cause the death of cardiac muscle tissue.
Other causes of MI include the following:
- Vasospasm (sudden constriction or narrowing of a coronary artery)
- Blood clots
- Electrolyte imbalances
- Trauma to the coronary arteries
A prolonged lack of oxygen to the heart may result in the most common symptom of a heart attack which is the feeling of pressure or discomfort in the chest. This pain may radiate to the neck, jaw, shoulder, or arm. Other symptoms may include cold sweat, fatigue, heartburn, dizziness, nausea and shortness of breath.
In this article:
- STEMI vs. NSTEMI
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Anxiety
- Decreased Cardiac Output
- Ineffective Tissue Perfusion
- Risk for Unstable Blood Pressure
STEMI vs. NSTEMI
Unlike an ST-elevation myocardial infarction (STEMI), a non-ST-elevation myocardial infarction (NSTEMI) may cause changes on an ECG such as T-wave inversion or ST depression but the ECG may also appear to be normal. These changes in electrical activity can be seen on an ECG. During an NSTEMI heart attack, the coronary artery is only partially blocked and the ST segment is not elevated, whereas for a STEMI, there will be ST elevation on the ECG caused by a larger blockage.
Nursing Process
The nurse should immediately assess the patient to identify whether the symptoms are chest pain (angina) or myocardial infarction (MI). While angina is a transient lack of blood flow to the heart muscle, an MI requires immediate intervention to save cardiac muscle tissue.
As soon as an acute MI patient is brought to the emergency room, steps are taken to reduce ischemia, relieve pain, and stop progressive circulatory collapse and shock. A common acronym that is used to guide the care of patients experiencing an MI is ‘MONA’ (morphine, oxygen, nitrates, and aspirin). The patient is placed on a cardiac monitor to track changes to the cardiac rhythm. IV access should also be established for the administration of fluids and emergency medications. The goal with an MI is to re-establish blood flow to the cardiac muscle. Depending on the services available at the center, this may be accomplished using drugs, stent placement or surgery.
During the recovery from MI, the nurse encourages and educates the patient on medication adherence, diet and weight management, and risk factor modification after MI. Cardiac rehabilitation programs may be advised after discharge for ongoing recovery.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section we will cover subjective and objective data related to myocardial infarction.
Review of Health History
1. Note the patient’s general symptoms.
Patients may complain of general symptoms, such as:
- Chest/back/shoulder/jaw pain
- Palpitations
- Shortness of breath (dyspnea) both at rest and during exertion
- Fatigue
- Sweating
- Nausea
- Fainting (syncope)
- Dizziness
2. Interview the chest pain further.
Let the patient describe their chest pain:
- Chest tightness
- Feeling of squeezing
- Heaviness
- Burning
- Pain in the arm/shoulder
- Pain during exertion or at rest
- Jaw pain during exertion or at rest
- Abdominal pain during exertion or at rest
- Intermittent or persistent pain
- Pain lasting for more than 20 minutes
- Pain during physical activity
- Pain triggered by stress or emotions
3. Identify the patient’s risk.
Non-modifiable risk factors:
- Sex and Age: MI is prevalent in males over the age of 45 and females over the age of 50 or after menopause.
- Family history of ischemic heart disease: If a first-degree relative has heart disease before age 55, the patient is at an increased risk of MI.
- Race/ethnicity: MI’s are more common in Black people and Latinos than in White people. However this is related to social rather than biological factors.
Modifiable risk factors:
- Hypertension: If high blood pressure is uncontrolled, the arteries may become stiff and rigid, increasing the risk of atherosclerosis and MI.
- Hyperlipidemia/hypercholesterolemia: Increased levels of low-density lipoprotein (LDL) or decreased levels of high-density lipoprotein (HDL) in the blood can increase the risk of MI.
- Diabetes or insulin resistance: Diabetes increases the risk of atherosclerosis which increases the risk of MI.
- Tobacco use: Firsthand and secondhand smoke inhalation has a strong association with MI.
- Obesity: Blood pressure rises in obese patients because they need more blood to provide oxygen and nourishment to their bodies. The body will also need to exert additional pressure to circulate blood.
- Physical inactivity: Being inactive increases the risk for MI such as hypertension and obesity.
- Diet: A diet rich in trans and saturated fats increases the risk of hyperlipidemia , which is associated with an increased risk of MI.
- Stress: Extreme stress causes the heart to pump more quickly and increases blood flow through veins that arterial plaques may already constrict.
- Alcohol use: Heavy alcohol consumption has different physiological effects on lipids, platelets, and heart function. It causes heart damage and increases the risk of sudden cardiac death.
- Lack of sleep: The blood pressure will remain elevated for an extended period without adequate sleep.
4. Assess precipitating emotional causes.
Anginophobia is the fear of pain or discomfort in the chest. Patients experience an irrational fear of choking, chest pain, or narrowness that can lead to a panic attack that mimics signs of MI, such as tachycardia, tachypnea, hypertension, and diaphoresis. An underlying anxiety disorder may cause this condition and requires mental health support.
Physical Assessment
1. Prioritize ABCs.
Call an ambulance or go to the nearest emergency room if someone is suspected of experiencing MI symptoms. The priority is stabilizing the airway, breathing, and circulation. Immediately perform CPR if the patient has no pulse.
2. Systemic assessment approach:
- Neck: jugular vein distention
- CNS: anxiety, a feeling of impending doom, syncope, dizziness, lightheadedness, and changes in mentation
- Cardiovascular: chest pain, murmur when assessing apical heart sounds or bruit on the carotid artery upon auscultation, arrhythmias, uncontrolled blood pressure
- Circulatory: palpitations, thready pulse
- Respiratory: dyspnea at rest or during exertion
- Gastrointestinal: nausea and vomiting
- Musculoskeletal: neck, arm, back, jaw, and upper extremity pain, fatigue
- Integumentary: cyanosis, pale skin, and excessive sweating
3. Calculate the patient’s risk.
Calculate the patient’s ASCVD (atherosclerotic cardiovascular disease) risk score. The ideal risk score is low (score <5%). It measures a 10-year risk of CAD and heart diseases objectively, considering the following:
- Age
- Gender
- Race
- Blood pressure
- Cholesterol
- Medications
- Diabetes
- Smoking
Diagnostic Procedures
1. Review ECG results.
The patient should receive an ECG as soon as possible upon arrival to the emergency department. If the patient arrives via ambulance, the ambulance will likely have telemetry read outs as well. A MI will present as:
- The Q wave may indicate MI. Pathological Q waves are Q waves greater than 25% of the height of the QRS complex. It indicates myocardial infarction.
- An NSTEMI does not result in the ST segment being consistently taller, as a STEMI does.
- A STEMI will result in ST-segment elevation
- The ST segment may fall below its baseline during an NSTEMI.
2. Monitor troponin levels.
Cardiac troponins are the primary blood test in examining patients suspected of having acute MI. Cardiac troponin I or cardiac troponin T are extremely sensitive and specific biomarkers of myocardial ischemia. Troponin levels are most elevated 4-9 hours after myocardial damage, peak after 12-24 hours, and may remain elevated for 1-2 weeks. Troponin will likely be increased in both STEMI and NSTEMI MIs.
3. Assist the patient with an echocardiogram.
An essential tool in diagnosing heart function after an MI is an echocardiogram. An echo is advised during the first 24-48 hours of an MI. The echo will determine how well the heart is pumping and the extent of the damage after the MI. A second echo establishes a baseline assessment of the heart post-infarction for the first three months following an infarction.
4. Investigate further.
- Cardiac CT scan accurately identifies coronary heart disease that can cause MI.
- CT coronary angiogram uses IV dye to obtain more detailed images of the heart.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section you’ll learn more about possible nursing interventions for a patient with myocardial infarction.
Relieve the Pain
1. Provide pain relief.
The analgesics most frequently used for pain treatment are intravenous opioids, such as morphine. During a MI, morphine lowers blood pressure, heart rate, and venous return and may activate local histamine-mediated mechanisms.
2. Administer supplemental oxygen as ordered.
Oxygen increases the cardiac tissue’s oxygenation and lessens ischemic pain. It also reduces infarct size and improves cardiac function.
3. Promote vasodilation.
For acute myocardial infarction, nitroglycerin continues to be a first-line treatment. It produces nitric oxide, which induces vasodilation and boosts blood flow to the myocardium. It is primarily used to relieve chest pain. Often Nitroglycerin will be ordered as a PRN medication.
Prepare for Anticipated Treatments for MI
1. Prepare for reperfusion procedures.
If available, patients experiencing MI will be sent for coronary angioplasty and potentially stent placement to restore blood flow. Primary percutaneous coronary intervention (PCI) and fibrinolytic therapy are reperfusion therapies that rapidly restore blood flow to the ischemic myocardium and reduce infarct size.
2. Fibrinolytic therapy
If angioplasty is not available, the patient may be offered fibrinolytic therapy to break up the clot and restore perfusion. During MI, the sooner thrombolytic medication is administered, the less damage the heart sustains and the higher the likelihood of survival.
3. Surgery
Coronary Artery Bypass Graft Surgery (CABG) or commonly known as bypass surgery, creates a second blood vessel in the heart, so the blocked or occluded artery is bypassed. This option may be chosen if it is not possibly to restore blood flow with stent placement alone.
4. Administer blood thinning agents cautiously as ordered.
By preventing the further growth or formation of blood clots, blood thinners can reduce the spread of damage.
- Anticoagulants prolong the time it takes for a blood clot to form by affecting chemical processes in the body. Reduced clotting prevents the formation of blood clots that can block blood flow.
- Antiplatelets prevent platelets from adhering to one another and producing a blood clot. Aspirin is typically used as an antiplatelet medication.
5. Stabilize blood glucose levels.
The stress brought on by an acute myocardial infarction disturbs the usual hormonal control of blood glucose levels, sometimes resulting in hyperglycemia. Regardless of the diabetic condition, blood glucose levels rise after myocardial infarction. Patients may benefit from glucose-lowering treatments that normalize blood sugar levels, if necessary.
Cardiac Rehabilitation
1. Follow the rehabilitation plan.
Adhering to the cardiac rehab plan is especially important for patients who experienced an MI and underwent a surgical procedure. Cardiac rehab decreases the risk of mortality following MI or cardiac bypass surgery.
2. Continue rehabilitation even after discharge.
After being discharged from the hospital, cardiac rehabilitation continues (at home or a community healthcare facility). It typically lasts about three months, depending on the program and the patient’s condition.
3. Educate on the benefits.
It is important that patients understand the benefits of following their cardiac rehabilitation plan. Patients should be educated on the importance of their medications as well as how lifestyle factors can contribute to their cardiac outcomes.
Prevent Future MIs
1. Encourage regular exercise.
By weeks four to six, the patient can usually begin to exercise for 15-20 minutes at a time. Exercise can progress as tolerated and advised by the healthcare provider.
2. Set a blood pressure goal.
Antihypertensive therapy sets a blood pressure goal to reduce severe complications from MI. The healthcare provider will determine target blood pressure goals.
Common medications that are used to maintain blood pressure goal include:
- Beta-blockers lessen the heart’s oxygen consumption by lowering heart rate, blood pressure, and myocardial contractility. They lessen the effects of circulating catecholamines and block beta receptors throughout the body, including the heart. Beta-blockers should not be taken if coronary vasospasm is suspected.
- ACE inhibitors are used for patients with systolic left ventricular dysfunction, heart failure, hypertension, or diabetes.
- Intravenous nitrates are effective in symptom alleviation and regression of ST depression (NSTEMI). They are considered superior to sublingual nitrates. The dose increases until the symptoms disappear, patients’ blood pressure stabilizes within normal range, or adverse effects such as headache and hypotension appear.
3. Lower the lipids.
Statin medications that lower low-density lipoproteins (LDLs) or bad cholesterol are advised. These medications stabilize atherosclerotic plaques, preventing them from dislodging and blocking the blood vessels.
4. Promote healthy weight maintenance.
People who are obese are at higher risk of hypertension due to many factors including metabolic disorders, increased arterial resistance and stimulation of the renin angiotensin-aldosterone system. MI is more likely in obese people due to high blood pressure.
5. Ask the patient to teach back MI treatments.
Patient education helps patients adhere to medications and treatments consistently. It also encourages patient-centered care and continuity of care. Ask the patient to verbalize their medication regimen, follow-up appointments, and ongoing lab or diagnostic testing requirements.
6. Avoid stress.
Stress activates the inflammatory response, causing high blood pressure, increased heart rate, and narrowed blood vessels. Yoga, muscular relaxation, guided imagery, deep breathing exercises, and meditation are the cornerstones of stress reduction.
7. Control the underlying conditions.
In patients with MI, underlying conditions such as diabetes, hyperlipidemia, and hypertension should be controlled. Managing these conditions can prevent complications and recurrent MI.
8. Assist the patient in lifestyle changes.
Many MI risk factors are controllable. When the patient maintains a healthy lifestyle, MI recurrence can be avoided. This includes:
- Regular exercise and physical activity
- A heart-healthy and balanced diet
- Smoking cessation
- Stress and anxiety management
- Limiting alcohol consumption (Limit consumption to one drink per day for women while two drinks per day for men)
7. Emphasize the need for regular visits.
Ensure patients recognize the importance of attending their scheduled follow up appointments after and MI. Depending on the severity of the MI, they may have follow up appointments with either a cardiologist or a general practitioner.
8. Encourage CPR training.
Encourage the patient’s caregiver and family to take CPR training. Cardiopulmonary resuscitation (CPR) can save a person’s life in an emergency. Knowing what to do when the patient’s breathing or heart stops can decrease the risk of complications and death.
9. Ensure the patient knows what actions to take if future MIs occur
The patient with a cardiac history must be advised when to call for immediate medical attention. Emphasize the need to take nitroglycerin or aspirin when symptoms (chest pain, dyspnea) are recognized if ordered.
10. Offer information on inquiries about sex after MI.
MI is rarely caused by sexual activity. Sexual activity may be resumed once the patient feels capable of physical activity.
11. Recommend a medical alert bracelet or ID.
Inform emergency responders about the patient’s potential risk of heart attack with a medical alert bracelet, necklace, or ID tag.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for myocardial infarction, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section you will find nursing care plan examples for myocardial infarction.
Acute Pain
Acute pain associated with myocardial infarction is caused by chest pain/discomfort from inadequate blood flow to the heart.
Nursing Diagnosis: Acute Pain
Related to:
- Blockage of coronary arteries
- Low or no oxygen-rich blood flowing to the heart
As evidenced by:
- Verbal reports of chest pain, pressure, or tightness
- Clutching the chest
- Restlessness
- Labored breathing and dyspnea
- Diaphoresis
- Changes in vital signs
Expected outcomes:
- Patient will verbalize pain relief or control.
- Patient will rate the chest pain lower than the baseline pain scale.
- Patient will appear relaxed and able to sleep or rest appropriately.
- Patient will be able to perform daily activities without assistance.
Assessment:
1. Determine if the chest pain is angina or myocardial infarction.
Chest pain in myocardial infarction is characterized by the following:
- Occurs without warning (usually in the early morning)
- Crushing pain in the substernum
- May radiate to the jaw, back, and left arm
- Lasts for 30 minutes or longer
- Unrelieved by rest or nitroglycerin
The main distinction between an MI and angina is that angina is associated with a trigger such as exertion and lasts a short amount of time (usually less than 10 minutes).
2. Assess pain characteristics.
Have the patient explain when the symptoms started, if they were precipitated activity or emotion, and if they took any measures to relieve the pain.
3. Obtain ECG during chest pain symptoms.
Expressions of chest pain should always be investigated using an ECG.
Interventions:
1. Administer nitroglycerin.
When chest pain initially appears in an adult, administer nitroglycerin as ordered. Nitroglycerin helps to dilate blood vessels in the heart which can help relieve chest pain. Always ensure that vital signs are taken prior and after administration.
2. Administer oxygen as ordered.
Chest pain can happen when the demand for oxygen is not being met. Supplemental oxygen administration will improve the oxygenation for the heart to function effectively.
3. Administer morphine.
Morphine may decrease the oxygen demand of the heart. It can also reduce blood pressure and slow the heart rate. Morphine will relax the patient and relieve anxiety.
4. Evaluate the effectiveness of pain control measures.
Frequently assess administered pain control measures for effectiveness.
Anxiety
Anxiety associated with myocardial infarction can be caused by the stimulation of the sympathetic nervous system (fight or flight response). Anxiety can also be a cause of MI.
Nursing Diagnosis: Anxiety
Related to:
- Threat of death
- Threat to health status
- Change to role functioning
- Lifestyle modification
As evidenced by:
- Increased tension
- Fearful attitude
- Apprehension
- Expressed concerns or uncertainty
- Restlessness
- Dyspnea
Expected outcomes:
- Patient will be able to verbalize the cause of their anxiety.
- Patient will verbalize an understanding of the necessary changes following myocardial infarction.
- Patient will implement individual coping mechanisms.
- Patient will display signs of reduced anxiety such as vital signs within normal limits and a calm demeanor.
Assessment:
1. Observe anxiety during myocardial infarction.
Anxiety is the most common psychological symptom which is linked to a poor prognosis following MI.
2. Examine the subjective and objective cues of anxiety.
Subjective and objective cues may reflect signs of anxiety in MI patients. Patients may not complain of chest pain yet they are holding their chest. Remain aware of symptoms to intervene.
3. Assess the patient’s coping mechanisms.
Recovery following MI is a long-term process of adapting to changes in all aspects of life. Help the patient recognize and develop coping behaviors to utilize later.
Interventions:
1. Recognize that the patient’s anxieties are valid.
Encourage them to verbalize their feelings and assure them that they will not be judged because of it. With support, the patient is more likely to overcome this threat to their health.
2. Offer information and answer questions.
The nurse should provide thorough explanations of tests, procedures, and interventions to alleviate the patient’s anxiety. Allow time for patients and families to ask questions and answer honestly.
3. Include the patient in the care planning process.
Involve the patient in the care plan by allowing them to take time to prepare for scheduled treatments. Patient involvement may restore a patient’s sense of autonomy when coping with the treatment and recovery from MI.
4. Manage stress.
Stress management will lower the risk of posttraumatic stress disorder (PTSD) following MI. PTSD is linked to decreased quality of life and increased risk of recurring MI.
5. Teach ways to reduce anxiety.
In conjunction with the patient, uncover ways the patient can reduce anxiety such as through exercise, journaling, breathing, music, and if necessary, medications.
Decreased Cardiac Output
Decreased cardiac output associated with myocardial infarction can be caused by the loss of viable heart muscle. This can result in decreased cardiac output and, in severe cases, cardiogenic shock and death.
Nursing Diagnosis: Decreased Cardiac Output
Related to:
- Changes in heart rate and electrical conduction
- Reduced preload
- Reduced cardiovascular blood flow
- Rupture of atherosclerotic plaque
- Occluded artery
- Altered muscle contractility
As evidenced by:
- Sudden and continuous chest pain unrelieved by rest and medication
- Shortness of breath
- Nausea
- Vomiting
- Anxiety
- Cool, pale, and moist skin
- Tachycardia
- Tachypnea
- Fatigue
- Dizziness
- Confusion
- Dysrhythmia
Expected outcomes:
- Patient will maintain blood pressure within acceptable limits set by the provider.
- Patient will be able to demonstrate decreased or absent dyspnea, angina, and dysrhythmias.
- Patient will be able to verbalize an understanding of myocardial infarction and its management.
- Patient will be able to participate in activities that decrease the workload of the heart.
Assessment:
1. Determine the patient’s risk and causative factors for decreased cardiac output.
Assess the patient’s medical history for atherosclerosis, blood clots, heart failure, and other conditions that place them at risk for decreased cardiac output and MI.
2. Determine if the condition is angina or myocardial infarction.
Stable angina is chest pain or discomfort that occurs with activity or stress but is relieved with rest or medications. MI occurs without regard to activity, lasts longer than stable angina, and is not relieved by rest or medications.
3. Closely monitor the blood pressure.
Immediately inform the provider when systolic blood pressure is less than 100 mmHg or 25 mmHg lower than the previous reading as it can lead to a cardiogenic shock. This is a complication that develops when the heart muscle deteriorates if oxygen-rich blood is not flowing to the heart.
4. Obtain ECG.
The most convenient and efficient approach for an early diagnosis of acute myocardial infarction is a 12-lead ECG. STEMI, NSTEMI, and other dysrhythmias can be detected.
5. Assess for signs of poor cardiac output.
- Cool, diaphoretic skin
- Weak or absent pulses
- Decreased urine output
- Altered mental status
- Peripheral vasoconstriction
6. Assess cardiac enzymes.
Myoglobin, troponin, and creatine kinase are cardiac enzymes, also known as cardiac biomarkers. Cardiac troponin I or cardiac troponin T are both extremely sensitive and specific for MI.
Interventions:
1. Prepare for potential resuscitation.
MI with decreased cardiac output is a medical emergency. The nurse should prepare for the potential need for resuscitation.
2. Administer oxygen as ordered.
Administer oxygen to increase perfusion to the heart and other tissues.
3. Establish IV access.
IV access is used for the immediate administration of medication, IV fluids, and blood products.
4. Prepare for possible cardiac catheterization or thrombolytic therapy.
Urgent cardiac catheterization evaluates the degree and location of coronary artery blockages. A stent may be placed to restore blood flow to myocardial tissue. Depending on availability, thrombolytics may be used in cases where it is not possible to access catheterization in a timely manner.
5. Encourage bed rest and activity restrictions.
During an MI, bed rest lessens the workload, preventing inadequate perfusion and potential harm to the heart. Until the heart muscle can be revascularized, the patient should limit activity.
6. Encourage cardiac rehabilitation.
Cardiac rehabilitation teaches the patient about diet modifications, exercise, and recovery following MI to improve outcomes and prevent further cardiac complications.
Ineffective Tissue Perfusion
Ineffective tissue perfusion associated with myocardial infarction can be caused by inadequate or blocked oxygenated blood flow to the tissues and organs.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Formation of plaque
- Narrowed arteries
- Obstructed arteries
- Rupture of unstable plaque
- Vasospasm of coronary arteries
- Ineffective cardiac muscle contraction
- Conditions that compromise the blood supply
- Difficulty of the heart muscle to contract
- Increased exertion in workload
- Inadequate blood supply to the heart
As evidenced by:
- Diminished peripheral pulses
- Increased central venous pressure (CVP)
- Tachycardia
- Dysrhythmias
- Decreased oxygen saturation
- Angina
- Dyspnea
- Change in the level of consciousness
- Restlessness
- Fatigue
- Exertional dyspnea or chest pain during activities
- Cold and clammy skin
- Prolonged capillary refill time
- Pallor
- Edema
- Reports of claudication
- Numbness
- Change in sensation
- Pain in the lower extremities
- Poor wound healing
Expected outcomes:
- Patient will achieve pulses and capillary refill time within normal limits.
- Patient will display warm skin without pallor or cyanosis.
- Patient will present an alert and coherent level of consciousness.
Assessment:
1. Obtain ECG.
An electrocardiogram (ECG) is a crucial test for a suspected myocardial infarction. Upon admission to the hospital, obtain ECG within 10 minutes to capture the heart’s electrical activity. An ECG can reveal signs of a present heart attack or one that has already occurred. The patterns on the ECG can identify the severity of the damage to the heart and the specific affected area.
2. Assess the cardiovascular status.
Myocardial infarction may result from the blockage of one or more coronary arteries resulting in tissue ischemia or death. The blockage is often thrombotic and brought on by a plaque that has ruptured in the coronary arteries. The obstruction causes ischemia resulting in inadequate cardiac output and ineffective cardiac tissue perfusion.
3. Assess the patient’s color, capillary refill, and pulses.
A cardiac blockage causes symptoms such as numbness, altered sensations, reduced capillary refill time, poor peripheral pulses, and a change in skin color (pallor, cyanosis, or mottled skin color) and temperature. These are all signs of shock and should be treated as a medical emergency.
Interventions:
1. Start CPR.
If myocardial infarction is suspected, call emergency help and begin CPR if a pulse is not detected.
2. Administer aspirin.
Unless contraindication, PO aspirin is often given immediately when MI is suspected. It aids in maintaining blood flow through a constricted artery by ensuring the clot doesn’t grow in size.
3. Initiate reperfusion treatment.
All patients with prolonged ST-segment elevation and symptoms of ischemia lasting less than 12 hours should receive reperfusion treatment. Depending on resources available, this may include fibrinolytics or angioplasty. It is important that reperfusion happens as soon as possible to save cardiac tissue.
5. Refer the patient to cardiac rehab.
After discharge, the cardiac rehabilitation program usually lasts for a few weeks or months. After a heart attack, those participating in cardiac rehab live longer and are less likely to experience another heart attack.
Risk for Unstable Blood Pressure
Risk for unstable blood pressure (BP) associated with myocardial infarction is related to poor contractility of the heart muscle associated with ischemia. While hypertension is a risk factor for MI, blood pressure instability during a MI is more related to the body’s compensation mechanisms rather than the underlying chronic hypertension.
Nursing Diagnosis: Risk for Unstable Blood Pressure
Related to:
- Ineffective heart muscle contraction
- Ischemia
- Constricted arteries
- Obstructed arteries
- Rupture of unstable plaque
- Coronary artery spasm
- Underlying cardiac conditions
- Increased workload exertion
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and the goal of nursing interventions is aimed at prevention.
Expected outcomes:
- Patient will manifest blood pressure within normal limits.
- Patient will perform activities without blood pressure fluctuations.
- Patient will adhere to their medication regimen to control blood pressure.
Assessment:
1. Monitor the patient’s blood pressure.
The heart muscle is deprived of oxygen and blood flow during myocardial infarction. Blood pressure may become unstable (increase or decrease) depending on the body’s compensation.
2. Assess the cardiovascular status.
Cardiac muscle injury is frequently the cause of heart attack complications. Arrhythmias, cardiogenic shock, heart failure, pericarditis, and cardiac arrest are possible myocardial infarction complications.
3. Assess for signs and symptoms.
In myocardial infarction, changes in blood pressure can cause headaches, chest pain, mental status changes, diaphoresis, dizziness, and shock.
4. Determine the patient’s risk factors.
Combining several risk factors (such as uncontrolled blood pressure and other conditions that can cause vasoconstriction) makes myocardial infarction more likely.
5. Assess the chest pain.
Myocardial infarction-related chest pain is accompanied by sympathetic stimulation, increasing vasoconstriction, and the ischemic heart’s workload. Hence, it causes unstable blood pressure.
Interventions:
1. Stabilize blood pressure in myocardial infarction.
Beta-blockers lessen the amount of oxygen the myocardium uses by reducing heart rate, blood pressure, and myocardial contractility. ACE inhibitors and calcium channel blockers relax blood vessels to lower blood pressure. Depending on the stage of the MI, blood pressure medications may be administered to lower blood pressure and workload on the heart. However, if the patient’s blood pressure is too low, vasopressors, fluid or even ECHMO may be necessary to sustain life.
2. Relieve fluid overload.
Diuretics can be administered to reduce the circulating volume if heart failure or fluid overload is a potential cause of hypertension.
4. Provide education.
Often patients experiencing MI have underlying hypertension. However, blood pressure instability during an acute MI will need different management than the management for chronic hypertension. Throughout the hospital stay, education can be provided about the importance of managing chronic hypertension.
The majority of the time, elevated blood pressure has no symptoms. The only method to check blood pressure is to monitor it, which makes high blood pressure a “silent killer” in some cases.
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