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. The major 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 MI (cardiac death).
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 which is the feeling of pressure or discomfort in the chest. This pain may radiate to the neck, jaw, shoulder, or arm. Diagnostic tests, lab results, and ECG changes may show damage to the heart.
In this article:
- STEMI vs. NSTEMI
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
STEMI vs. NSTEMI
Unlike an ST-elevation myocardial infarction (STEMI), a non-ST-elevation myocardial infarction (NSTEMI) doesn’t cause a specific change in the electrical activity of the heart. 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. The patient may still show symptoms of a heart attack.
The nurse should immediately assess the patient to identify whether the symptoms are chest pain (angina) or myocardial infarction (MI). MIs require immediate intervention to save cardiac 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. The MONA regimen is started (morphine, oxygen, nitrates, and aspirin). The patient is placed on a cardiac monitor. IV access is established for the administration of fluids and emergency medications. Additional tests and procedures, such as cardiac catheterization or CABG, may be required.
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.
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 and complaints
1. Note the patient’s general symptoms.
Patients may complain of general symptoms, such as:
- Chest/back/shoulder/jaw pain
- Shortness of breath (dyspnea) both at rest and during exertion
- Fainting (syncope)
2. Interview the chest pain further.
Let the patient describe their chest pain:
- Chest tightness
- Feeling of squeezing
- 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:
- Gender and Age: MI is prevalent in men over the age of 45 and women 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, it increases the risk of MI.
- Race/ethnicity: Black patients have double the risk of MI compared to non-black patients.
Modifiable risk factors:
- Hypertension: If high blood pressure is uncontrolled, the arteries may become stiff and rigid, causing less oxygenated blood to go to the heart.
- 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: Hardening of the blood arteries and highly viscous blood due to high glucose are effects of diabetes or insulin resistance.
- 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 can lead to rigid arteries. If the arteries that deliver blood to the heart are damaged and clogged, it can lead to cardiac tissue death.
- Diet: A diet rich in trans and saturated fats clogs the arteries with cholesterol, causing less blood to go to the heart.
- 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. Review the patient’s medication list.
Knowing about the possible side effects of treatment is crucial. Some medications have the potential to restrict the blood arteries in the heart, forcing the heart to pump blood more quickly and forcefully, such as:
- Antipsychotic drugs
- Nonsteroidal anti-inflammatory drugs
- Type 2 diabetes medications (thiazolidinediones and rosiglitazone)
- Recreational and street drugs
- Amphetamines and amphetamine-like substances
- Anabolic steroids
- Cocaine and crack
5. Assess 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.
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 victim 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:
- Blood pressure
1. Review ECG results.
The patient should receive an ECG within 10 minutes of their arrival at the emergency room. A MI will present as:
- The Q wave is the first negative ECG wave away from the baseline. 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.
- Both involve an increase in troponin brought on by the degeneration of cardiac muscle.
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.
3. Assist the patient with an echocardiogram.
An essential tool in diagnosing patients with acute myocardial infarction is an echocardiogram. An echo is advised during the first 24-48 hours of an 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 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.
Restore Blood Perfusion
1. Assist the patient in reperfusion therapy.
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. Fix the blocked artery.
- Coronary angioplasty and stent placement unclog the blocked heart arteries by inflating a balloon stent to widen the narrowed artery. The stent will keep the artery open and prevent narrowing.
- 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.
3. Reduce ischemia.
It is recommended to administer dual antiplatelet treatment (DAPT) for patients undergoing PCI. Bivalirudin, enoxaparin, and unfractionated heparin are common anticoagulants utilized.
4. Administer blood thinning agents cautiously as ordered.
By preventing the growth or formation of blood clots, blood thinners lower the risk of MI and blockages in the arteries and veins.
- 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. Break the clots.
Thrombolytics and fibrinolytic are the “clot busters,” dissolving any blood clots obstructing the heart’s blood flow. During MI, the sooner thrombolytic medication is administered, the less damage the heart sustains and the higher the likelihood of survival.
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. These effects lessen the need for myocardial oxygen.
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.
Manage the Symptoms
1. 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.
2. Maintain the blood pressure within acceptable limits.
Provide the following drugs to treat high blood pressure in patients with MI:
- 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 clogging the blood vessels.
4. Stabilize blood glucose levels.
The stress brought on by an acute myocardial infarction disturbs the usual hormonal control of blood glucose levels, resulting in hyperglycemia. Regardless of the diabetic condition, blood glucose levels rise after myocardial infarction. Patients can benefit from glucose-lowering treatments that normalize blood sugar levels.
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. Prevent complications and readmissions.
Following MI, cardiac rehabilitation aids the patient’s recovery. Their likelihood of experiencing complications and being readmitted to the hospital is reduced.
3. 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.
4. Educate on the benefits.
Cardiac rehab improves exercise capacity, body mass index, lipid profiles, psychological well-being, and quality of life in patients recovering from MI.
Prevent MI Complications
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. Promote healthy weight maintenance.
Blood pressure rises in obese people because they need more blood to provide oxygen and nourishment to their bodies. MI is more likely in obese people due to high blood pressure.
3. 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.
4. 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.
5. 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.
6. Assist the patient in lifestyle changes.
The majority of 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.
Recommended follow-up with the patient with STEMI is three to six weeks after discharge. Similarly, advise outpatient follow-up for low-risk patients with NSTEMI and those who have received revascularization.
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. Ask the patient what to do during an attack.
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.
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 associated with myocardial infarction is caused by chest pain/discomfort from inadequate blood flow to the heart.
Nursing Diagnosis: Acute Pain
- 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
- Labored breathing and dyspnea
- Changes in vital signs
- 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.
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
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 for quick results.
1. Administer nitroglycerin.
When chest pain initially appears in an adult, one tablet of nitroglycerin should be placed under the tongue or in the space between the cheek and gum. Nitroglycerin dilates blood vessels.
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 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
- Threat of death
- Threat to health status
- Change to role functioning
- Lifestyle modification
As evidenced by:
- Increased tension
- Fearful attitude
- Expressed concerns or uncertainty
- 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.
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.
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 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
- 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
- Cool, pale, and moist skin
- 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.
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.
1. Administer oxygen as ordered.
Administer oxygen to increase perfusion to the heart and other tissues.
2. Administer thrombolytic therapy as ordered.
If cardiac catheterization is not required immediately, administer thrombolytic therapy within the first 6 hours following the first symptom. Monitor for signs of bleeding.
3. Administer beta blockers as ordered.
Beta-blockers are used to lower myocardial contraction force, promote myocardial perfusion, and slow the heart rate.
4. Establish IV access.
IV access is used for the immediate administration of medication, IV fluids, and blood products.
5. Prepare for possible cardiac catheterization.
Urgent cardiac catheterization evaluates the degree and location of coronary artery blockages. A stent may be placed to restore blood flow to myocardial tissue.
6. Encourage bed rest and activity restrictions.
Bed rest lessens the workload, preventing inadequate perfusion and potential harm to the heart. Following a cardiac catheterization, the patient should be advised not to lift over 10 lbs or partake in strenuous activity.
7. 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
- 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)
- Decreased oxygen saturation
- Change in the level of consciousness
- Exertional dyspnea or chest pain during activities
- Cold and clammy skin
- Prolonged capillary refill time
- Reports of claudication
- Change in sensation
- Pain in the lower extremities
- Poor wound healing
- 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.
1. Obtain ECG.
An electrocardiogram (ECG) is a crucial test for a suspected heart attack. 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 for longer than 20 to 40 minutes. 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.
1. Start CPR.
If myocardial infarction is suspected, call emergency help and begin CPR if a pulse is not detected.
2. Initiate reperfusion treatment.
All patients with prolonged ST-segment elevation and symptoms of ischemia lasting less than 12 hours should receive reperfusion treatment.
3. Consider surgical procedures.
Percutaneous coronary intervention (PCI) can be completed within 120 minutes after an ECG diagnosis.
4. Immediately administer fibrinolytics.
Fibrinolytics should be initiated within 10 minutes following STEMI when urgent PCI is impossible (>120 minutes). Fibrinolytics bust blood clots and can salvage tissue by prompt blood flow restoration, improving short- and long-term survival.
5. Administer aspirin.
PO aspirin is often given immediately when MI is suspected. It aids in maintaining blood flow through a constricted artery while clot-busting medications (thrombolytics or fibrinolytics) aid in dissolving any blood clots obstructing blood flow.
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 can be caused by blood pressure instability leading to insufficient blood flow and poorly oxygenated blood to the heart.
Nursing Diagnosis: Risk for Unstable Blood Pressure
- Ineffective heart muscle contraction
- 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.
- 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.
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, and dizziness.
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.
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.
2. Administer vasodilators as prescribed.
Blood pressure goals of less than 140/90 mm Hg can be achieved with antihypertensive medication. Patients with systolic left ventricular dysfunction, heart failure, hypertension, or diabetes should take ACE inhibitors and beta-blockers. Patients with left ventricular ejection fraction (LVEF) lower than 40% should take beta-blockers if there are no other contraindications.
3. 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.
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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