Pathophysiology of Myocardial Infarction

Week 3 Discussion: Myocardial Infarction (MI) (USLOs 1, 2, 3, 4)

You are the nurse caring for a 48-year Leslie Collins, retired army officer for the United States military, He arrives to the emergency department after experiencing chest pain and shortness of breath.  His EKG indicated he had a myocardial infarction (MI). He has a history of hypertension and high cholesterol. He states he used to smoke about 15 years ago, he has no other reported risk factors.

Based on this information, your prior knowledge of this client (refer to medical card from the Collins-Kim family tree interactive), and your knowledge of the pathophysiology of myocardial infarction (MI), respond to the following prompts:

1. 1. Thoroughly explain the pathophysiology of myocardial infarction (MI). Use a scholarly or authoritative source to support your answer.
   2. Examine each of the following three factors related to this disease process. Support all three with a scholarly source.
      cultural
      financial
      environmental implications
   3. Identify 3-5 priority nursing interventions for the client while in the emergency department.
   4. Describe labs and diagnostic testing you would want to include in client’s plan of care and why. What are critical indicators? Support with a scholarly source.
   5. What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and support with a scholarly source.

1. Pathophysiology of Myocardial Infarction (MI): Myocardial infarction, commonly known as a heart attack, is a critical event that occurs due to the interruption of blood supply to a part of the heart muscle, leading to myocardial cell death (necrosis). The primary cause of MI is atherosclerosis, a chronic inflammatory process that results in the formation of plaques within the coronary arteries. Here is a breakdown of the pathophysiology:
   • Atherosclerosis: Atherosclerosis involves the accumulation of fatty deposits, cholesterol, and inflammatory cells within the arterial walls, leading to the development of plaques. These plaques can narrow the coronary arteries over time, reducing blood flow.
   • Plaque Rupture: MI often occurs when a vulnerable plaque ruptures. When the fibrous cap covering the plaque breaks, it exposes the plaque’s lipid core to blood components. This leads to platelet activation and the formation of a thrombus (blood clot) at the site of rupture.
   • Coronary Artery Occlusion: As the thrombus grows, it can partially or completely block the coronary artery, restricting blood flow to the heart muscle downstream. The heart muscle beyond this blockage begins to suffer from ischemia (lack of oxygen and nutrients).
   • Myocardial Cell Death: Prolonged ischemia causes irreversible damage to myocardial cells, resulting in necrosis. This leads to the release of cardiac enzymes (e.g., troponin) into the bloodstream, which is a key diagnostic marker for MI.
2. Factors Related to MI and Implications:
   • Cultural Implications: Cultural factors can influence an individual’s perception of health and healthcare-seeking behaviors. It is important to consider Leslie Collins’ cultural background and beliefs as they may affect his understanding of the disease, his willingness to follow medical recommendations, and his ability to access appropriate care.
   • Financial Implications: Financial factors can significantly impact a patient’s ability to manage and recover from MI. Costs associated with hospitalization, medications, cardiac rehabilitation, and ongoing follow-up care can be substantial. Insurance coverage, access to financial resources, and employment status may all influence the patient’s financial well-being during and after an MI.
   • Environmental Implications: Environmental factors such as air quality, pollution, and access to recreational facilities can influence cardiovascular health. Identifying and addressing environmental factors that may have contributed to Leslie’s condition, such as exposure to secondhand smoke or a lack of opportunities for physical activity, is essential for his long-term well-being.
3. Priority Nursing Interventions in the Emergency Department:
   • Assessment: Thoroughly assess Leslie’s vital signs, cardiac status, pain level, and oxygen saturation. Continuous monitoring is crucial to detect any changes in his condition.
   • Pain Management: Administer prescribed pain relief medications promptly to alleviate chest pain and reduce cardiac workload.
   • Oxygen Therapy: Ensure oxygen therapy to maintain adequate oxygenation and reduce myocardial workload.
   • IV Access: Establish intravenous access for medication administration and fluid resuscitation if necessary.
   • Emotional Support: Provide emotional support and education to Leslie and his family about the diagnosis, treatment plan, and lifestyle modifications.
4. Labs and Diagnostic Testing:
   • Cardiac Enzymes: Serial measurements of cardiac biomarkers, such as troponin and creatine kinase-MB (CK-MB), are critical to confirm myocardial damage and assess its extent.
   • Electrocardiogram (ECG/ EKG): Frequent ECG monitoring is essential to identify changes in cardiac rhythm and ST-segment elevation or depression, which are indicative of MI.
   • Chest X-ray: A chest X-ray can help rule out other causes of chest pain and assess for signs of heart failure or pulmonary edema.
   • Coronary Angiography: This invasive procedure may be performed to visualize coronary artery blockages and guide potential interventions such as angioplasty or stent placement.
5. Interdisciplinary Team for Holistic Care:
   • Cardiologist: The cardiologist is the primary medical specialist responsible for diagnosing and managing MI. They may perform interventions such as angiography and stent placement.
   • Nurse: Nursing staff provide continuous monitoring, administer medications, and offer emotional support. They play a crucial role in patient education and discharge planning.
   • Dietitian: A dietitian can provide dietary recommendations, including managing hypertension and cholesterol levels through diet modifications.
   • Pharmacist: Pharmacists help manage medication regimens, ensuring proper dosing and minimizing drug interactions.
   • Cardiac Rehabilitation Team: Physical therapists, exercise physiologists, and psychologists are important members of the cardiac rehabilitation team, assisting in the patient’s physical and emotional recovery.
   • Social Worker/Financial Counselor: These professionals can help address financial concerns, access to resources, and any psychosocial issues that may impact Leslie’s recovery.
   • Case Manager: A case manager can coordinate the various aspects of Leslie’s care, including transitions between hospital and home and ongoing outpatient follow-up.

Holistic patient-centered care involves addressing not only the physical aspects of MI but also the patient’s emotional, cultural, and financial needs to support their overall well-being and recovery. These interdisciplinary team members work together to ensure comprehensive care and a smooth transition from the emergency department to ongoing management and rehabilitation.