Nursing Management in Myocardial Infarction

Causes, incidence, risk factors and how it can impact on the patient and family

According to Beckerman (2015), the main cause of myocardial infarction is atherosclerosis of the coronary arteries (coronary artery disease). The blood clot can be formed in coronary arteries and block the blood flow. This could be the reason for myocardial infarct for Mr. Savea because he was suffering from stable angina pectoris. It can also be detached from the artery wall and carried by the blood stream block an artery in its further course. Another cause of heart attack is a spasm of coronary arteries. It is a rare cause. Also, another rare cause of cardiac infarction is inflammation of the coronary artery wall which can enhance stenosis of the lumen of the coronary artery. Other causes of myocardial infarction according to Zafari (2016) are hypertrophy of ventricles, heart trauma, drug abuse, heart anomalies, severe anemia. 7,3 million of people worldwide suffered a death from myocardial infarction (Mendis, Puska & Norrving, 2011). It is the most common cause of death. According to Heart Foundation (2014), over 350,000 of people in Australia suffered a myocardial infarct. Every year, more than 54,000 people had a myocardial infarct.

According to Zafari (2016), risk factors for myocardial infarction can be divided into two groups. First are risk factors which cannot be modified. Those factors are age, sex, positive family history. The second group is risk factors which can be modified. Those factors are smoking, elevated plasma levels of cholesterol and triglycerides, diabetes mellitus, arterial hypertension, obesity, sedentary lifestyle, psychosocial stress, low vegetable and fruit consumption. According to Heart foundation (2012), risk factors for cardiovascular disease are different for different groups of people. Every third Australian over the age of 45 has high blood pressure. Also, 4 out of 10 have elevated levels of cholesterol. Diabetes mellitus can be found in 8,9 out of 100 Australians. Around 72% of this group of the population are obese and do not have any regular physical activity.  14,6 are regular smokers. Myocardial infarct with ST elevation can occur in a patient with mitral valve stenosis (Cardoz, Jayaprakash  & George, 2015). Our patient, Mr. Savea is 54 year old male, which is suffering form high blood pressure, his  cholesterol level and serum lipid levels are elevated. He is also obese and he was a regular smoker until recently. That are major risk factors which could lead to myocardial infarct. There are described case studies of patients with mitral valve stenosis, which suffered myocardial infarct just like our patient.

According to Singer (2010), myocardial infarct can change the physical and emotional integrity of the patient and his family. After the MI, the patient has to change his lifestyle. Mr. Savoa would probably need to change his job because his current job requires him to strain. He needs to avoid all the activities which will get him tired. It can also cause a big impact on a financial plan for the whole family and because of that family members might need to alter their lifestyle (Tselika-Garfe, 1992). He would need to go on a sick leave which will impact him and his family regarding finances. Also, if he changes his job he may have financial problems if a new job is not as good paid as previous job. Because of his age, he might have problems adjusting to the new job environment and obligations of the new job. Mayou, Foster, and Williamson (1990) state that wives of patients with myocardial infarct can have severe psychological symptoms while taking care of their husbands. Their work, family life, social activities might expiate. Mr. Saveas wife would need to alter her lifestyle. When he arrives home from the hospital, she would need to be with him all the time to provide him all the help he needs. Also, she might need to take a leave from her job in order to help Mr. Savoa.

Common signs and symptoms – pathophysiology of each symptom

Common signs and symptoms of myocardial infarct are chest pain, radiating pain, sweating, shortness of breath , nausea and vomiting.


Chest pain

Pain radiation



Nausea and vomiting


According to Malik, Khan, Safdar, and Taseer (2013), chest pain is the most common symptom of myocardial infarction. It is caused by a ischemia of myocard. If the ischemia last for a longer period of time myocardial cells will die and cell necrosis will occur. It will cause accumulation of pain mediators which will cause the sense of pain.  That pain is usually described as pressure in the chest, squeezing or a “burning” feeling. That pain can be provoked by a psychological stress or exercise. It is very important to evaluate every chest pain.The chest pain in myocardial infarct can radiate in different parts of the body. In the most of cases it radiates in left shoulder and arm. The pain will radiate to these parts of the body because they are located in the same dermatome as heart. According to Albarran, Durham, Gowers, Dwight, and Chappell (2002), there is more significant pain radiation to the right shoulder, arm and upper right body part in woman with myocardial infarction.



Sweating can be a significant sign of myocardial infarction with ST elevation (Gokhroo, Ranwa, Kishor, Priti, Ananthraj, Gupta & Bisht, 2016).  It is caused by stimulation of sympathetic nervous system during a myocardial infarction.  Stimulated sympathetic nervous system causes increased perfusion of the peripheral tissues such as skin and activation of sweat glands, which will cause increased production and secretion of sweat.According to Hagman & Wilhelmsen (1981), shortness of breath (dyspnea) is often a symptom of angina pectoris and myocardial infarct. It is not caused by smoking or decreased physical activity. The main cause of shortness of breath in myocardial infarction is reduced ability of the heart to pump the blood around the body. It is impossible for the damaged heart muscle to perform at its highest level. Because of that blood flow may be slowed down as well as gas exchange in the lungs.Previously it was thought that vomiting and nausea are caused by an inferior myocardial infarction. Fuller, Alemu, Harper, and Feldman (2009), proved that there was a greater incidence of nausea and vomiting in patient with inferior infarct than in patients with anterior infarct. However, correlation between location of the myocardial infarct and nausea and vomiting is not that significant.

Common classes of drugs and physiological effect

The cause of myocardial infarction is blockage of blood flow in heart arteries and therefore in heart muscle. After the blood flow is blocked there is not enough oxygen supply to the heart muscle which causes symptoms of myocardial infarction. The main goal of treatment of myocardial infarction is prevention of further heart muscle damage. According to Aylward (1996), further development of myocardial infarct can be prevented by removing causes of blockage and restoration of blood flow. Another treatment method is the reduction of oxygen consumption of heart muscle. It is important that the medicines are administered as quickly as possible to prevent further damage. There is a great variety of medicines which can be used for treatment of myocardial infarction.

Vasodilatators are used to dilate blood vessels. According to Klabunde (2007), vasodilatators can be divided into two categories: arterial and venous dilatators. Arterial dilatators reduce afterload on the heart and decrease the demand for oxygen in the heart muscle. The demand for oxygen is lower due to lower blood pressure and consequently lower stress on the wall of the ventricle. They can also prevent vasospasm of arteries.Venous dilatators lower cardiac output by reducing pressure in  the veins and consequently preload on the heart. This all will cause a lower need for oxygen in the heart muscle. Nitrodilatators are one of categories of vasodilatators which is used for treatment of myocardial infarction. It works by preventing spasm of coronary arteries. Another mechanism is lowering resistance in systemic blood vessels and reducing blood pressure. These all mechanisms will improve the ratio between demand and supply of oxygen in the heart muscle. For Mr. Savea nitrodilatators are indicated because they will lower his elevated blood pressure and reduce preload on the heart.

Beta-blockers are another category of medicines which can be used for treatment of symptoms of myocardial infarction. Beta-blockers bind to beta-adrenoceptors and on that way they prevent epinephrine and norepinephrine to bind to beta-adrenoceptors. By blocking the receptors, beta-blockers will reduce the demand for oxygen in the heart. The main mechanisms for that are reducing blood pressure, rate of heart beat and contractility. This all will improve oxygen supply/demand ratio. Beta-blockers will also reduce the risk of arrhythmia (Klabunde, 2007). For Mr. Savoa beta blockers are indicated because they will also reduce his high blood pressure.

Identify and explain nursing strategies

According to Martin, Murphy, Scanlon, Naismith, Clark and Farouque (2014), nurses play a very important role in the treatment of patients with myocardial infarct. That is especially important in cardiac care unit and  in emergency care. When Mr. Saveawas admitted to the coronary care unit he should be monitored all the time using noninvasive methods. Electrocardiography should be done in series to confirm infarct. Also, variations in Mr. Savoa heart rate should be monitored. After myocardial infarct there is a chance of disorders in heart rate. His SpO2 saturation should be monitored. Adequate oxygen supply should be continued. On admission his SpO2 was 98%, while he was on 8L/min Oxygen. Monitoring of saturation is important because it may decrease to a level when he would need to be intubated. If there are any changes in heart rate, ECG, SpO2 saturation nurse should notice the medical doctor.

According to Vera (2014), the main goal of nursing strategy is pain reduction. The nurse should monitor Mr. Savea more often and document all the visible signs of pain, such as crying, moaning or elevated blood pressure or elevated heart rate. If he complains about pain, it should be documented and well described. A nurse should ask Mr. Saveaabout pain localization, radiation of the pain, intensity, duration and description. Detailed personal and family history regarding chest pain should be taken. Mr. Savea should be told to report if he feels any pain or discomfort. For pain management morphine (2.5 mg. IV) can be used. Vital signs should be monitored before and after administration of medications.

In the first 12 hours Mr. Savea should be advised to rest (Ryan, Anderson, Antman, Braniff, Brooks, Califf, (…) Weaver, 1996). Any physical activity should be avoided. The nurse should provide other activities which will not strain him.   The nurse should pay attention to the presence of fear or anxiety (Vera, 1996). If any signs of anxiety are observed nurse should not leave MR. Savea alone. The nurse should prevent any type of destructive behavior. If Mr. Savea has any questions regarding his state, the nurse should give him short informative answers and if Mr. Savea asks again, the nurse should try to repeat the same answer. Mr. Savea should have quiet time to rest and sleep without any distraction.

Attention should be paid to the decreased cardiac output (Vera, 1996). On admission Mr. Savea was hypertensive, because of that nurse should check blood pressure often. It should be checked in both arms, in lying and sitting position. The pulse should also be checked on both sides. In the first 24 hours caffeine intake should be limited. Preliminary cardiac enzymes and troponin were elevated. These laboratory analysis should be also obtained after admission and evaluated. Fluid intake and urine output should be checked. Fluid intake should be limited at 2000ml/24 hour (Vera, 1996). The content in urinary bag should be checked and documented. Respirations should be checked for abnormality in quantity and quality. Watch for any changes in behavior. Auscultation should be used to identify the presence of abnormal breath phenomena such as crackles.

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