This is a case study about the treatment for a post-Myocardial Infarction (MI) patient. This case study will be presented in the following manner: (i) a brief overview of the case; (ii) a definition of MI; (iii) an examination of standard treatment options; and, (iv) case specific care for this patient. The paper was researched by reading peer-reviewed and grey literature located in the PubMed database and online medical journal databases. The search terms used were the following: ‘Myocardial Infarction’; ‘post-Myocardial Infarction care’; ‘coronary artery disease’; ‘nursing care Myocardial Infarction’; and, ‘patient care Myocardial Infarction’.
This case study is about the post-MI treatment and care of a 37-year-old male lawyer, who still continues to have chest pain and some shortness of breath.
Definition & Standard Treatment of MI
MI is defined as an “Acute thrombotic obstruction of the blood flow in coronary arteries precipitates myocardial infarction, with deleterious consequences on heart function” (Zouggari, et al., 2013, 2). Specifically, the blood flow in the heart stops and precipitates a heart attack. Diagnosis is usually by “…clinical evaluation, the electrocardiogram (ECG), biochemical testing, invasive and noninvasive imaging, and pathological evaluation” (Anderson & Morrow, 2017, 2053). Surgeons repair this damage by either restoring the coronary artery mechanically or by “thrombolytic and antiplatelet therapies” (Zouggari, et al., 2013, 2), which reduce the amount of oxygen consumed and which acts as a protector of the heart muscle. The choice of therapy is dependant on the risk factors. For example, multiantithrombotic therapy provides an increased risk of haemorrhaging (Ishibashi, et al., 2017, 333). As well, it is important to note that the type of heart attack determines treatment. That is, the MI can be ST-elevation MI (STEMI) or it can be a non–STEMI (NSTEMI). STEMI occurs when a major artery supplying oxygen and blood that is nutrient-rich, becomes blocked. An ECG is used to determine this. SEMI patients have the worst prognosis (ACCF/AHA, 2012, 6). NSTEMI refers to when an artery is only partially blocked and when blood flow becomes severely reduced. As MI is “a leading cause of death” (Kirchberger, et al., 2014, 1) is Western industrialized nations, it is important that awareness and education of patients be implemented.
Cardiac Rehabilitation Care for 37-year-old Male
The immediate needs of the patient are to understand and relieve the continued chest pain and shortness of breath. The patient requires an oxygen mask or the use of a nasal cannula. This is to ensure the continuous flow of oxygen. For the pain, the patient should be given a low dosage of aspirin, if the patient is not allergic to aspirin. If the patient can chew the aspirin, this is better because this leads to faster absorption of the medication. As well, nitrates can be used, as nitrates cause the venous blood system to relax and cause a reduction of chest pain. The patient’s blood pressure needs to be checked first because if the patient has marked hypotension, nitrates should not be used. If the patient has a slow heart rate, that is, under 60 beats per minute, nitrates should also not be used. The nitrate is administered as a tablet under the tongue or sublingually. If nitrates are used in combination with aspirin, low dosages of both medications should be used to reduce the chance of bleeding (Huang, Strate, Ho, Lee, & Chan, 2010, e15722). The patient should be observed to see if the dosage of medication can be tolerated or if further medication is needed. The side effects of aspirin, if the dosage is not low enough, can be gastrointestinal bleeding. The side effects of nitrates may be hypotension and headaches. Nitrates should not be used if the patient experienced a right ventricular infarction (Thadani & Ripley, 2007, 385-386). The patient needs to be closely observed to ascertain if there are side effects.
Cardiac rehabilitation also involves “…prescriptive exercise, health education and counseling” (Kadda, Marvaki, & Panagiotakos, 2012, 635). As well, patients should be carefully observed and monitored for the onset of depression. As the 37-year-old patient’s immediate post-operative health improves, the nurse will need to address his long-term recovery. This will include significant attention to education about lifestyle changes, health, nutrition, exercise and the importance of reducing stress levels (Kadda, Marvaki, & Panagiotakos, 2012, 635). Patients who engage in their own therapeutic healing are less likely to return to the hospital with the same symptoms or complications related to MI (Stark, et al., 2014, 237-238; Ergatoudes, et al., 2016, 7). A rehabilitation plan should be developed, with the help of a social worker and the patient, so that they patient has instructions to take home and follow. There should be phone and in-person follow-up when the patient leaves the hospital.
Research by Kirchberger, et al. (2014) indicates that, overall, the number of deaths from MI has decreased (Kirchberger, et al., 2014, pp. 1; 12). The research was conducted over 12 years, and mortality among educated individuals was higher than poorly educated individuals. Within the sample, however, the survival rates were higher for females than for males. The long-term prognosis for the patient in the case noted above, therefore, is high, based on his education and socioeconomic status. His financial situations will reduce the stress of having to return to work before he is fully able to and he has the financial resources to obtain appropriate nutrition and any necessary assisted exercise to strengthen his overall health. With appropriate attention to education and awareness, the patient has a good chance of long-term survival.
ACCF/AHA. (2012). 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. ACCF/AHA. Dallas: ACCF/AHA.
Anderson, J., & Morrow, D. (2017). Acute Myocardial Infarction. The New England Journal of Medicine , 376, 2053-2064.
Ergatoudes, C., Thunström, E., Rosengren, A., Björck, L., Bengtsson Boström, K., Falk, K., et al. (2016). Long-term secondary prevention of acute myocardial infarction (SEPAT) – guidelines adherence and outcome. BMC Cardiovascular Disorders , 16 (226), 1-8.
Huang, E., Strate, L., Ho, W., Lee, S., & Chan, A. (2010). A Prospective Study of Aspirin Use and the Risk of Gastrointestinal Bleeding in Men. PLoS ONE , 5 (12), e15721-e15721.
Ishibashi, K., Miyamoto, K., Kamakura, T., Wada, M., Nakajima, I., Inoue, Y., et al. (2017). Risk factors associated with bleeding after multi antithrombotic therapy during implantation of cardiac implantable electronic devices. Heart Vessels , 32 (3), 333-340.
Kadda, O., Marvaki, C., & Panagiotakos, D. (2012). The role of nursing education after a cardiac event . Health Science Journal , 6 (4), 634-646.
Kirchberger, I., Meisinger, C., Golüke, H., Heier, M., Kuch, B., Peters, A., et al. (2014). Long-term survival among older patients with myocardial infarction differs by educational level: results from the MONICA/KORA myocardial infarction registry. International Journal for Equity in Health , 13 (19), 1-11.
Stark, R., Kirchberger, H. M., Heier, M., Leidl, R., von Scheidt, W., Meisinger, C., et al. (2014). Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines. Clinical Research in Cardiology , 103 (3), 237-245.
Thadani, U., & Ripley, T. (2007). Side effects of using nitrates to treat heart failure and the acute coronary syndromes, unstable angina and acute myocardial infarction. Expert Opin Drug Saf. , 6 (4), 385-96.
Zouggari, Y., Ait-Oufella, H., Bonnin, P., Simon, T., Sage, A., Guérin, C., et al. (2013). B lymphocytes trigger monocyte mobilization and impair heart function after acute myocardial infarction . Nat Med. , 19 (10), 1273–1280.