Nursing Blog

A myocardial infarction, commonly known as a heart attack, is a medical emergency that occurs when a portion of the heart is deprived of oxygen because of blockage of one of the coronary arteries, which supply the heart muscle (myocardium) with blood. Lack of oxygen causes characteristic chest pain and death of myocardial tissue. Predisposing Factors of Myocardial Infarction Biological risk factors that can not be changed : More than 40 years of age Sex: high incidence in males, whereas in women increases after menopause Heredity Race: higher incidence in blacks. Risk factors that can be modified : Major: Hyperlipidemia Hypertension Smoke Diabetes Obesity Diets high in saturated fat, calories Minor: Physical activity Personality pattern: type A (emotional, aggressive, ambitious, competitive). Excessive psychological stress.

Orthostatic Vital Signs Orthostatic vital signs are a series of vital signs of a patient taken standing, supine and sometimes sitting to form a baseline for analysis and comparison. Used to identify orthostatic hypotension, orthostatic vital signs are commonly taken in triage medicine when a patient presents with vomiting, diarrhea or abdominal pain; with fever; with bleeding; or with syncope, dizziness or weakness. Orthostatic vital signs are not collected where spinal injury seems likely or where the patient is displaying an altered level of consciousness. Additionally, it is omitted when the patient is demonstrating hemodynamic instability, which term is generally used to indicate abnormal or unstable blood pressure but which can also suggest inadequate arterial supply to organs. Orthostatic vital signs are also taken after surgery. The process of taking orthostatic vital signs is also called a "tilt test". A tilt test is judged to be "positive" when the bl

Myocardial Infarction - Mitral Stenosis Mitral stenosis Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart. Symptoms of mitral stenosis include: Heart failure symptoms, such as dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea (PND) Palpitations Chest pain Hemoptysis Thromboembolism in later stages when the left atrial volume is increased (i.e., dilation). The latter leads to increase risk of atrial fibrillation, which increases the risk of blood stasis (motionless). This increases the risk of coagulation. Ascites and edema and hepatomegaly (if right-side heart failure develops) Fatigue and weakness increase with exercise and pregnancy. Myocardial Infarction Myocardial infarction (MI) or acute myocardial infarction (AMI) , commonly known as a heart attack, is the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a co

Complications of Myocardial Infarction The complications of a myocardial infarction are as follows : Arrhythmias – These usually occur within the first 48 hours following an infarct and may be life-threatening. They are due to myocardial irritability caused by lack of oxygen (ischaemia), release of potassium and calcium from dead cells and disturbances to the conductive mechanism of the heart. This is particularly true when the area around the sinoatrial or atrioventricular nodes is affected. Myocardial irritability is identified by the number of ventricular ectopics seen. There is a danger that an ectopic may fall on the T wave (r on T) and ventricular fibrillation ensues. Heart failure – Backpressure from the ventricle affected onto the atrium on the same side exists due to the ventricle being unable to expel the blood in it effectively. This will cause backpressure on either the pulmonary circulation (causing pulmonary oedema) or the systemic circulation (peripheral in organ o

Treatment of Myocardial Infarction The management of a myocardial infarction is with regard to alleviation of symptoms, prevention of extension of the infarct and detection / treatment of the complications of a myocardial infarct. The first priority with these patients is to maintain a clear airway and breathing, monitoring will be established as soon as the patient arrives in the resuscitation room. (NB This will have already been initiated by the ambulance crew). It is also likely that intravenous access will have been established unless the patient was brought in by relatives. A high percentage of prescribed oxygen will be administered via a facemask unless contraindicated by chronic respiratory disease. This will serve to optimise the patient’s oxygenation. Chest pain and nausea are relived by diamorphine and an anti-emetic given intravenously. Diamorphine also acts by offloading the heart and reducing the preload and afterload. If the patient has pulmonary oedema, diuretics

Clinical Manifestations of Myocardial Infarction Pain Chest pain that occurs suddenly and constantly not subside, usually above the sternal region and upper abdomen, this is the main symptom. The severity of pain can increase settled until unbearable pain. Pain is very ill, such as punctured-pin that can spread to the shoulder and continued down to the arm (usually the left arm). The pain started spontaneously (not occur after activity or emotional disturbance), persist for several hours or days, and do not disappear with the help of rest or nitroglycerin (NTG). Pain may spread to the jaw and neck. Pain is often accompanied by shortness of breath, pale, cold, severe diaphoresis, dizziness or head was floating, and nausea and vomiting. Patients with diabetes mellitus will not experience severe pain because of neuropathy that accompany diabetes can interfere neuroreseptor (collect the experience of pain). Laboratory examination Examinat