Case Study: Myocardial Infarction Pathophysiology Myocardial infarction occurs as a result of imbalance between the demand and supply of oxygen to the muscles of the heart that is critical enough to result in necrosis of the myocardium. This occurs due to rupture of a plague in coronary artery leading to sudden reduction of blood supply to the portion of myocardium supplied by the coronary artery…
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When a portion of myocardium is affected thus, the function of the whole heart is affected resulting in blood supply to other parts of the body like brain and vital organs (Fenton, 2008). This leads to multiorgan dysfunction. Arteries that supply the muscles of the heart are known as coronary arteries. These arise from the aorta and lie on the surface of the heart. There are 2 main coronary arteries, namely the right and left coronary arteries. The right coronary artery supplies the right ventricle and the left one supplies the lower parts of the heart. Most of the left ventricle is supplied by left anterior descending coronary artery. The circumflex artery supplies the back portion of the left ventricle (Zevit, 2006). Atherosclerosis, which results in coronary artery plagues is the most common cause of myocardial infarction. Other causes of myocardial infarction are respiratory failure, profound anemia, cocaine abuse, carbon monoxide poisoning, anamolous coronary artery and coronary artery vasospasm (Fenton, 2008). Risk factors for myocardial infarction are advanced age, smoking, sedentary lifestyle, male gender, abnormal lipid profile, hypertension, diabetes mellitus, family history of ischemic heart disease and hypertension. Compensatory mechanisms Physiological response to myocardial infarction include increased heart rate, increased mean arterial pressure, increased respiratory rate and raised serum cortisol levels (Cherrington et al, 2002). Medical treatment The goals of treatment in a patient with myocardial infarction are to restore oxygen supply to the heart, to prevent worsening of ischemia, cause relief of pain and finally to prevent and also manage various complications related to myocardial damage. Treatment of patient diagnosed to have myocardial infarction includes oxygen administration, aspirin, sublingual nitrate, betablockers and pain relief using morphine. Administration of aspirin in the prehospital phase or even after immediate arrival to the hospital has shown to decrease mortality and chances of reinfarction. Those allergic to aspirin must be administered clopidogrel. Sublingual nitrate decreases preload and also decreases paon. However, this drug must not be administered in right ventricular infarction and hypotension. Betablcokers decrease the heart rate and hence decrease the oxygen demand of the myocardium. Morphine decrease pain and thus demand of oxygen. Further treatment depends on the type of infarction (Fenton, 2008). In STEMI, immediate reperfusion therapy must be initiated and this includes either percutaneous coronary interventions or thrombolytic therapy. NSTEMI patients must receive antiischemic treatment along with percutaneous coronary interventions. Reperfusion therapy must be started immediately in STEMI patients. Percutaneous coronary interventions are better than thrombolytic therapy (Fenton, 2008). These are done after angiogram. Adjunctive intravenous heparin therapy is given for maintenance of patency of the arteries (Fenton, 2008). The patient under discussion was given aspirin, heparin, Vitamin E,B and D and protonix. Protonix is proton pump inhibitor and it is give in conjunction with aspirin therapy because of risk of gastrointestinal complications following aspirin therapy. Nursing management Nursing management
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An imbalance in this predisposes the heart muscle to ischemia, which means reduced blood flow. The tissue death as a result of ischemia occurs because of two reasons, reduced oxygen supply and the decreased delivery of nutrients, both of which are brought in by the flow of blood though the heart muscle.
Design A combination of both quantitative and qualitative approaches using analysis of synthesized primary and secondary data from clinical trials and cardiac/coronary research. Setting The setting of the study will be health institutions emergency departments.
The author explains that there are many predisposing factors to the higher number of MI cases. Some of these factors can be controlled while others cannot. These factors are; age, gender, positive family history of MI, high blood pressure, obesity, high levels of cholesterol, lack of physical activity, diabetes, stress, hypertension.
The studies have found that the administration of streptokinase within 6 hours of acute myocardial infarction can reduce the mortality rate. As the time increases, the mortality rate increases and the effect f streptokinase is present in the body upto 48 hours.
These factors are; age, gender, positive family history of MI, high blood pressure, obesity, high levels of cholesterol, lack of physical activity, diabetes, stress, hypertension, increased serum triglycerides, excessive intake of saturated fats, salt and carbohydrates.
Imbalance between demand and supply of oxygen to the muscles of heart can occur either due to decreased supply of oxygen to the heart muscle or due to increased oxygen demand, or both. The main cause for ischemia of the muscles of the heart is coronary artery disease and hence ischemic heart disease and coronary artery disease are often used synonymously.
Cardiovascular defects such as malformation of heart structure, holes in the heart, abnormal valves, or abnormal heart chambers could exist at births. When the condition is present at birth, they are referred to as congenital heart disease. These may
Various diagnostic features aid in determining MI; these include sustaining regional ST rise through ECG, cardiac enzyme studies etc. In developed nations like the United States, deaths from heart disease are more abundant than the mortality from cancer. One in five deaths in the United States is due to coronary heart attacks.
Not surprisingly, ethical issues aroused from this development, prompting researchers to identify and to harvest adult stem cells (ASC), as well as develop induced pluripotent stem cells (iPSCs) by reprogramming specialized adult cells, although the latter is only used in drug development (National Institutes of Health, 2009).
4 Pages(1000 words)Research Paper
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