Acute Myocardial Infarction (MI) – also known as a heart attack is one of the leading causes of death, with more than one million deaths in the United States annually. Myocardial Infarctions can be divided in to two categories:
1. non-ST-segment elevation MI (NSTEMI)
NSTEMI is a type of heart attack involving a partial blockage of one of the coronary arteries, causing reduced flow of oxygen-rich blood to the heart muscle.
2. ST-segment elevation MI (STEMI)
STEMI’s are the most deadly type of heart attack as this occurs when there is a total or near total blockage of the coronary artery that supplies oxygen-rich blood to part of the heart muscle. Lack of blood and oxygen can cause that part of the heart to fail.
A myocardial infarction results in irreversible damage to the heart muscle due to lack of oxygen, and can impair the pumping mechanisms of the heart making patients more prone to irregularities in heart rhythm. When an individual is suffering from an MI, it is essential to identify quickly and treat early (less than 6 hours from symptoms onset), for better prognosis.
Typical symptoms of Myocardial Infarction:
· Bilateral arm radiating pain
· Choking sensation
· Irregular heart rate
· Abdominal pain (women)
When a patient experiences any of these symptoms they should be evaluated immediately with cardiac imaging such as an electrocardiogram (EKG) as well as lab work to assess cardiac markers, blood counts, lipid profile, metabolic function and kidney function.
Treatment/Management of Myocardial Infarction:
· Immediate chewable Aspirin (160 mg to 325 mg)
· Oxygen supplementation if oxygen saturation is less than 91%
· Sublingual nitroglycerin
· Opioids for pain control
Treatment for STEMI’s include immediate reperfusion. Typically, this would involve intervention via cardiac catheterization to open the blocked artery to reestablish blood flow to the heart muscle. This type of treatment should occur within 90 minutes of diagnosis.
Individuals suffering from an NSTEMI who are stable and asymptomatic typically do not need emergent percutaneous coronary intervention (PCI) and can be managed on antiplatelet agents. If these patients become unstable, PCI should be performed emergently.
Prior to discharge, patients suffering from an acute MI my routinely be given aspirin, high-dose statin, beta-blocker, and/or ACE-inhibitor.
Long Term Outcomes:
· Acute MI still can have a high mortality rate, with most deaths occurring prior to arrival to the hospital.
· At least 5%-10% of survivors die within the first 12 months after the MI and close to 50% need hospitalization within the same year.
· Overall prognosis depends of extent of muscle damage.
Good outcomes are typically seen with patients who undergo perfusion-thrombolytic therapy within 30 minutes of arrival or PCI within 90 minutes.
Bottom line, early identification of myocardial infarction and swift treatment is important for a good outcome to not only reverse muscle wall damage, but to prevent further damage from occurring.
If you have a case involving the misidentification and mistreatment of a myocardial infarction, contact Weiser Nurse Consulting. We can help review the case and identify possible breaches in standard of care.
Mechanic OJ, Gavin M, & Grossman SA. Acute Myocardial Infarction. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459269/.
Reeder, GS & Kennedy, HL. [2021 Sept]. Overview of the acute management of ST-elevation myocardial infarction. UpToDate. https://www.uptodate.com/contents/overview-of-the-acute-management-of-st-elevation-myocardial-infarction.