Myocardial Infarction in a Young Patient

Jaya Menon1*, U. Thenmozhi2, J Jane Abishak3, Dhivya Bharathi4

 1Nursing Superintendent, Kauvery Heartcity, Trichy, India

2Nursing Asst., Manager, Kauvery Heartcity, Trichy, India

3Nursing Supervisor Nursing, Kauvery Heartcity, Trichy, India

4Nursing Critical Staff, Kauvery Heartcity, Trichy, India

Definition:

A Myocardial infarction (MI) commonly known as heart attack occurs when blood flow decreases or stops in one of the coronary arteries of the heart causing infraction (tissue death) to the heart muscle.  It occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures causing catastrophic thrombus formation, totally occluding the artery and preventing blood flow downstream to the heart muscle.

Risk Factors:

Modifiable Risk Factors:

Hypertension: High blood pressure accelerates atherosclerosis.

Hyperlipidemia: High level of LDL cholesterol

Diabetes Mellitus: Insulin resistance and hyperglycemia

Smoking: Smoking damages the endothelium

Obesity: Excess weight increases the risk of developing carotid stenosis.

Physical inactivity: Sedentary life style

Unhealthy diet: Consuming a diet high in saturated fats, cholesterol and sodium increase the risk.

Non-Modifiable Risk Factor:

Age: Risk increases with age especially after 65 years.

Family History: Genetic predisposition to atherosclerosis.

Male Sex: Men are more likely to develop carotid stenosis than women.

Previous Stroke or TIA: History of stroke or TIA increases the risk.

Anatomy:

Blood Supply:

 The RCA and LMCA extend from the aortic root to supply different regions of the heart.  The RCA gives rise to the sinoatrial nodal branch of the right coronary artery posterior descending artery branch of the RCA and the marginal branch.  The LMCA branches into the circumflex and LAD.  The circumflex artery gives rise to the left marginal artery and posterior descending artery (in a left dominant heart).  The left anterior descending artery given off the diagonal branches.

The RCA supplies blood to the right side of the heart.  The sinoatrial nodal branch of the RCA.  Provides blood to the SA node and the atrio-ventricular nodal artery delivers blood to the AV node.  The marginal branch of the right coronary artery provides blood supply to the lateral portion of the right ventricle.  The posterior descending artery branch supplies blood to the inferior aspect of the heart.

The LMCA supplies blood to the left side of the heart.  The LAD provides blood to the anterior ventricular septum and the greater portion of the anterior portion of the left ventricle.  The LCX supplies blood to the lateral wall of the left ventricle and sometimes to the posterior interior aspect of the heart when there is left heart dominance.

Symptoms:

  • Chest pain that may feel like pressure tightness, pain, squeezing or aching pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly.
  • Cold sweat
  • Fatigue
  • Heartburn or indigestion
  • Lightheadedness or sudden dizziness
  • Nausea
  • Shortness of breath

Clinical Signs:

  • Frequent chest pain
  • Fatigue
  • Dizziness
  • Indigestion or nausea
  • Sweating
  • Swelling in the legs, ankles and feet
  • Irregular heart beat
  • Pain in other parts of the body
  • Shortness of breath

ECG Report:

ECHO Report:

CAG Report:

Doppler Report:

USG Abdomen Report:

Pathophysiology of Myocardial Infarction:

Presenting Complaints and History:

A 43 years old male is euglycemic and hypertensive on treatment presented with complaints of chest pain radiating to left shoulder pain on 11.05.25. He was diagnosed as ASMI with moderate LV dysfunction.  He was diagnosed with coronary artery disease with moderate LV dysfunction.  His coronary angiogram done, revealed triple vessel disease and was advised for CABG.  Preoperative assessment was initiated during treatment.  USG abdomen showed right renal cortical cyst.  CT KUB revealed no significant abnormality seen in the KUB region.

Diagnosis:

        CAD, ACS ASMI, TVD, Moderate LV dysfunction, primary POBA to LAD.

Course of Stay in Hospital:

A 43-year-old male with family history of CAD and habitual history of smoking for 10 years is euglycemic and hypertensive on treatment was diagnosed coronary artery disease.  ASMI with moderate LV dysfunction.  His coronary angiogram showed triple vessel disease primary POBA to LAD done.  Planned for CABG, his preoperative workups were initiated, fitness attained and surgery was successful CABG X 3 grafts (LIMA – LAD, SVG – OM, SVG – PD on 21.05.25.  His operative and post operative hospital stay was uneventful.  During the postoperative period, he was managed with necessary supportive measures.  The patient condition improved and discharged on stable hemodynamic status with the following advice.

Pre OP Nursing Management:

  • Patient was on continuous cardiac monitoring.
  • Hourly vital signs and intake / output monitored and assessed neurologically.
  • Blood sampling done for pre –op investigation under aseptic technique to prevent thrombophlebitis that is (BC < B/G, serum electrolytes, RFT, serology, USG abdomen and carotid Doppler.
  • Doctors explained about risk and benefits of procedure to the attender and informed consent obtained.
  • Skin preparation was done, and patient was given a povidone bath to minimize the risk of infection.
  • NPO instructions were explained to the patient.
  • Nurses provided psychological support before shifting to OT for CABG.

Post OP Nursing Management:

  • The patient was transferred from OT to CTICU for continuous cardiac monitoring and connected to ventilator.
  • Nurses monitored and maintained vital sign every 15mins, blood pressure stabilized with inotropic IV fluids.
  • Blood samples collected for CBG, ABG, RFT and electrolytes, etc.,
  • Used sterile technique to prevent thrombophlebitis.
  • The doctors explained the patient condition to attenders.
  • Early upright position in and out of the bed as soon as possible after patient is woken up with endotracheal tube still in place.
  • Inotropes were tapered according to blood pressure.
  • Early ambulation and mobilization done with the help of physiotherapist prevent from deep vein thrombosis.
  • All the care bundles were followed properly to prevent hospital acquired infection.
  • Ventilator support was weaned and disconnected, patient encouraged for deep breathing exercise using respirometer.
  • All the drains were removed and shifted to ward for further management on 5th POD and prepared for discharge. On 6th POD daily octenisan solution bath was given.
  • On 8th POD patient condition improved and he was discharged in stable hemodynamic status.s

Conclusion:

Coronary artery bypass grafting revascularization procedure is aimed at reducing the risk of cardiovascular events.  The focus should be on not only the immediate surgical intervention but also on long-term cardiovascular health and rehabilitation.

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