Risk Factors
Sedentary lifestyle, age, family history, HTN, high
cholesterol, smoking, male, race, obesity, diabetes,
stress, alcohol consumption, diet and nutrition, Metabolic
syndrome
Signs & Symptoms
Pain—severe, immobilizing chest pain not relieved by
rest, position change, or nitrate administration. Described
as a feeling of heaviness, pressure, tightness, burning or
constriction or crushing feeling. Locations: substernal,
retrosternal, and epigastric area. The pain radiates to
neck, jaw, and the arms or back. Women may experience
discomfort, SOB or fatigue. Diabetics experience silent MIs
due to cardiac neuropathy and may experience atypical
Sympathetic nervous system stimulation—increased SNS
stimulation from release of catecholamines resulting in
release of glycogen, diaphoresis and vasoconstriction of
peripheral blood vessels. Pt skin may be ashen, clammy
and cool to touch
Cardiovascular manifestation—BP and HR elevated
initially then BP may drop because of decreases cardiac
output. Renal perfusion and urine output may decrease.
Crackles may be present, jugular venous distention,
hepatic engorgement, and peripheral edema. Splitting
heart sound
Nausea and vomiting + Fever
Cardiovascular: chest pain/discomfort not relived by rest
or nitroglycerin; palpitations. Heart sounds may include
S3, S4, and new onset murmur. Increased jugular venous
distention, blood pressure may be elevated d/t
sympathetic stimulation or decreased d/t decreased
contractility, impeding cardiogenic shock or meds,
irregular pulse, ST -segment and T wave changes,
tachycardia, bradycardia or dysrhythmias
Respiratory: SOB, dyspnea, tachypnea, crackles,
pulmonary edema
Gastrointestinal: N&V, indigestion
Genitourinary: Decreased urinary output
Skin: cool, clammy, diaphoretic, pale
Neurologic: anxiety, restlessness, and light-headedness
Psychological: fear of feeling of impending doom
Potential Complications
Etiology
Myocardial infarction (MI) occurs form ischemia which results in irreversible
myocardial cell death. 80%-90% of MIs occur secondary to the formation of
thrombus. When a thrombus occurs, perfusion to the myocardium is blocked
and then necrosis occurs, therefore leading to altered function and
contractility. Depending on the level of infarction and where the blockage
occurs, will determine the level of altered function. Most of the MIs occur in
the left ventricle. Cardiac cells can withstand ischemic conditions for 20 mins
until the cells begin to die. The entire thickness of the myocardium necrosis
within 5-6 hours oof ischemia.
Diagnosis
Acute Myocardial Infarction
Labs/Diagnostic Tests
ECG
Serum cardiac markers
Cardiac enzymes—troponin, creatinine kinase, myoglobin
Coronary angiography
Exercise stress test
Echocardiography
Holter monitoring
Assessment Findings
Health Teaching
Objective:
Cold, clammy skin
Diaphoresis, Nausea and vomiting
Indigestion and heartburn
Dyspnea, Weakness, Tachycardia
Palpitation, Dysrhythmias
Decreased O2, Decreased BP
Crackles and wheezing
Pericardial friction, Edema
Elevated troponins, LDH and cardiac
enzymes

Subjective:
Patient health history
Activity level
Smoking use
Pain in chest, neck, arm, shoulder
Chest pressure
Anxiety
I can’t breathe well
I’ve been tired
“I feel like I’m dying”




Provide information regarding
CAD, angina, precipitating
factors for angina, risk factor
reduction and medication
Avoid extreme weather and
avoid consumption of large,
heavy meals
If a heavy meal is ingested,
adequate rest is required to aid
in digestion and absorption
Teach patients about low
sodium and saturated fat diets
Maintain ideal body weight
Dysrhythmias
Heart failure
Cardiogenic shock—condition in which inadequate oxygen and
nutrients are supplied to the tissues due to severe left
ventricular failure
Papillary muscle dysfunction—this may occur if the infarcted
area includes or is adjacent to the papillary muscle that
attaches to the mitral valve. This results in mitral valve
regurgitation
Ventricular aneurysm—results when the infarcted myocardial
wall becomes thin and bulges out during contraction
Pericarditis
Dressler’s Syndrome—characterized by pericarditis with
effusion and fever that develops 4-6 weeks after MI
Nursing Management/Care
Nursing Diagnosis
Ineffective cardiac tissue perfusion related to reduced
coronary blood flow

Monitor vitals frequently including cardiac rhythm
bilaterally

Administer supplement oxygen as ordered

Monitor cardiac rhythms for arrhythmias, ST
depression or elevation, T wave inversions, and or Q
waves

Preform a 12-lead ECG as ordered
Acute chest pain related to increased cardiac workload as
evidenced by self-report of pain characteristics

Evaluate chest pain using PQRST to treat and prevent
further ischemia

Provide optimal pain relief with analgesic

Regularly assess patient for presence of pain and
response to pain management interventions

Administer analgesia around the block for continuous
pain
Anxiety related to threat of death as evidenced by distress

Observe for verbal and nonverbal signs of anxiety

Use calm, reassuring approach to prevent increasing
anxiety

Instruct patient to use relaxation techniques

Encourage family members to stay with patient
Medical Management (Pharmacological/Surgical)
Nitroglycerin—reduce angina pain and improve coronary
blood flow

Monitor BP
Anticoagulants such as ASA
Morphine—Given for chest pain unrelieved by nitro
Vasodilator, it can decrease cardiac workload by lowering
myocardial oxygen consumption, reducing contractility,
and decreasing BP and HR

Monitor for bradypnea and hypoxia
Oxygen given usually between 2L to 4L via nasal cannula
ACE inhibitors—recommended after anterior wall MIs or
MIs that result in decrease left ventricular function. Can
help prevent ventricular remodelling and prevent or slow
progression of HF
Surgical procedure
CABG—placement of conduits to transport blood between
aorta or other major arteries. Involves use of grafts
Coronary artery bypass---minimally invasive and uses
thoracoscope
Percutaneous coronary intervention—procedure to open
the occluded coronary artery and promote reperfusion to
the area that has been deprived of oxygen
References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to
planning care. St. Louis, MO: Elsevier.
Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarths textbook of medical-surgical nursing. Philadelphia: Wolters Kluwer.
Lewis, S. L., Bucher, L., MacLean Heitkemper, M., Harding, M. M., Barry, M., Lok, J., Tyerman, J., & Goldsworthy, S. (Eds.). (2019). MedicalSurgical Nursing in Canada: Assessment and Management of Clinical Problems (4th ed.). Elsevier Canada
Skidmore-Roth, L. (2015). Mosbys Drug Guide for Nursing Students. Mosby.