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Pathomap: ST Elevated Myocardial Infarction
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Pathophysiology
ST elevated Myocardial Infarction (STEMI)
The heart is one of the most vital organ of the human body as it acts as the pump that
moves blood throughout the body, supplying oxygen-rich blood from the lungs to the organs and
circulating deoxygenated blood through the lungs. This circulation of blood is achieved through
a network of arteries and veins which are the vessels that carry the blood to the body. Therefore,
the health of these arteries and veins is critical for optimum perfusion. An injury to the
endothelial cells of the arteries initiates the inflammation reaction which is known to be the key
early event in the forming of atherosclerosis which causes obstruction and disrupts the normal
blood flow through the arteries. The coronary arteries are a small network of arteries that directly
perfuse the myocardium and supplies the heart with blood; obstruction of these arteries can
initially lead to acute coronary syndrome (ACS), including stable angina, unstable angina,
STEMI and Non-ST Elevated myocardial infarction (NSTEMI). STEMI, which stands for ST
elevated myocardial infarction is a heart condition defined as total obstruction of blood flow.
When this obstruction is sustained for a prolonged period, the myocardial (heart) cells undergo
“ischemic necrosis” or death due to inadequate oxygenation that results in irreversible damage to
the heart muscles at the site of the infarction (Capriotti, 2020). Most commonly, myocardial
infarctions are caused by obstruction of coronary arteries by a build-up of plaque
(atherosclerosis) or thrombus (clot) that results in the blockage of the blood flow in the vessels
and thereby reduced perfusion to organ tissues.
Myocardial infarction can also result without obstruction such as in the case of chronic
hypertension, ventricular hypertrophy, especially of the left ventricle, or severe narrowing of the
aortic valve (aortic stenosis). In a normal healthy working heart, the coronary arteries maintain a
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constant supply of blood to the heart that enables the heart to efficiently pump blood throughout
the body (Ignatavicius, 2021). In the presence of hypertension, ventricular hypertrophy, or aortic
valve stenosis, there is an increased demand for blood supply to overcome resistance whereas the
supply remains constant. This causes a state of ischemia in the myocardial cells and prolonged
ischemia can lead to the death of myocardial cells, leading to infarction (Capriotti, 2020).
The ability of the heart to pump normally is achieved by the regulation of the action
potential of the myocardial cells which causes the contraction and relaxation of the heart.
However, in the presence of a prolonged ischemic event, cell death causes changes within the
cells that can lead to the failure of the sodium-potassium pump which regulates the action
potential of the myocardial cells by maintaining the concentration of these electrolytes (Capriotti,
2020). This has a profound impact on the heart because failure of the sodium-potassium can
cause imbalances of these electrolytes which can lead to cardiac dysrhythmias such as STEMI
which can be life-threatening due to the complete obstruction of a major coronary artery (usually
the Left Anterior Descending artery that primarily feeds the left ventricle).
Capriotti (2020) notes that the extent of damage to the myocardial cells due to infarction
is influenced by the location or level of occlusion, length of time of the occlusion, and the
availability of the heart’s “collateral circulation” (p. 378). Therefore, a patient with myocardial
infarction must be diagnosed and treated promptly. Clinically, a prolonged ischemic event lasting
more than 30 minutes causes irreversible damage to the cells, leading to tissue death and
decreased cardiac function (Captiotti, 2020). However, if timely treatment is provided, some of
the cells may be saved and further necrosis of cardiac tissues can be prevented.
Hypertension
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Blood pressure is the amount of pressure that the blood exerts on the walls of the vessels.
Therefore, maintaining appropriate blood pressure is crucial because higher than normal blood
pressure can have a damaging effect on the endothelial lining of the arteries (Capriotti, 2020). In
cases of chronic hypertension, the increased amount of pressure in the vessels exerts a hearing
force against the epithelial membrane of the vessels and causes injury to the arterial wall. The
weakened area in the arterial wall is termed an aneurysm. Aneurysm coupled with increased
pressure and pulsating force of the arteries further exacerbates the damage to the arteries which
can lead to vessel rupture or hemorrhage and the formation of atherosclerosis (Capriotti, 2020).
Furthermore, hypertension can lead to vessel wall hypertrophy and become thicker causing a
reduction in the radius of the vessel and thereby increasing pressure in the vessels (Ignaviticius,
2021).
When the vessels are injured and weak, it decreases their ability to perfuse vital organs
which can then lead to multiple organ dysfunction. Some of the vital organs that can be damaged
due to hypertension include the heart, retina of the eyes, brain, kidney, and peripheral arteries. In
terms of parameters, according to the American Heart Association, high blood pressure is when
the systolic blood pressure exceeds 130 mmHg or when the diastolic blood exceeds 80 mmHg
(2017). This patient has a history of hypertension which has likely played a big role in the
development of myocardial infarction that led to the diagnosis of STEMI.
Elevated blood pressure can take a tremendous toll on the heart because it increased its
workload. When the cardiac workload is increased for a prolonged period, it leads to hypertrophy
or enlargement of the ventricles, especially the left ventricle, which is part of the heart that
pumps oxygenated blood to the rest of the body. This enlargement of the left ventricle can then
lead to reduced filling capacity of the ventricle, which decreased the overall cardiac output or
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afterload (Capriotti, 2020). Furthermore, the hypertrophy of the ventricles also increases it blood
supply for oxygen, but the coronary arteries fail to meet this increased demand, and this results in
myocardial infarction or death of cardiac tissue (Capriotti, 2020). The net effect of these changes
is a reduced ejection fraction or cardiac output which places the whole body in a state of
decreased perfusion, especially the organs such as the brain and kidney which is likely the reason
for the patient’s ejection of 25%. Hypertension is also a major predisposing factor for
hemorrhagic stroke which could have likely led to the patient’s transient ischemic stroke in the
past.
Aortic Valve Stenosis
Aortic stenosis is a valvular disorder that causes the narrowing of the aortic valve and is most
common in the elderly population and in patients with chronic hypertension, both of which are
true for this patient. Although there is no definitive understanding of the pathophysiology of this
disorder, it is understood that it has a degenerative process and its incidence is increased with
aging, hypertension, hyperlipidemia, hypercholesterolemia, and diabetes (Shah Et al., 2023). The
degenerative part of the pathogenesis revolves around the build-up of atherosclerosis and
lipoproteins depositing at the sites of vessel wall inflammation (Shah et al., 2023). Over time, the
build of these lipoproteins leads to calcification at the site of valve injury, and stiffening of the
valves (Otto & Prendergast, 2014).
Chronic hypertension also plays a significant role in the pathogenesis of aortic stenosis
and aortic stenosis, in turn, exacerbates hypertension. As discussed earlier, ventricular
hypertrophy caused by hypertension leads to an enlarged left ventricle which ultimately causes
reduced cardiac output and ejection fraction. This reduced cardiac output causes a low gradient
across the aortic valve and thereby narrowing of the valve occurs (Armstrong, 2022). According
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to Shah et al., (2023), the hypertrophy of the left ventricle can be a “maladaptive” physiological
change that can contribute to diastolic dysfunction. The primary effect of this disorder is that it
obstructs the outflow of blood from the left ventricle, thereby affecting the perfusion of the
body’s vital organs. According to Otto & Prendergast (2014), calcific valvular disorders such as
aortic stenosis are strongly related to old age, male sex, elevated levels of low-density
lipoprotein, cholesterol, and lipoproteins, hypertension, smoking, and diabetes.
Signs and Symptoms
STEMI
Acute myocardial infarction (MI) may present with or without signs or symptoms or it
can be very specific and vary from patient to patient. The absence of signs and symptoms of MI
is termed silent MI (Capriotti, 2020). However, some of the generally expected signs and
symptoms of MI include diaphoresis, extreme anxiety, pallor, and retrosternal chest pain
radiating to the shoulders, arm, jaw, or back. Patients also may present with shortness of breath
with or without chest pain (American Heart Association, n.d). This patient presented to the ED
with fatigue and generalized weakness without chest pain. The patient’s oxygen saturation was
also low at the time of admission.
It is also important to point out that men and women may present differently and
therefore it is important to know the differences. According to Ignatavicius (2021), women may
present with atypical angina which manifests as indigestion, pain between the shoulders, an
aching jaw, or a choking sensation that occurs with physical activity. Women may also report
unusual fatigue, shortness of breath, heart palpitations, and flu-like symptoms. Due to these signs
and symptoms that can be subtle, it is important to assess for any changes in daily routine as
these signs and symptoms can be mistaken for minor illnesses such as flu (Ignatavicius, 2021).
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The signs and symptoms of MI can also present differently among the older population
and the high ambiguity of symptoms in the older adult put them at high risk for delaying medical
attention (Ignativitius, 2021). It appears that older adults generally present with associated
symptoms such as shortness of breath, fatigue, and generalized weakness due to decreased
cardiac output. Furthermore, for patients older than 80 years, a major sign or symptom may be a
change in mental status, and acute confusion (Ignatavicius, 2021). Through my physical
assessment of the patient, I have observed that despite the absence of the more common signs
and symptoms such as chest pain, the patient’s skin tone certainly had some pallor, the patient
was experiencing acute generalized weakness and the patient also had an episode of change in
his mentation and acute confusion.
Hypertension
Hypertension or high blood pressure is clinically known as the “silent killer” because it is
a gradual process that generally has no specific signs and symptoms until organ damage has
occurred and it is the most common predisposing factor for heart failure (Capriotti, 2020).
However, according to the World Health Organization, severe episodes of hypertension may
present with headaches, dizziness, nose bleeds, nausea and vomiting, blurred vision or other
vision changes, and heart palpitations. This patient did not present with any of these signs and
symptoms and the only indication of his hypertensive state was a blood pressure of 183/103.
Capriotti (2020) states that a thorough review of the patient's medical history can help determine
the cause of hypertension which can be due to medical disorders such as diabetes, medicationinduced hypertension, or lifestyle-related risk factors such as smoking and obesity. Therefore,
signs and symptoms of HTN may vary depending on the cause.
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Aortic Valve Stenosis
Aortic valve stenosis by itself does not have a specific sign and symptom. However, due
to the stenotic valvular disorder, it can lead to hypertension and myocardial infarctions which
have presenting signs and symptoms as discussed earlier. Capriotti (2020) notes that some
patients with aortic stenosis have a heart murmur that is usually heart after the S2 due to
regurgitant backflow of blood from the aortic valve.
Labs and Diagnostics
STEMI
Myocardial Infarction is primarily diagnosed with the use of an electrocardiogram
(ECG), or through imaging assessments such as an echocardiogram (ECHO). The typical finding
for STEMI on the ECG strip shows an elevated ST segment. In ST elevation, because of cardiac
tissue damage or death, causes a shift in electrolytes, especially potassium that results in
abnormal depolarization of the ventricle which is represented in the ECG strip as ST elevation.
ST elevation, therefore, represents the inability of the site of the infarction to depolarize and
which is evidence of tissue death due to complete obstruction of a coronary artery. The location
of the obstruction can then be identified with the help of a diagnostic procedure such as a cardiac
catheterization or cardiac angiography. Cardiac angiography is an invasive procedure in entails
the insertion of a catheter into the body and deploying radiopaque dye into the vessels that can
reveal areas of obstruction in the coronary arteries (Capriotti, 2020).
An echocardiogram is another commonly used diagnostic imaging test that helps to
identify abnormal cardiac structure and function by capturing images of the patient's heart. The
underlying concept for echocardiography is that when there are cardiac tissue injuries due to
ischemia such as with STEMI, it leads to contractile dysfunction causing abnormal wall motion
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at the site of infarction (Capriotti, 2020). Echocardiography can help locate these abnormal wall
motions and thereby aid in the diagnosis of myocardial infarctions. Echocardiography is most
commonly done via two different methods which are Transthoracic echocardiography (TTE) and
Transesophageal echocardiography (TEE). While TTE is a non-invasive procedure that utilizes
ultrasound imaging to capture anterior portions of the heart, a TEE is a more invasive procedure
that entails the insertion of a probe through the esophagus to capture images of the posterior
cardiac structures.
For laboratory assessments of STEMI, troponin level is one of the primary indicators of
myocardial tissue damage and it is a cardiac enzyme that is released when cellular injury occurs.
These enzymes are not found in healthy patients and as such elevation of this enzyme indicates
myocardial infarction. According to Van Leeuwen & Bladh (2021), normal troponin I levels
should be less than 0.003 ng/mL. Compared to troponin T, troponin I is a more specific marker
for MI because it is only found in myocardial muscle tissue. I would have expected to see
elevated troponin I levels for this patient but the patient results do not show troponin levels.
However, the patient’s troponin levels may be normal at the time of my assessment because
troponin levels begin to rise 3 to 6 hrs after a MI event, peaks between 12 to 16 hours, and
resolve in 5 to 9 days (Van Leeuwen & Bladh, 2021).
B-Type Natriuretic Peptide (BNP) is produced in the heart’s ventricles and it acts as an
antagonist to the renin-angiotensin-aldosterone system. The BNP is released by the heart in
response to fluid volume overload and the amount of BNP being released is directly related to
the extent of ventricles being stretched by blood volume. Normal BNP levels should be less than
100 pg/mL (Van Leeuwen & Bladh, 2021). Given that the normal range of BNP should be
<100pg/mL and the patient’s BNP level is 958 pg/mL, this is a clear indication of heart failure.
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This is relevant to the patient’s previous history of arterial stenosis, aortic valve replacement, and
hypertension which are all comorbidities that could have led to STEMI.
Hypertension
Hypertension is the elevation of blood pressure that is diagnosed when two or more
diastolic blood pressure measurements on at least two or more clinical visits are 80 mmHg or
greater, or when the systolic blood pressure readings on two or more clinical visits are 130
mmHg or greater (Capriotti, 2020). The American Heart Association, hypertension can be
further diagnosed into categories based on a patient’s blood pressure. Stage 1 hypertension is a
blood pressure of 130 to 139 systolic or diastolic blood pressure greater than 80 to 89, stage 2 is
systolic blood pressure greater than 140 and diastolic blood pressure greater than 90.
Electrolyte imbalances are a common finding for patients with hypertension due to their
damaging effect on the whole body system. However, this patient’s electrolytes are all within
normal ranges which may be indicative of good hydration and nutritional intake of the patient at
the time. However, given the progressive nature of the disorder, it is important to continuously
monitor organ function that can be affected by HTN such as the kidney.
Creatinine levels are used to assess kidney function found in acute kidney injury or
chronic kidney diseases. Creatine is a chemical present in the skeletal muscle and some of this
creatine is converted into creatinine by the liver during muscle metabolism and is usually
excreted by the kidneys. Therefore, the presence of creatinine is a good indicator of kidney
function because a healthy kidney does not reabsorb creatinine (Van Leeuwen & Bladh, 2021).
The normal creatinine levels in adults are 0.61-1.21 mg/dL but the patient’s creatinine levels are
elevated at 2.34 mg/dL. The last three creatinine results show continued elevation of creatinine
levels which is indicative of a deteriorating kidney function. It is likely that the patient’s history
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of chronic hypertension, and other heart-related issues such as STEMI are affecting the adequacy
of perfusion to the kidneys which can lead to kidney injury.
The glomerular filtration rate is another test that can help assess the extent of renal
impairment of a patient. PeaceHealth hospital parameters indicate that a GFR of <60 signals
renal impairment. The patient’s GFR was 26 which is indicative of severe loss of kidney
function. The last three GFR results have been consistently low which indicates that the patient’s
kidney function is deteriorating and the patient’s hypertension likely affecting his kidney
function.
Blood urea nitrogen is often ordered with creatinine for comparative analysis of renal
impairment. This lab tests for urea nitrogen found in the patient’s blood, normally filtered by the
kidney. Elevated BUN, therefore, is indicative of renal impairment. The patient’s GRF is greatly
elevated at 43 mg/dL and it appears to be in an upward trend based on the last three results. This
result aligns with the elevated creatinine and low GFR which is indicative of renal impairment
secondary to hypertension.
Aortic stenosis:
Diagnosis of aortic valve stenosis is mainly done through an echocardiogram TEE or
TTE to assess the valvular structure and function-related problems. Exercise tolerance testing
(ETT) may also be performed to evaluate symptomatic response as well (Ignaviticius, 2021).
Medications and Treatments
STEMI
The primary treatment for STEMI is done by surgical interventions. Some of the common
surgical treatment procedures include Percutaneous Coronary Interventions (PCI) such as
angioplasty, and Coronary Artery Bypass Graft (CABG). PCIs are generally a follow-up
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intervention based on the finding of cardiac angiography discussed earlier, which identified the
location of a coronary artery obstruction. PCI is a non-surgical and minimally invasive procedure
that may involve a combination of clot retrieval, coronary angioplasty, and stent placement
(Ignaviticius, 2021). Dependent on the severity of the obstruction, a cardiologist can either
perform a balloon angioplasty wherein a balloon is inserted and inflated at the side of clot
formation which opens the vessel and increase blood flow. However, some patients may develop
restenosis of these vessels post-surgically within the first 24 hours (Ignaviticius, 2021). If a
patient is identified with a risk of restenosis, the cardiologist may also place a stent at the site of
obstruction to increase vessel patency for a longer period. Patients who have stent placement are
generally on anticoagulant medications for the remainder of their life to prevent the risk of clot
formation generally and more importantly at the stent site. Percutaneous coronary interventions
serve as a bridge for patients to Coronary Artery Bypass Graft (CABG).
CABG is a highly invasive and open heart surgery that is generally indicated for patients
with greater than 50% occlusion of the left main artery, heart failure due to ischemia, acute MI,
valvular diseases or if coronary vessels are unsuitable for PCI (Ignaviticius, 2021). CABG is
performed under general anesthesia and patients are put on cardiopulmonary bypass machines
and the heart is pharmacologically arrested for the procedure. Surgeons may harvest veins from
the person’s own body or use synthetic grafts for the bypass. The grafted vein is anastomosed
(sutured) proximally to the aorta and the distal ends are surgically attached below the site of
obstruction, thereby improving myocardial perfusion (Ignaviticius, 2021).
In terms of medical treatment for STEMI, medications are based on the client’s
presenting symptoms. One of the classic signs of MI is chest pain and the primary treatment for
chest is Nitroglycerin or Nitro which is an antianginal medication. Nitro helps increase blood
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flow by dilating coronary arteries and improving blood flow to the site of ischemia (Vallerand
and Sanoski, 2021). Nitro has a high risk of tolerance and therefore, an important patient
education would be to consult their cardiologist and take drug holidays. Further, during acute
chest pains, the patient should be educated to take up to 3 nitro pills at 3-5 minute intervals for
relief. However, if relief is not achieved after 3 nitro pills, the patient should be educated to seek
medical help immediately.
Hypertension
Patient education on a heart-healthy diet and physical activity including life style changes
are high priorities for hypertension. American Heart Association recommends the Dietary
Approaches to Stop Hypertension (DASH). The DASH diet includes a low sodium intake of
1,500 mg a day because using less sodium is crucial for keeping blood pressure at a healthy
level. Excessive sodium intake leads to fluid retention or hypervolemia which can exacerbate
hypertension (Ignaviticius, 2021). It also includes the use of foods that are high in fiber and low
in saturated fats, and cholesterol such as fruits and vegetables, whole grains, poultry, fish, (n.d).
Obesity is another critical risk factor for hypertension and the DASH diet is effective at weight
loss and management. Another important patient education is to advise them to be cautious about
using salt substitutes in an effort to reduce sodium intake because the salt substitutes are high in
potassium which can have detrimental effects on cardiac function.
Stress reduction and physical activity are also known to play a significant role in the
development of HTN. Stress is a major contributor to HTN because the human body releases
stress hormones such as adrenaline and cortisol which initiates the body’s fight or flight response
which increases the workload on the heart and constriction of vessels (American Heart
Association, n.d). Therefore, stress management through various modalities such as yoga,
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relaxation techniques, and biofeedback are known to have stress reduction benefits. For physical
activity, it is recommended that at least thirty minutes of vigorous exercise for 5 days per week
to reduce the risk of cardiovascular diseases (Ignaviticius, 2021). Smoking cessation is another
critical lifestyle change to reduce cardiovascular diseases.
In terms of pharmacological treatment of HTN, adherence to medication treatment is a
critical component of managing HTN. The primary choice for the treatment of HTN are betablockers such as metoprolol which selectively blocks the stimulation of beta1-adrenergic
receptors (Vallerand & Sanoski, 2021). The effect of this medication decreases HR and BP. This
will also decrease the incidence of angina pectoris attacks. Post-MI patients are given beta
blockers to reduce infarct size and protect against arrhythmia. This medication also prolongs
diastole while decreasing contractility resulting in improved perfusion with a reduced workload
on the heart. The patient is taking 50 mg of Metoprolol twice daily.
Angiotensin II receptor blockers (ARBs) are another common treatment regimen for
HTN. This medication blocks vasoconstriction and the aldosterone-producing effect of
angiotensin II receptors and thereby helps reduce blood pressure. Therapeutically, this
medication is an antihypertensive which will help the patient maintain his blood pressure. This
patient has a history of hypertension and is at high risk for heart failure. As such this medication
will help control his blood pressure and reduce the risk of cardiovascular crisis. This will also
help the patient reduce the risks of stroke. The patient is taking 25 mg of Losartan once a day
The patient takes 2.5 mg of Apixaban (Eliquis) twice daily. Apixaban (Eliquis) is a newer
anticoagulant that helps inhibit thrombin-induced platelet aggregation and thereby reduces the
risk of thromboembolic events. This patient has a history of hypertension, had a transient
ischemic attack in the past, and is at high risk for heart failure and stroke recurrence. Taking this
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medication will help reduce the risk of thromboembolic events which can be serious given the
state of his heart with a history of valvular stenosis.
The patient is taking 40 mg of Furosemide twice daily. Furosemide is a loop diuretic and
it inhibits sodium and chloride reabsorption in the loop of Henle and the distal convoluted
tubules and increases the renal excretion of water and electrolytes. This medication is appropriate
for this patient because it will remain effective despite his renal impairment. The actions of this
diuretic help remove excess body fluid and lower blood pressure. The patient is at high risk for
heart failure, and furosemide will help his body remove the excess fluid through diuresis, thereby
reducing the risk of heart failure.
Aortic Valve Stenosis
Nonsurgical management of aortic stenosis is focused on drug therapy and rest. Drugs
therapy may include beta-blockers, diuretics, ACE inhibitors, ARBs may be prescribed which
are discussed earlier to improve symptoms of heart failure. Patients may also be prescribed
digoxin which is an antiarrhythmic which helps increase the force and efficiency of myocardial
contraction and decreases heart rate giving the ventricles more time to fill. The net effect of
digoxin intervention is to increase stroke volume and cardiac output (Vallerand & Sanoski,
2021). Digoxin is also a highly toxic medication that may cause bradycardia, GI distress, and
vision changes. Therefore, it is important to closely monitor the patient for signs of toxicity. It is
also important to monitor blood potassium levels because digoxin and potassium bind to the
same receptor sites on cardiac cells. As such, hyperkalemia may lead to a subtherapeutic
outcome of digoxin therapy, whereas hypokalemia may induce digoxin toxicity (Ignaviticius,
2021).
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Transcatheter Aortic Valve Replacement (TAVR) is an alternate option for the treatment
of aortic stenosis which involves surgical replacement of the dysfunctional valve with a
bioprosthetic valve (Ignavitius, 2021). This patient has a history of aortic valve replacement in
the past.
Conclusion
Hypertension plays a critical role in various cardiovascular diseases such as STEMI,
which is primarily caused by inflammation of the vessel walls leading to build up of
atherosclerosis and weakens the vessel structure and function. While myocardial infarction can
due to partial obstruction which is known as NSTEMI and STEMI is the complete obstruction of
the coronary arteries. Signs and symptoms differ between patients but generally most patients
present with diaphoresis, extreme anxiety, pallor, and retrosternal chest pain radiating to the
shoulders, arm, jaw, or back. Diagnosis of STEMI is primarily done through ECG and a more indepth look at cardiac structure and function is further done through diagnostic imaging
procedures such as ECHO. Treatment of STEMI is primarily surgical because the goal of the
surgical intervention is reperfusion of the heart to prevent excessive damage and heart failure. In
severe cases of obstruction of coronary arteries, open heart surgeries such as CABG may be
indicated to prevent heart failure.
Treatment and management of hypertension is critical to prevent further complications.
Diet is a key feature of the management of hypertension and as discussed earlier, a heart-healthy
diet that is low in sodium, trans-fat, and cholesterol should be followed religiously for a positive
disease management outcome. Patients with hypertension should avoid a sedentary lifestyle and
engage in vigorous physical activity at least thirty minutes of vigorous exercise for 5 days per
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week to reduce the risk of cardiovascular diseases. These lifestyle changes should then be
complemented by appropriate adherence to the pharmacological treatment.
Aortic stenosis is a condition of valvular dysfunction that leads to impaired cardiac
function. It is known to be caused primarily due to calcification of the valvular structure and the
risk of which is increased aging. It is diagnosed with the help of echocardiographic procedures
such as TEE or TTE. Aortic stenosis does not have specific signs and symptoms attached to it
but it is strongly linked with many cardiac complications. Surgical treatment of valvular stenosis
includes procedures such TAVR wherein, the stenotic valve is replaced with a mechanical valve
that is surgically inserted at the site.
References
American Heart Association. (2022, December 2). Managing blood pressure with a hearthealthy diet. www.heart.org. https://www.heart.org/en/health-topics/high-bloodpressure/changes-you-can-make-to-manage-high-blood-pressure/managing-bloodpressure-with-a-heart-healthy-diet
American Heart Association. (2023, March 21). Warning signs of a heart attack. www.heart.org.
https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack
Armstrong, G. P. (2023, April 18). Aortic stenosis - cardiovascular disorders. Merck Manuals
Professional Edition. https://www.merckmanuals.com/professional/cardiovasculardisorders/valvular-disorders/aortic-
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stenosis#:~:text=Pathophysiology%20of%20Aortic%20Stenosis&text=With%20time%2C
%20the%20ventricle%20can,low%2Dgradient%20severe%20AS).
Capriotti, T. (2020). Davis Advantage for pathophysiology: Introductory concepts and clinical
perspectives (2nd ed.). F.A. Davis.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2021). MedicalSurgical Nursing: Concepts for Interprofessional Collaborative Care (10th ed.). Elsevier.
Otto, C. M., & Prendergast, B. (2014). Aortic-valve stenosis — from patients at risk to severe
valve obstruction. New England Journal of Medicine, 371(8), 744–756.
https://doi.org/10.1056/nejmra1313875
Shah, S. M., Shah, J., Lakey, S. M., Garg, P., & Ripley, D. P. (2023, March 9). Pathophysiology,
emerging techniques for the assessment and novel treatment of Aortic Stenosis. Open heart.
https://pubmed.ncbi.nlm.nih.gov/36963766/
Vallerand, A. H., & Vallerand, A. H. (2021). Davis’s drug guide for Nurses (17th ed.). F.A.
Davis Company.
Van, A. M. (2021). Davis’s comprehensive manual of Laboratory and diagnostic tests with
nursing implications (9th ed.). Davis Company, F. A.