Myocardial infarction, also known as heart attack, is the irreversible collapse of the heart muscles as a result of a prolonged deficiency in oxygen supply to the heart. It is characterized by intense chest pain and discomfort, fatigue and uneasiness.
Case history
Ms. Amalia Ross is a 61-year-old who works as a bus terminus operator. She is ferried to the hospital facility’s emergency department by ambulance. She has a sixty-minute history of uncomfortableness in the jaw and heaving forearms. She appears pale and nauseated. An ECG done in the ambulance en route to the hospital showed ST elevation. Ms. Ross is single with two grown up children. She jogs regularly and quit smoking twenty years ago. Her average weekly intake of wine is six glasses. Her medical history indicates she has modest arthritis and elevated cholesterol levels. She has hypertension and also has a family history of heart disease (her brother had a Coronary Artery Bypass Graft surgery at 52 years, and her father died from a Myocardial Infarction at 70 years). She has no history of depression or any other mental disorder.
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Physical Examination Findings
Ms. Ross was experiencing tachycardia – increased heart rate which was attributed to a quickened idioventricular rhythm. She had hypertension due to constriction of the arteries as a result of pain and ventricular dysfunction. Her respiratory rate was elevated due to congestion of the pulmonary tract. Her body temperature was at 38°celcius. The veins on her neck were dilated, and on palpation of the heart, sidelong deracination of the apical impulse was found. During the examination, a pericardial detritions rub was heard. Chest wheezes were examined, and the deduction was that it was due to pneumonic venous high blood pressure. Ms. Ross was vomiting, which was attributed to a breach in the papillary muscle.
Diagnostics Tests
An Electrocardiogram (ECG) was carried out to determine the electrical activity of Ms. Ross’ heart and the electrical impulses recorded were significantly abnormal. A blood test was conducted, and the presence of heart enzymes in the blood was confirmed. An X-ray showed alterations in the size of the heart and its blood vessels and some fluid in the lungs. An echocardiogram showed damage at the point where the aorta and the left ventricle of the heart are enjoined. A Coronary Catheterization (Angiogram) procedure was carried out on Ms. Ross to ascertain which blood vessels in the heart were damaged or blocked. For a definite prognosis of the extent of harm to the heart, Ms. Ross underwent cardiac computerized tomography/ imaging (CT scan).
Diagnostic Impression
1.7mm ST (STEMI) levels
Pulmonary Embolism caused by a clot that moved from Ms. Ross’ right leg to her lungs
Cardiac tamponade as a result of pericardial effusion, which is the unnatural accruement of a liquid substance in the pericardial cavity. In her case, it was caused by a viral infection.
Aortic dissection caused by her hypertension condition. There was a severance in the inside wall of her aorta which led to blood flowing between the layers of the vessel’s wall, thus drawing them apart.
Abnormal aggregation of air in the pleural space of her left lung made the lung dissociate from her chest wall, reducing oxygen supply and blood pressure.
Treatment
Provision of additional oxygen using the nasal cannula
Administration of 325mg of Aspirin
Administration of 0.4mg of Nitrates to reduce cardiac pain which did not yield a satisfactory effect
Gradual additional administration of 5mg of IV Nitrates in a bid to attain chest relief but this was still not enough
Administration of 3mg of IV morphine which saw the realization of chest relief
A Percutaneous Coronary Intervention (PCI) was performed on Ms. Ross using Bare Metal Stents to institute reperfusion
Medication
Ms. Ross was given a prescription of four drugs that she is required to take for the rest of her life. They cut down the chances of a resurgence of another myocardial infarction and prevent the already existing heart condition from deteriorating. They include;
Aspirin – it reduces the stickiness aspect of platelets that helps them in the formation of clots. By reducing the possibilities of clot formations, aspirin consequently reduces the chances of heart attacks. Ms. Ross should see a doctor if she develops adverse reactions to aspirin at any point.
Beta-blockers – beta receptors on the heart muscle cells are stimulated by hormones such as adrenaline. This stimulation overworks the heart leading to elevated heart rates and blood pressure. Beta-blockers inhibit the stimulation of these receptors.
Angiotensin-Converting Enzyme (ACE) inhibitors – they block the angiotensin enzyme found in the bloodstream. This blockage allows blood vessels to broaden appropriately thus lowering the pressure at which blood flows through them; easing the load on the heart.
Statins – they reduce the levels of cholesterol that forms along the inward lining of the blood vessels. Excessive cholesterol levels are a common cause of heart-related disorders and strokes.
Life after a Myocardial Infarction
Everyone, those who have suffered from heart attacks and those who have not are advised to do the following;
Do not smoke
Take up regular exercise activities
Watch your weight to ensure it is at the right place
Always eat a balanced diet
Control alcohol intake
References
Bates, E. R. (2008). Reperfusion therapy for acute myocardial infarction . New York: Informa Healthcare USA.
Hutchison, S. J. (2009). Complications of myocardial infarction: Clinical diagnostic imaging atlas. Philadelphia, PA: Saunders/Elsevier.
