DNRS 6501 Week 3 Assignment Concept Map

Pathophysiology of Primary Diagnosis

A myocardial infarction means that one of the arteries that supply blood to the heart muscles is blocked in such a way that a section of the cardiac muscle mass has an insufficient blood flow, which is mostly oxygenated. Research finds that the obstruction of this portion of the coronary artery is consequent in the event of rupture of its atherosclerotic plaque. In fact, this sign consists of cholesterol, fatty substances, wastes of the cells, calcium, and fibrin. At a certain point, when the plaque can no longer hold any more, it then ruptures and causes the bending of a blood clot (thrombus) to partially or completely block the blood vessels, resulting in ischemia and subsequent necrosis of the cellular tissue at that location (the myocardium) (Cleveland Clinic, 2022).

Causes

Risk Factors (genetic/ethnic/physical)

•Lipid Accumulation: The accumulation of low-density lipoprotein (LDL) cholesterol in the arteries slowly formed the walls and started to create a process known as a fatty streak (Cleveland Clinic, 2022).

•Inflammation: Other inflammatory cells, such as macrophages, penetrate the plaque. These cells release proteinases that thin the plaque fibrous cover, making it susceptible to rupture (Cleveland Clinic, 2022).

•Plaque Rupture: When the fibrous cap becomes weak enough, it may rupture, and therefore opens the lipid core to the blood and triggers the coagulation cascade.

•Thrombus Formation: In case of this rupture, platelets adhere to the rupture site and create a thrombus that may obstruct blood flow (Cleveland Clinic, 2022).

Modifiable Risk Factors:

•Smoking: It is an undesirable habit that damages the endothelium (lining of your blood vessels/arteries), adds to the formation of plaque, and increases the risk of forming a clot.

•Hypertension: This results in the alteration of the texture and the rigidity of the arteries, as well as promotes high blood pressure that promotes atherosclerosis (Cleveland Clinic, 2022).

•Hyperlipidemia: Plaque buildup is significantly increased by high levels of LDL cholesterol.

•Diabetes: Not only does this condition predispose a person to atherosclerosis, but it also accelerates the process (Cleveland Clinic, 2022).

•Obesity: Related to hypertension, hyperlipidemia, and diabetes.

•Physical Inactivity: Associated with risk of obesity and cardiovascular disease.

•Unhealthy Diet: Cholesterol, saturated fats (also considered trans fats).

•Alcohol Consumption: Overconsumption may raise the levels of blood pressure and cholesterol (Cleveland Clinic, 2022).

•Stress: Repeated stress is a cause of high blood pressure and a poor lifestyle.

Non-Modifiable Risk Factors:

•Age: The other factor, which is put into consideration in this case, is age, whereby risks are higher in men over the age of 45 years and women over the age of 55 years.

•Gender: To be more precise, men have a higher risk of getting the condition at a younger age in comparison to women.

•Family History: Hereditary inclination towards heart disease.

•Ethnicity: These include the different ethnic groups that possess actuarial risk due to genetic and lifestyle factors.

Signs and Symptoms – Common presentation

How does the diagnosis impact each body system? Complications?

i. Chest Pain or Discomfort: It is said to be a pressure, commonly, tightness, squeezing, or burning pain in the middle of the chest. Such pain can be transferred to the arm, neck, jaw, back, or stomach (Zafari, 2019).

ii. Shortness of Breath: Breathlessness or the sensation of difficulty breathing occurs with or without chest pain.

iii. Sweating: Soon cold, clammy perspiration (Zafari, 2019).

iv. Nausea and Vomiting: Feeling sick to the stomach or actual vomiting.

v. Lightheadedness or Dizziness: Feeling lightheaded or feeling dizzy, which may result in passing out at times (Zafari, 2019).

Fatigue: Feeling bizarre fatigue that occurs mostly in women.

The myocardial infarction (heart attack) may be characterized by the extensive impact on the other body systems and by the occurrence of numerous complications:

Cardiovascular System:

i. Heart Failure: Such causes as the difficulty of breathing, fatigue, and limb swelling are caused by disruption of blood flow and the capacity of the heart to pump blood (Zafari, 2019).

ii. Arrhythmias: Arrhythmias encompass irregular heartbeats, which can be normal or severe, as well as those that are life-threatening, such as ventricular fibrillation, which culminates in cardiac arrest.

iii. Cardiogenic Shock: It is a very poor heart coordination in pumping blood, which is usually brought about by very damaged heart tissue.

iv. Respiratory System: Pulmonary Edema – the accumulation of fluid in the lungs, which makes it difficult to breathe (Zafari, 2019).

v. Renal System: Acute Kidney Injury – an acute loss of kidney functionality that has an impact on the kidney filters’ capacity to eliminate blood waste (Zafari, 2019).

vi. Nervous System (Stroke)

vii. Gastrointestinal System (Nausea and Vomiting)

viii. Musculoskeletal System

There are a number of conditions that have similar symptoms to myocardial infarction, and so a differential diagnosis is crucial:

i. Angina Pectoris: chest pains, especially due to a low flow of blood to the heart muscle via the coronary vessels. Unlike MI, which is a condition that impacts the heart muscles, angina is not, and a patient has the risk of getting it again in the future, although not always (Sullivan, 2021).

ii. GastroesophagealReflux Disease (GERD): One of the possible causes of chest pain or discomfort that can be misdiagnosed as evidence of a heart attack is persistent heartburn or indigestion.

iii. Pericarditis: A number of cardiac causes of chest pain include inflammation of the pericardium, which results in sharp and stabbing chest pain that is aggravated by breathing or lying down (Sullivan, 2021).

iv. Pulmonary Embolism: Speaking of the situation when a clotting of blood to the lungs takes place, one may experience an acute chest pain, dyspnea, and additional symptoms that resemble those of MI (Sullivan, 2021).

v. Aortic Dissection: The disease is critical in nature, where the inner lining of the aorta tears due to pressure and causes severe center-line pain, which can spread to the back. It requires timely action by the medical practitioner.

vi. Musculoskeletal Pain: Pericarditis-inflammation of the membrane surrounding the heart may mimic a heart attack, and costochondritis-inflammation of the breastbone-fastening cartilage that connects to the ribs may also cause chest pains (Sullivan, 2021).

vii. Panic Attack: It is positive to mention the panic attacks as serious manifestations of fear and anxiety that may also cause chest pains, difficulties in breathing, and other aspects that can also fit in MI (Sullivan, 2021).

Here are some diagnostic tests and labs for a heart attack:

· Electrocardiogram (ECG or EKG)

· Blood Tests (CK-MB)

· Echocardiogram

· Coronary Angiography

· Chest X-ray

· Computed Tomography (CT) Scan

· Magnetic Resonance Imaging (MRI) (Jenča et al., 2020)

Medications:

· Aspirin

· Thrombolytics (Clot Busters) Drugs

· Antiplatelet Agents (clopidogrel or ticagrelor)

· Anticoagulants (Drugs such as heparin or low molecular weight heparin (enoxaparin))

· Nitroglycerin

· Beta-Blockers (Medications such as metoprolol)

· ACE Inhibitors (Drugs like enalapril or lisinopril)

Procedures:

1. Percutaneous Coronary Intervention (PCI): It is also referred to as angioplasty, and entails the insertion of another thin tube with a small expansion on the tip, which resembles a balloon, into the blood vessel and threading it until it reaches the affected coronary blood vessel. It is performed with the use of a balloon that inflates the artery, or occasionally a stent is placed to make sure that the artery is not blocked (Jenča et al., 2020).

2. Coronary Artery Bypass Grafting (CABG): This is a procedure that involves the removal of the veins that are obtained elsewhere in the body, especially the leg, and applying them to maintain the circulation of blood around blocked coronary arteries, to supply blood to the heart muscle (Jenča et al., 2020).

Ongoing Care:

1. Cardiac Rehabilitation: A structured plan including a workout, educational, and counseling processes to help MI patients to resume their normal status and/or to improve their heart condition, reduce the risk of heart-related complications episodes in the future (Jenča et al., 2020).

2. Lifestyle Changes: They include: non-smoking, a healthy diet and exercising, regular exercising, being at the right weight, and coping with stress (Jenča et al., 2020).

Potential Referrals:

· Cardiologist

· Cardiac Rehabilitation Specialist

· Dietitian

· Physical Therapist

· Psychologist or Counselor (Jenča et al., 2020)