EPIDEMIOLOGY
The leading cause of death in the United States is coronary heart disease. It is estimated that 15.4 million Americans have coronary heart disease, making them seven times more likely to have a heart attack than the general population(1). The annual incidence of myocardial infarction is estimated to be 715,000, with approximately 29% of these being ST-segment elevation MI (STEMI)(1). It is important to note that the mortality rate from STEMI has decreased over the years; however, there is still a considerable proportion of eligible STEMI patients who do not receive any form of reperfusion therapy. In an analysis of 10,954 STEMI patients enrolled in the Global Registry for Acute Coronary Events, it was found that 33% of eligible patients received no reperfusion therapy(2).
PATHOPHYSIOLOGY
Under normal conditions, coronary arteries deliver oxygenated blood to the myocardium in order to meet the oxygen demands of the cardiac muscle supplied by those arteries. In patients with coronary atherosclerosis, an atherosclerotic plaque develops in the lumen of the coronary artery. When this plaque becomes vulnerable, its fibrous cap may rupture and stimulate platelet aggregation and thrombus formation(3). An occlusive thrombus forms and impedes blood flow through the coronary artery, thus leading to ischemia of the myocardium supplied by that artery. Evidence of this ischemia is reflected on the electrocardiogram as ST-segment elevation. Due to lack of blood flow and oxygen delivery, cardiac myocytes begin to die in a wave-like fashion, from the endocardium to the epicardium, over several hours(3). Restoration of blood flow through the occluded coronary artery needs to occur quickly to prevent a large infarct from forming.
CLINICAL PRESENATION
The most typical presentation of acute myocardial infarction is chest pain. It is often described as a squeezing or crushing sensation in the central part of the chest. Unlike angina, chest pain due to a myocardial infarction continues at rest and typically is not relieved by nitroglycerin(4). The pain will frequently radiate to the shoulder, arm, neck, jaw, or back. However, some patients having a heart attack may present with no chest pain at all. A retrospective secondary analysis of 2,541 patients presenting with cardiac ischemia found that women (P=.007), diabetics (P=.01), and older patients (P=.0001) were less likely to present with classic chest pain(5). They may experience some of the associated symptoms including nausea and vomiting, breaking out in a cold sweat, light-headedness, shortness of breath, or a feeling of weakness or apprehension(4). Physical exam findings for patients with acute myocardial infarction vary significantly.
While the respiratory and cardiovascular systems are most reliant on one another, all body systems require a functioning circulatory cycle in order to thrive. Blood circulation and consistent transfer of oxygen to cells is required to maintain cell and tissue life. Disturbances to this process will cause cells and tissues to die (Red Cross 48). This state of balance and functioning body systems is referred to as homeostasis, defined as a “condition of equilibrium in the body’s internal environment due to constant interaction of body’s many regulatory processes” (Tortura 8). Changes or disruptions to homeostasis are regulated by the Endocrine and Nervous systems of the body. The endocrine system is made up of glands placed throughout the body
Revascularization strategies including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are recommended as treatments for coronary artery disease. [8-11] CABG generally cost more ...
The records have been reviewed. The member is an adult male with a birth date of 02/09/1959. He has a diagnosis of ischemic cardiomyopathy. His treating provider, Maria Costanzo, MD, recommended the Zoll LifeVest (wearable cardioverter defibrillator) for the following dates of service 09/02/2015, 10/02/2015, 12/02/2015, 01/02/2016-02/02/2016 (totaling 4 units).
The blood circulates through coronary arteries and then to smaller vessels into cardiac muscle (myocardium). The blood flow is influenced by aortic pressure, which increases in systole, and the pumping activity of the ventricles. When the ventricle contracts, in systole, the coronary vessels are compressed by the contracted myocardium and partly blocked by the open aortic valve therefore the blood flow through the myocardium stops.
The preliminary step in myocardial infarction is atherosclerosis. Atherosclerosis does not occur abruptly, it is a gradual and dynamic inflammatory disease which causes the narrowing of lumen due to the deposition of lipid and foam cells. The formation of fatty streak; which will eventually become a plaque causes the vessel lumen to diminish. The plaque will become unstable, rupture and eventually lead to the event of plaque disruption.
Coronary artery disease (CAD) is the most common type of multifactorial chronic heart disease. It is a consequence of plaque buildup in coronary arteries. The arterial blood vessels, which begin out smooth and elastic become narrow and rigid, curtailing blood flow resulting in deprived of oxygen and nutrients to the heart [1].
Coronary heart disease is defined by the hardening of the epicardial coronary arteries. The buildup of plaque in the arteries slowly narrows the coronary artery lumen. In order to better understand the physiology of the disease, it is important to first know the basic anatomy of the human heart. The aorta, located in the superior region of the heart, branches off into two main coronary blood vessels, otherwise known as arteries. The arteries are located on the left and right side of the heart and span its surface. They subsequently branch off into smaller arteries which supply oxygen-rich blood to the entire heart (Texas Heart Institute, 2013). Therefore, the narrowing of these arteries due to plaque buildup significantly impairs blood flow throughout the heart.
... of the need of duplicate revascularization over balloon angioplasty [75]. Both pre- and post -conditioning appears to protect cardiomyocytes at the time of reperfusion therapy. Ischemic post-conditioning is a chain of repetitive intermissions of coronary blood flow administered after a period of ischemia. Inhibition of ONOO−-induced nitro-oxidative stress might pay a critical role in postcon-mediated cardioprotection [76]. Iliodromitis et al also reported that postcon-mediated cardioprotection was in cohorts with reduced nitro-oxidative stress in vivo. The acknowledgment that iNOS activation in cardiac myocytes could be advantageous and that nitriate/NO could have both beneficial and detrimental effects, lead to the dose of 1400W iNOS inhibitor being chosen to significantly inhibit, but not restrict, increase in the level of myocardial iNOS activity after MI [77]
Succinctly speaking, a myocardial infarction is not a disease but rather an event occurring due to the progression of coronary heart disease. 1(p.125) With coronary heart disease, the flow of blood which supplies the heart with oxygen is blocked, reducing the amount of oxygen received by the cardiac muscles and resulting in damage or death of cardiac muscle....
759. Mr. Miller is likely presenting with an acute myocardial infarction. Based on his past medical history of hypertension, hyperlipidemia, obesity, and diabetes, along with his current symptoms of chest pain, shortness of breath, pale skin with beads of sweat on the forehead, as well as elevated lab 's Troponin, CK, and CK-MB, he is most likely presenting with an acute myocardial infarction.
Coronary heart disease or coronary artery disease affects 16.8 million people in the United States and causes more than 607,000 deaths annually (Lemone, chap.30). It is caused by atherosclerosis which is the accumulation of fatty deposits in the arteries causing impaired blood flow to the myocardium. CAD or coronary artery syndrome is usually without symptoms but may induce heart attack, angina and acute coronary syndrome if not properly treated. There are many risk factors associated with CAD like obesity, high cholesterol diet, hereditary, physical inactivity, just to name a few. Patients with CAD may be unable to identify and manage their risks factors. It is imperative for nurses to educate the patient about CAD and measures to enhance their health.
Coronary heart disease occurs when some of the arteries that carry blood to the heart muscle become narrowed with fatty deposits. In this condition fatty deposits called plaque, composed of cholesterol (see later) and fats, build up on the inner wall of the coronary arteries. When arteries are narrowed, the heart is not fully supplied with the oxygen and other nutrients it needs. If an artery is completely blocked, a heart attack occurs. Heart disease is very common.
Matocha, D. (2013). The 'Secondary'. Achieving Near-Zero and Zero: Who Said Interventions and Controls Don't Matter? Journal of the Association For Vascular Access, 18(3), 157-163. doi:10.1016/j.java.2013.03.003. Secondary:Curtis, L. (2008).
Oxygen was first admitted to the client with chest pain over 100 years ago (Metcalfe, 2011). Chest pain is a large bracket that can contain many different conditions, but for the purpose of this analysis it is focused manly upon a myocardial infarction. A myocardial infarction is mainly referred to as a heart attack, and occurs when one or more coronary arteries leading to the heart reduce or completely stop blood flow (Tuipulotu, 2013 ). Administering high concentrations of oxygen to patients with chest pain is now embedded in guidelines, protocols and care pathways, even with a lack of clear supporting evidence (Nicholson, 2004 ). High concentration of oxygen means that up to 60% is administered (Knott, 2012). More recent research has suggested that the use of oxygen in this scenario is unnecessary and can lead to unwanted side effects, especially in normoxic cardiac patients (Moradkham & Sinoway, 2010 ). The aim of this comparative analysis is to dismantle and understand both the benefits and risks of the commonly known practice of administration of oxygen to the client with chest pain. Through completing this analysis using recent and appropriate evidence a more improved practice can be given and understood.
Etiology Myocardial infarction occurs when the coronary arteries are blocked by a blood clot. It is commonly known as a “heart attack”. The heart needs its own constant supply of oxygen and nutrients to work properly. Two coronary arteries deliver oxygenated blood to the heart, and if one of these two arteries fails or becomes blocked, then a portion of the heart will not acquire the necessary oxygen. This clot could be because of CAD (coronary artery disease), which happens when the inner walls of the coronary arteries thicken because of buildup of cholesterol, fatty deposits, calcium among other elements that are carried in the blood (Boston Scientific, 2009).