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- NURS 6501 Week 3 Assignment Concept Map
Student name
Walden University
NURS 6501
Professor Name
Submission Date
Primary Diagnosis: Myocardial Infarction
- What are the patient’s risk factors for this diagnosis?
| Pathophysiology of Primary Diagnosis | |
| Myocardial infarction is a condition that occurs when one of the blood vessels supplying blood to the heart muscles is blocked to the extent that a portion of the cardiac muscle bulk does not receive enough blood flow, which is highly oxygenated. It is reported that blockage of this section of the coronary artery is due to rupture of its atherosclerotic plaque. In fact, this is a sign that is composed of cholesterol, fatty material, waste products of the cells, calcium, and fibrin. Once the plaque becomes overloaded, it ruptures, forming a blood clot (thrombus) to partially or completely block the blood vessels, which causes ischemia and then the resultant necrosis of the damaged myocardial tissue (Cleveland Clinic, 2022). | |
| Causes | Risk Factors (genetic/ethnic/physical) |
| •Lipid Accumulation: A hard cholesterol LDL was slowly deposited in the walls of the arteries, and this process began the creation of an object known as a fatty streak (Cleveland Clinic, 2022). •Inflammation: A number of inflammatory cells, such as macrophages, have infiltrated the plaque. These cells produce that release proteinases that damage the fibrous cap, which thickens the plaque and makes it susceptible to rupture (Cleveland Clinic, 2022). Plaque rupture: When the fibrous cap becomes weak enough, it may rupture, allowing the lipid core to be exposed to the bloodstream and triggering the coagulation cascade. •Thrombus Formation: In the case of the occurrence of this rupture, platelets adhesive to the site of rupture create a thrombus, and this thrombus can obstruct the blood flow (Cleveland Clinic, 2022). | Modifiable Risk Factors:•Smoking: This is an unhealthy habit that damages the endothelium (lining of your blood vessels/arteries), aids in the formation of plaque, and has a tendency towards clotting. •Hypertension: This makes the arteries change their texture and become stiffer, and makes high blood pressure promote atherosclerosis (Cleveland Clinic, 2022). •Hyperlipidemia: An excess of LDL cholesterol is a significant contributor to plaque accumulation Diabetes: This disease not only puts one at risk of developing atherosclerosis but also accelerates the process (Cleveland Clinic, 2022). Obesity: It correlates with hypertension, hyperlipidemia, and diabetes. •Physical Inactivity: Is associated with cardiovascular risk and obesity. •Unhealthy Diet: Saturated fats, which are also considered to be trans fats, and cholesterol. •Alcohol Consumption: The excessive use of alcohol may increase blood pressure and cholesterol (Cleveland Clinic, 2022). Stress: Chronic stress is a cause of hypertension and unhealthy behaviors. Non-Modifiable Risk Factors: •Age: The other aspect that is taken into consideration here is age, whereby the risk increases in men older than 45 years and women older than 55 years. Gender: To be more precise, men will be more susceptible to the development of the condition when younger than women. •Family History: Family history of heart disease. Ethnicity: A number of ethnic groups exist that have actuarial risk due to genetic and lifestyle factors. |
- How does the diagnosis impact other body systems, and what are the possible complications?
| Signs and Symptoms – Common presentation | Complications? |
| i. Chest Pain or Discomfort: It is usually described as a pressure, but in many instances, a tightness, squeezing, or burning pain in the mid-point of the chest. This pain can be referred to the arm, neck, jaw, back, or stomach (Zafari, 2019). ii. Shortness of Breath: This is the difficulty in breathing or feeling short of breath, and may be accompanied by chest pain or not. iii. Sweating: Cold, clammy sweat, which suddenly appears (Zafari, 2019). iv. Nausea and Vomiting: To have a sore stomach or to vomit. v. Lightheadedness or Dizziness: A feeling of feeling lightheaded or dizzy, and sometimes it may result in passing out (Zafari, 2019). Fatigue: Experiencing unusual tiredness, especially common in women. | A myocardial infarction (heart attack) can have widespread effects on other body systems and lead to various complications: Cardiovascular System: i. Heart Failure: Such causes include short breathing, tiredness, and swelling of the limbs caused by the disruption of blood flow and weakening of the heart to pump blood (Zafari, 2019). ii. Arrhythmias: Arrhythmias can consist of various irregular heartbeats ranging in severity to more serious ones that are life-threatening, such as ventricular fibrillation, resulting in cardiac arrest. iii. Cardiogenic Shock: This is a very poor heart coordination in pumping blood that is usually due to very damaged heart tissue. iv. Respiratory System: Pulmonary Edema – accumulation of fluid in the lungs, which causes difficulty in breathing (Zafari, 2019). v. Renal System: Acute Kidney Injury – acute injury of the kidneys, which impairs their functioning by slowing down their capacity to eliminate waste substances in the blood (Zafari, 2019). vi. Nervous System (Stroke) vii. Gastrointestinal System (Nausea and Vomiting) viii. Musculoskeletal System |
3.
| Several conditions can present with symptoms similar to myocardial infarction, making differential diagnosis essential: i. Angina Pectoris: chest pains, especially due to insufficient blood flow to the heart muscles in the coronary arteries. ii. Gastroesophageal Reflux Disease (GERD): Continuous heartburn or indigestion is one possible cause of chest pain or discomfort, which can be mistaken for the signs of a heart attack. iii. Pericarditis: Some of the cardiac causes of chest pains include inflammation of the pericardium that causes sharp and stabbing chest pains that worsen upon breathing or lying down (Sullivan, 2021). iv. Pulmonary Embolism: When the blood clots in the lungs, it may cause sudden chest pain, shortness of breath, and other symptoms that are similar to MI (Sullivan, 2021). v. Aortic Dissection: A life-threatening condition where some of the inner aortic lining ruptures due to the pressure and causes severe mid-area pain that can extend to the back. It requires immediate attention by the healthcare provider. vi. Musculoskeletal Pain: Pericarditis, inflammation of the membrane surrounding the heart, can mimic a heart attack, and costochondritis, inflammation of the rib cartilage that connects to the breastbone, can also cause pain in the chest (Sullivan, 2021). vii. Panic Attack: It is constructive to mention that panic attacks are serious phases of fear and anxiety that can also cause chest pains, difficulty breathing, and other characteristics that are compatible with MI (Sullivan, 2021). |
- What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
| 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) |
- What treatment options would you consider? Include possible referrals and medications.
| Procedures:1. Percutaneous Coronary Intervention (PCI): This is also referred to as angioplasty, which entails the insertion of another tube that is narrow with a small but similar to that of a balloon at its tip into the blood vessel and passing this until it reaches the affected coronary blood vessel. This is done with the help of a balloon that opens the artery, or in some cases, a stent is implemented to keep it open (Jenča et al., 2020). 2. Coronary Artery Bypass Grafting (CABG): This is a procedure that involves the removal of the veins formed in other parts of the body, especially the leg, and the utilization of these veins to form a circulation around the blocked coronary arteries to supply blood to the heart muscle (Jenča et al., 2020). Ongoing Care:3. Cardiac Rehabilitation: A structured model that involves exercise, education, and counseling processes that help MI patients resume normalcy and/or improve their cardiovascular fitness, reducing the risk of subsequent instances of heart-related problems (Jenča et al., 2020). 4. Lifestyle Changes: They are: non-smoking, a healthy diet and exercising, regular exercise, maintaining a healthy 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) |
Reference for NURS 6501 Week 3
Cleveland Clinic. (2022). Heart Attack (Myocardial Infarction). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction
Jenča, D., Melenovský, V., Stehlík, J., Staněk, V., Kettner, J., Kautzner, J., Adámková, V., & Wohlfahrt, P. (2020). Heart failure after myocardial infarction: incidence and predictors. ESC Heart Failure, 8(1), 222–237. https://doi.org/10.1002/ehf2.13144
Ojha, N., & Dhamoon, A. S. (2023, August 8). Myocardial Infarction. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537076/#:~:text=Myocardial%20infarction%20(MI)%2C%20colloquially
Sullivan, D. (2021, November 3). Acute Myocardial Infarction: Causes, Symptoms, and Treatment. Healthline. https://www.healthline.com/health/acute-myocardial-infarction
Zafari, M. (2019, June 6). Myocardial Infarction: Practice Essentials, Background, Definitions. Medscape.com. https://emedicine.medscape.com/article/155919-overview
