Emergency

Management of
Acute Myocardial
Infarction
Busto
Gloria
Malinao
Quingua

Introduction
An acute myocardial infarction (AMI) is a medical emergency requiring immediate
intervention.
Myocardial infarction (MI)) , commonly known as a heart attack, is the interruption
of blood supply to part of the heart, causing heart cells to die. This is most commonly
due to occlusion (blockage) of a coronary artery following the rupture of a
vulnerable atherosclerotic plaque, which is an unstable collection of lipids(fatty
acids) and white blood cells(especially macrophages) in the wall of an artery.
The resulting ischemia(restriction in blood supply) and oxygen shortage, if left
untreated for a sufficient period of time, can cause damage or death (infarction) of
heart muscle tissue (myocardium).

A 48 year old Jason Dixon had not been feeling well all day and around 10:00
p.m he went to bed. At around 4:00 a.m. his wife awakened to see him slump to
the floor, breathing with difficulty and drenched in perspiration. Alarmed when
he told her of the pain in his chest, neck and arm, she called 911.
The patient carried several risk factors related to both lifestyle and family
history. He is 180 lbs. and worked long hours in a high stress environment as an
advertising agency manager. He was also a moderate cigarette smoker.
According to his wife, he exercised very little and paid virtually no attention to
diet, often eating fast food, as well as eating late at night. His father died at age 56
from heart disease.

Assessment Data
Vital signs
BP: 100/70
RR: 32 bpm
HR: 106 bpm
Temp: 37.9
O2 sat: 89%
ECG: ST segment depression

Cardiac Markers
Cardiac markers are biomarkers measured to evaluate heart
function. They are often discussed in the context of myocardial
infarction, but other conditions can lead to an elevation in
cardiac marker level.

Normal Value

Result

Creatinine
Phosphokinase
CPK

25-90 U/L

130 U/L

CPK-MB
(cardiac
fraction)

3-5%

5.6 %

Troponin I

0-0.4 ng/ml

1.5 ng/ml

Pathophysiology of
Myocardial Infarction

Nonmodifiable risk factors

Age: 48 years old

Sex : Male

Family history of heart

disease

Modifiable risk factors

Obesity

Moderate Cigarette Smoker

High Stress Environment

Lifestyle and diet

Exercises little
Often eats at fastfood

Atheromatous plaque formation

A sudden disruption of atheromatous

plaque

Platelets adhere, aggregate, become activated

Release potent secondary aggregators

Presence of any damage that may causes

obstruction along artery and vessels

vasospasm

Perfusion to myocardium becomes halted

Causes heart tissue to be

necrotic which injury and
inflammation occurs

Low-grade fever

Ischemia develops which impaires

myocardial contractility and function.

The

respiratory rate may

be increased in response
to pulmonary congestion
or anxiety.

Decreased perfusion
in the brain

sympathetic overstimulation
of the heart causes increase in
pulse rate and decrease on
the blood pressure.

RR:32 bpm
Causes oxygen
depletion

Dizziness/lightheadedness

BP: 100/70
HR: 106 bpm

Leakage of hart
enzymes into
circulating blood.

Sever chest Pain

difficulty of breathing.
Clammy and diaphoretic skin

Normal Value

Result

Creatinine
Phosphokinas
e CPK

25-90 U/L

130 U/L

CPK-MB
(cardiac
fraction)

3-5%

5.6 %

Troponin I

0-0.4 ng/ml

1.5 ng/ml

Standard Emergency Treatment Protocol for

MI Symptoms
CHEST PAIN SUGGESTIVE OF AN ACUTE MYOCARDIAL INFARCTION < 10 MINUTES

Immediate Assessment
Obtain Vital Signs with Continuous
Readout
Obtain Standard 12-Lead
Electrocardiogram with Continuous
Readout
Check Breathing (oxygen saturation)
Obtain I.V. Access
Brief, Targeted History
Obtain Blood for Cardiac Serum Markers,
Electrolyte and Coagulation Studies

Immediate General Treatment

Oxygen at 4/Liters minute
Aspirin 160-325 milligrams
Nitroglycerin either sublingual or spray
Morphine for Pain if not Relieved by
Nitroglycerine

1. Administer supplemental oxygen via nasal

cannula at a rate of 2 to 4 L/min and position
patient in upright position unless
contraindicated

When a patient is experiencing an

angina attack, institute the following
measures:

Goal: 10 minutes

2. Assess vital signs.

3. Obtain a 12-lead ECG
4. Provide prompt pain relief first with a
nitrate followed by an opioid analgesic if
needed
5. Auscultate heart sounds: May reveal an
atrial (S4) or a ventricular (S3) gallop.

Pharmacological
Management:

1. Sublingual Nitroglycerine and

Aspirin (chewable) are given to treat
angina pectoris
2. Morphine sulfate is given IV for
pain unrelieved by Nitroglycerine.

Non-Pharmacological
Management:

Ask the patient to describe pain and to

rate it on a scale of 0-10 before and
after the treatment to evaluate the
effectiveness of the interventions.
-Assess for other manifestations of
pain, such as restlessness, elevated
heart rate, respiratory rate or BP,
clutching of bedclothes, or other
nonverbal cues.
Supportive and realistic assurance and
a calm, soothing manner help reduce
the patients anxiety during an angina
attack.
-Maintain bed rest and limitation of
activity for 12-24 hours with a gradual
increase in activity unless
contraindicated.

Dependent Interventions:

Nursing
Priorities
Relieve pain.
Reduce myocardial
workload.

Monitor/document characteristics of
pain
Obtain full description of pain from
patient including location, intensity
(010),
duration,characteristics(dull/crushin
g), and radiation
Instruct patient to report pain
immediately
Provide quiet environment, calm
activities.

Independent Interventions:

Collaborative Interventions:

Administer supplemental
oxygen by means of nasal
cannula or face mask, as
indicated.
Administer medications
as indicated:
Antianginals
(nitroglycerin)
Analgesics (morphine)

Collaborate with Medical

technologists for
monitoring laboratory
data, e.g., ABGs, BUN,
creatinine, electrolytes,
coagulation studies (PT,
aPTT, clotting times)
Collaborate with dietician
for low-sodium diet