Fatigue and Physical Activity in Older Women After Myocardial Infarction

The article uses correlation quantitative research as the method for research. The method uses two variables to test or determine their relationship to the topic of the research. The use of this method exposes the outcome of the research to risks associated with biasness, manipulation, and control. The use of this article by nurses in their practices would have the risks associated with having negative outcomes of the practices and the majority of their patients developing more complicated issues.

The method used is subject to manipulation and biases during the research and cannot achieve the required outcomes. This is due to the use of the variable that may have a little relationship and thus the research may have to false the research outcomes (Anthony & Jack, 2009). This causes the outcomes or the reached findings to be unreliable for use. For instance, in the article, the “strong correlations were noted among depression, sleep, and fatigue” (Crane, 2005). However, the research indicated that only 32.7% of the women exposed to sleep and depression suffer from myocardial infarction.

The findings indicate that majority of the women meet the minimal kilocalories required per week to prevent myocardial infarction (Crane, 2005). These findings though they have their recommendations, may not be fully reliable as they may have some contradicting issues between the variables.

To avoid these risks; the research method needs to be elaborative and has different approaches. The use of experimental research would have reliable findings, as the methods used to sample out the data are generally better than for correlation (Anthony & Jack, 2009). The method has low risks of biasness, control, and manipulation as it involves randomization of samples that make every sample in the population to have a given probability.

References

Anthony, S. & Jack, S. (2009). Qualitative case study methodology in nursing research: An integrative review. Journal on Advanced Nursing, 65(6):1171-81.

Crane, P. (2005). Fatigue and physical activity in older women after myocardial infarction. Heart & Lung, 34(1), 30-37.

Myocardial Infarction: Changes in Sites of Care

Introduction

The transition from one setting to another may be difficult for older adults. While many facilities are not attempting to implement the transitional care model to assist patients in adapting to the new environment, many examples of unsuccessful transitions exist (Hirschman, Shaid, McCauley, Pauly, & Naylor, 2015). The present case discusses the choices of an 89-year-old man who was admitted to a hospital for several days because of myocardial infarction (MI). After a week of being in a hospital, the patient was discharged to his home according to his wishes. While follow-up visitations and communication supported the transition, the man’s health affected his reintegration into the home setting.

Impact of Differences and the Advance Directive

In this instance, the patient was admitted to the hospital with the assistance of his daughter, who was with her father when the MI happened. While in the hospital, the patient received the necessary care, regaining consciousness and mobility. The patient’s fall damage (he fell during the MI and hit his head) was also treated. He was discharged to go back home with directions to continue taking medication and slowly resume his physical activity.

Nevertheless, upon returning home, the patient did not adhere to the recommendations. He did not take medications on time and did not balance his physical activity when performing household chores. The setting of the hospital allowed him to rest and communicate with other people, and nurses helped him to take his medication (Kogan, Wilber, & Mosqueda, 2016). The man did not have a supportive framework at home because he lived alone, and his only daughter lived far away from him.

The patient’s decision to return home could not be questioned since it was specified in his advance directive. The man firmly believed that he did not want to reside in a facility and wanted to stay at home regardless of the circumstances. The hospital staff discussed options of changing the advance directive, seeing that the man’s health could quickly deteriorate without proper care. However, since he did not change his decision, he went home after being treated. The patient’s choice presented healthcare providers with an ethical issue – to respect the wishes of the person even if they were detrimental to his health (Lum, Sudore, & Bekelman, 2015). During the follow-up conversations, nurses attempted to review the environment of the patient and see what could be changed to improve medication adherence and help the patient to limit physical exertion.

Financial Issues

In this case, the patient’s placement was explained by his personal wishes. Nonetheless, in some situations, patients’ options are limited due to financial problems. For instance, several nursing homes do not allow Medicare, which usually covers the residence costs partially or in full (Resnick, 2016). People who do not have insurance may not afford to stay in a facility. Some people also refuse treatment, resuscitation, and life support due to financial difficulties.

Conclusion

In the present case, the patient was admitted to the hospital after an MI. Upon discharge, he returned to his home, where he quickly abandoned the practices that were suggested to him by healthcare providers. The lack of a caring culture and professional attention led to complications, as the patient could not care for himself. However, an advance directive limited the extent to which advanced practice nurses could influence the patient’s choice for sites of care. Financial difficulties can have a similar effect if a person’s insurance does not cover the costs of assisted living or nursing homes.

References

Hirschman, K. B., Shaid, E., McCauley, K., Pauly, M. V., & Naylor, M. D. (2015). OJIN: The Online Journal of Issues in Nursing, 20(3). Web.

Kogan, A. C., Wilber, K., & Mosqueda, L. (2016). Person-centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society, 64(1), e1-e7.

Lum, H. D., Sudore, R. L., & Bekelman, D. B. (2015). Advance care planning in the elderly. Medical Clinics, 99(2), 391-403.

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

Myocardial Infarction: Cardiac Shock and Transportation the Patients

Myocardial infarction

Anterior wall myocardial infarction is a severe condition that results due to the restricted blood supply to the heart muscle. Given the patient’s age, smoking history, and related health conditions, such as diabetes, the risk of complications is high. Low blood pressure, difficulty breathing, nausea, and sweating are common symptoms for myocardial infarction, but they can also signify the development of complications, such as congestive heart failure or cardiogenic shock (Bajaj et al., 2014). Moreover, these complications can be followed by acute kidney injury in the case of this patient.

Heart failure, or congestive cardiac failure, is when the heart is weakened or stiff, and pumping chambers cannot be adequately filled. Although this condition develops slowly, it can be life-threatening for the patients. Myocardial infarction is a significant predictor of heart failure, but the risks increase along with such factors as age, diabetes, or smoking history. Low blood pressure, nausea, and confusion can signify the dangers of cardiac failure for this patient.

Cardiogenic shock is a dangerous condition defined as “a state in which ineffective cardiac output caused by a primary cardiac disorder results in both clinical and biochemical manifestations of inadequate tissue perfusion” (Van Diepen et al., 2017, p. e2). The symptoms that include rapid breathing, tachycardia, low blood pressure, and limited urination are present in this patient’s case. This complication is of a higher priority not only because of its feasibility but also because of its severity and rapid development. According to Puerto et al. (2018), it is “the main mechanism for early death after AMI in elderly patients… causing roughly one-half of initial deaths, followed by mechanical complications” (p. 960). That is why this condition can be predicted, and immediate treatment practice should be conducted to prevent a lethal outcome.

Cardiac shock

When the cardiac shock is caused by STEMI, as in the case with this patient, the guidelines published by Queensland Ambulance Service (2020) recommend the same treatment procedures as for acute coronary syndrome (ACS). The primary purpose of this practice is to “ensure adequate circulatory and respiratory support” (Queensland Ambulance Service, 2020). In the case of this condition, early revascularization is a significant predictor of survival rate (Reddy, Khaliq, and Henning, 2015). According to Chew et al. (2016), “primary percutaneous coronary intervention (PCI) or fibrinolytic therapy is recommended” (p. 130). The use of IABP (intra-aortic balloon pump) is recommended before primary PCI to decrease mortality risk (Yuan and Nie, 2016). Primary PCI is the best solution for this patient, but it should be done within the first 90 minutes of treatment. Therefore, it is of the highest priority to transfer the patient to the tertiary hospital as soon as possible.

Immediate pharmacological treatment for the patient with cardiogenic shock caused by STEMI includes aspirin, P2Y inhibitors, and inotropes to maintain blood pressure. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand recommend immediate use of Aspirin “300 mg orally, followed by 100-150 mg/day” (Chew et al. 2016, p. 130). The use of P2Y inhibitors should include “ticagrelor 180 mg orally, then 90 mg twice a day; or prasugrel 60 mg orally, then 10 mg daily; or clopidogrel 300e600 mg orally, then 75 mg daily” (Chew et al. 2016, p. 130). Lastly, Dobutamine infusion is necessary “to maintain mean arterial pressure to prevent end-organ damage” (Bajaj et al., 2015). Van Diepen et al. (2017) suggest using 2.5 µg/kg/min dosage for cardiogenic shock treatment. Lastly, the treatment should include long-term anticoagulant medication in the following days.

The nursing care plan for the patient developing cardiogenic shock includes assessment and proper documentation of health parameters, as well as the adjustment and management of therapies and medication. Health parameters should be assessed directly after the admission, and then they should be closely monitored with the documentation of all changes. Patient data for this client should include:

  • Vital signs: Heart rate, breathing rate, pulse pressure, and blood pressure;
  • Cardiac rhythm and rate monitored with ECG;
  • Monitoring of oxygen saturation and ABG with pulse oximeter;
  • Control and assessment of renal output;
  • Evaluation of client’s consciousness level, check for signs of anxiety, pain assessment.

The management of the prescribed therapies and medication, as well as communication and reassuring, are essential parts of a nursing care plan that include the following:

  • Management of IV sites, keeping fluid balance chart, reducing swelling with ice if needed;
  • Manage oxygen if to keep blood saturation;
  • Administration of the prescribed medication according to the treatment plan;
  • Administration of pain medications when needed;
  • Continuous communication with the patient and his wife to reassure and answer the questions.

The process of patient transfer

As the process of patient transfer bears significant health risks, it should be done only when health benefits are significantly higher. In the case of the discussed patient, the decision is justified by the need for PCI intervention in case of cardiogenic shock. As logistic arrangements must ensure safety and time-efficiency of transportation, it is essential to use the advanced life-support ambulance with “cardiac monitoring, defibrillation, administration of intravenous fluids” (Kulshrestha and Singh, 2016, p. 451). Kulshrestha and Singh (2016) also claim that the patient should be accompanied by an emergency team of at least two people. Communication with the receiving hospital is a necessary procedure that ensures preparedness and safe handover.

The vehicle should be provided with all the necessary equipment, including respiratory support, circulatory support (monitor, defibrillator, pulse oximeter, infusion pumps, and intravenous fluids set), and with the required pharmacological set (ANZCA, 2015, p. 9). Additionally, the ambulance must contain all the necessary documentation to provide accurate handover history. The recommendations state that “the patient must be reassessed before transport begins, especially after being placed on monitoring equipment and the transport ventilator” (ANZCA, 2015, p. 8). During transportation, the medical officer should monitor and document basic parameters for respiration, circulation, and oxygenation.

Symptoms of AKI

If the patient is developing cardiogenic shock, low or absent urine output are common symptoms of the condition. The feasibility of AKI is increased due to the previously observed low renal function reported by the patient. Additionally, there are significant risks of AKI (acute kidney injury) development among patients with STEMI. Schmucker et al. (2017) claim that a decline in renal function is commonly observed among patients with such conditions. More precisely, one-center study evidence provides the 18% ratio of AKI among patients with STEMI (Schmucker et al., 2017). AKI is a severe condition that negatively influences health outcomes. That is why the patient will be diagnosed on the subject of acute kidney injury to identify the problem and develop an appropriate care plan in case of complication.

Nevertheless, it cannot be precisely stated that the patient is suffering from AKI until the necessary assessment is conducted. According to Van Diepen et al. (2017), urinary output reduction is a symptom of AKI among patients with myocardial infarction or cardiogenic shock. Still, serum creatinine levels should also be evaluated to indicate renal hypoperfusion. According to Prowle et al. (2015), the levels of Hepcidin and NGAL (neutrophil gelatinase-associated lipocalin) are informative methods of AKI diagnosis. That is why the biomarkers assessment will be conducted for this patient due to the feasible acute kidney injury. Furthermore, the treatment will be designed to reduce support patient’s renal function.

References

Australian and New Zealand College of Anaesthetists (ANZCA). (2015). Guidelines for transport of critically ill patients. Web.

Bajaj, A., Sethi, A., Rathor, P., Suppogu, N., & Sethi, A. (2015). Acute complications of myocardial infarction in the current era. Journal of Investigative Medicine, 63(7), 844-855.

Chew, D. P., Scott, I. A., Cullen, L., French, J. K., Briffa, T. G., Tideman, P. A., … Aylward, P. E. (2016). National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Medical Journal of Australia, 205(3), 128-133.

Kulshrestha, A., & Singh, J. (2016). Inter-hospital and intra-hospital patient transfer: Recent concepts. Indian Journal of Anaesthesia, 60(7), 451.

Prowle, J. R., Calzavacca, P., Licari, E., Ligabo, E. V., Echeverri, J. E., Bagshaw, S. M., … Bellomo, R. (2015). Combination of biomarkers for diagnosis of acute kidney injury after cardiopulmonary bypass. Renal Failure, 37(3), 408-416.

Puerto, E., Viana-Tejedor, A., Martínez-Sellés, M., Domínguez-Pérez, L., Moreno, G., Martín-Asenjo, R., & Bueno, H. (2018). Temporal trends in mechanical complications of acute myocardial infarction in the elderly. Journal of the American College of Cardiology, 72(9), 959-966.

Queensland Ambulance Service. (2020).

Reddy, K., A., Khaliq., & Henning, R. J. (2015). Recent advances in the diagnosis and treatment of acute myocardial infarction. World Journal of Cardiology, 7(5), 243-276.

Schmucker, J., Fach, A., Becker, M., Seide, S., Bünger, S., Zabrocki, R., … Wienbergen, H. (2017). Predictors of acute kidney injury in patients admitted with ST-elevation myocardial infarction – results from the Bremen STEMI-Registry. European Heart Journal: Acute Cardiovascular Care, 7(8), 710-722.

Van Diepen, S., Katz, J. N., Albert, N. M., Henry, T. D., Jacobs, A. K., Kapur, N. K., … Cohen, M. G. (2017). Contemporary management of cardiogenic shock: A scientific statement from the American Heart Association. Circulation, 136(16), e1-e24.

Yuan, L., & Nie, S.-P. (2016). Efficacy of intra-aortic balloon pump before versus after primary percutaneous coronary intervention in patients with cardiogenic shock from ST-elevation myocardial infarction. Chinese Medical Journal, 129(12), 1400-1405.

Myocardial Infarction Treatment With Clopidogrel & Plavix

Abstract

At a time when the rate of myocardial infarction recording shows shocking percentages and the question of whether there are other therapy measures adoptable to reduce heart attack cases, the research was inevitable. The research aimed to answer the question posed by the confusion that was generated as to whether myocardial infarction can be treated by clopidogrel and Plavix, as opposed to monotheraphy and aspirin.

The sources used in formulating clinical question were mainly from the National Institute of Health, Cochrane Library, MEDLINE and relevant books. The literature review in this research has clearly shown that the treatment of myocardial infarction is not limited to clopidogrel. Thus, discord of dual or monotherapy with aspirin and clopidogrel has proven reliable. In conclusion, the clinical trials and the reviewed data have shown that the rise in the rates of myocardial infarction is alarming. The curbing and treating of the disease will take proper coordination between the patient and the physician since lifestyle modifications can only be initiated by the patient.

Introduction

There are numerous diagnostic tests conducted to detect the heart muscle damage in an effective manner. Some are blood tests and use of electrocardiogram or echocardiography. The most used blood markers for the blood tests are creatine kinase fraction. Many cases of myocardial infraction are sometimes treated by the use of reperfusion therapy. Immediate diagnosis of myocardial infraction can be through the use of oxygen, aspirin and subliminal nitroglycerine (Hutchison, 2009). This paper focuses on presenting a review of the literature evidence regarding the treatment of myocardial infarction and the use of Clopidogrel and Plavix.

In this research, the patient intervention research method was adopted (PICO) to formulate a clinical question. In addition, the OVID, MEDLINE, PUBMED, AMERICAN HEART ASSOCIATION MIOCARDIAL INFARCTION GUIDELINES, a service available at the National Institute of health and Cochrane Library which encompasses data being arranged in databases that contain high quality data with credibility and neutral evidence to enhance informed decision on treatment of myocardial infarction.

In the literature search, the following key words were used and understood for literature search. The key terms include myocardial infarction; discord of dual or monotherapy, clopidogrel and Plavix. In the literature search, each question was identified in the clinical context and subsequently combined with the relevant articles. The research was further subjected to certain limitation, which includes use of English language and randomized review articles and books.

Literature Review

Geeganage (2010) argues that, in prevention of recurrent vascular events, it is important to consider dual antiplatelet since it usually gives out superior results compared to monotherapy treatment. In addition, the triple antiplatelet can also be used to achieve a comparing mode. In the research, random controlled research was put under investigation. The main aim of the investigation was to find out the effect of dual platelets compared to triple platelets on patients suffering from Myocardial infarction (MI) or acute myocardial infarction (AMI). A total of twenty randomized trials were completed.

Estimates of 17,383 patients were included in the investigation. Extraction of data was done from patients of myocardial infarction and stroke. Further, data on death and bleeding were analyzed with 95% random calculated effects models. The results of the said investigation found out that Triple therapy with intravenous inhibitor sufficiently had a reducing effect on the patients suffering from myocardial infraction.

The results showed 95% reduction in myocardial infarction and the same percentage with non ST elevation of acute coronary syndromes. It was further identified that there was a 95% reduction on the death of the patients admitted with myocardial infarction and treated with GP inhibitor. On the other hand, minor bleeding was also noted. Stroke events were significantly cut and no substantial data identified.

The identifiable results linked with the above mentioned investigation led to the following deductions. First, it was found out that the triple antiplatelet therapy based on GP inhibitor was more effective compared to aspirin dual therapy. Secondly, the results deduced that there was a reduction in the bleeding was detected. It was also evidenced that patients with elective PCI had no substantial effect when given triple therapy. There was 80% increase in transfusions and a noted increase in thrombocytopenia.

It is to be noted that what the foregoing research does is that it demonstrates that pathogens have an influence to different vascular syndromes. These vascular syndromes include myocardial infarction. Anti-platelet helps in bringing the said occurrence under prevention. The process of inhibiting platelets is one which requires blockade of the ADP platelet receptor. The blockade goes hand in hand with a significant increase in nitric oxide levels. From the conducted research, it has shown that many of the antiplatelet agents are taken orally, but the trend has changed due to indicators pointing at increased deaths.

Recurrent events are substantially reduced by use of aspirin. An estimation of 15-20% data from the use of indirect comparisons show that aspirin and clopidogel have different mechanisms, and there are indications that the drugs are addictive. The use of aspirin and clopidogrel is discouraged if it is used for long term prophylaxis. The use of the combined drugs for more than 6 months shows excess bleeding.

The most common drug linked with the treatment of cardial infarction is clopidogrel. In its nature, the drug requires inactive prodrug that relies on oxidation. The risk of heart attack can be substantially addressed by the little amount of aspirin dose. Studies have shown that aspirin is one of the widely used anti platelet agent. In the growing concerns of the efficacy of cardial infarction drugs, Plavix has been under scrutiny.

It is undisputable that Plavix rates are second to aspirin in selling. Clinical trials indicate that the combination of clopidogrel and aspirin is more effective mainly to patients with unstable angina and who have myocardial infarction. The combination does not increase the risk of bleeding in the short term. However, long term tests have proved that bleeding can occur in advanced stages of the use of the combination. The benefits are to be put at a weighing balance whereby the decision should be based on what out weighs the other between risk and benefits. It is also said that not all patients using the combination are affected. It has also been found out that prasugrel, which is an antiplatelet agent, is stronger than clopidogrel combined with aspirin (Topol, 2007).

Whereas the combination of aspirin and prasugrel is said to be effective, there is evidence that indicate that higher risks of major bleeding are possible compared to the aspirin and clopidogrel combination. The class of patients unlikely to benefit from the latter combination is those with history of stroke and low body weight and of the age of 75 and above years. The debate as to whether the benefits of aspirin combination with clopidogrel outweigh has more benefits than effects its still ongoing (Cannon, Steinberg & Sharis, 2011).

The combination of clopidogrel and aspirin is said to reduce death at a rate of 9% while reinfarction or stroke is reduced at a rate of 9.2%. The results are achieved despite the use of other treatments. It has argued that all patients with the history of myocardial infarction require a long term and well managed anti-platelet therapy. This is regardless of the nature of intervention used to treat it. Increased treatment has shown that many patients can survive. The key role of anti-platelets therapy cannot be ignored either before or after Myocardial infarction. Dual anti-platelet therapy with aspirin, which is otherwise known as a thromboxane inhibitor, is successful if carried out through clopidogrel or prasugrel. The recommended daily dose of aspirin ranges from 75mg to 325 mg (Khan, 2007).

Research conducted shows that premature stopping of antiplatelet therapy has disastrous effects on patients suffering from myocardial infarction shown that mortality can be reduced compared to historical controls. In recent years, it has been shown that ACE inhibitors play a role in reducing the mortality of myocardial infarction (Aschenbrenner & Venable, 2009).

Evidence has identified that high risk patients who continuously use aspirin have a reduced range of a vascular event. Also, in these patients, non-fatal strokes and death from vascular diseases are reduced. The rate of reduction ranges from 26%-32% compared with other types of treatments. In addition, segment elevation of myocardial infarction decrease when aspirin is used. It should be noted that there are post effects of aspirin range up to 72% increase in the amount of mortality. The non-adherence to blockers is said to constitute 10% to 40% increase in the cases of cardiovascular hospitalization (Grech, 2010).

Substantial question as to whether early identification and treatment of myocardial infraction can reduce the death rate from 50-60% has been raised. The answer to such a question has been hard to identify. However, it is clear that any effort is geared towards reducing the mortality and morbidity of myocardial infraction. There are studies that show that resuscitation saves lives. It has been found out that 75% of the sudden cardiovascular collapses are caused by fibrillation (Jacobson & Linden, 2011).

There are risk factors associated with myocardial deaths are said to have delineated in the recent past. Elevations of other substances, which increase blood pressure such as cigarette smoking, have led to increase in the risk. The most prominent prognostic variables are highly linked with the myocardial damage which is said to occur after the infarction. The natural history of the disease is highly determined by age (Iskandrian & Garcia, 2008).

Summary and Conclusion

Evidence from these studies clearly shows that the level of myocardial infarction is hitting the skies. The studies further indicate that several treatments have been used to help in reducing the risk of cardiovascular attack. The use of clopidogrel and Plavix has been considered one of the most famous forms of treatment. In addition, combination of aspirin and clopidogrel has also been taken into consideration. The greatest limiting factor in this research is that much time is required if highly reliable results are to unfold. The follow ups in the research require a lengthy time.

Clinical Recommendation

According to the literature reviewed, it has been established that the treatment of myocardial infarction is a process with numerous essential steps which must be followed in order to achieve reliable results. The combination of aspirin and clopidogrel is not in itself conclusive. Therefore, the thrombolytic therapy is necessary when dealing with acute myocardial infarction. On the other hand, a healthy lifestyle has to be in tandem with the treatment preferred. The intake of alcohol and cigarettes should be reduced and eventually abstained. The treatment of myocardial infarction requires patience and consistency.

The table of the studies

Table 1. Literature Review on myocardial infarction treatment.
Authors Research Design Sample Intervention (I)/Outcome Measure (OM) Results
Geeganage (2010) Meta-analysis 17,383 trials Literature on the treatment of myocardiology presented in answers form. Triple antiplatelet therapy was more effective than aspirin based dual therapy. Range of VE: OR 0.69, 95% CI
0.55-0.86; MI: OR 0.70, 95% CI 0.56-0.88)
Woodward (2004). Randomized study 7 studies conducted and left uninterrupted Presentation of evidence on myocardial seeking to answer the question of other interventions. Use of staff, patient experience. Evidence showed direct relationship between the period of treatment and the results seen
Garavalia (2010) Qualitative study clinicians interviewed, 33% of the physicians
specialized in internal medicine, 53% in cardiology, and
13% in interventional cardiology.
Physicians answered questionnaires on myocardial treatment Both groups were
approximately 53 years old and ranged from 45 to 77 years
of age, more likely male (55% Continuers vs. 64%
Discontinuers), the majority were Caucasian (82% for
both) Interventions contributions to the treatment of myocardial ranged from 40-68% across all physicians.
Commit (2005) Randomized control trial 45 852 patients physicians intensive care units in a tertiary care center Question answered on Use of cigarettes and alcohol Allocation to clopidogrel produced a highly significant 9% (95% CI 3–14) proportional reduction in death,
reinfarction, or stroke (2121 [9·2%] clopidogrel vs 2310 [10·1%] placebo; p=0·002),
Ashna (2008) Meta-analysis clopidologrel Asprin Healthcare workers in a neonatal intensive care unit Creation of awareness and educating the patients. High levels of using life style interventions witnessed

References

Ashna, Y. (2008). Meta-Analysis of the Efficacy and Safety of Clopidogrel Plus Aspirin as Compared to Antiplatelet Monotherapy for the Prevention of Vascular Events. Web.

Aschenbrenner, D.S. & Venable, S.J. (2009). Drug therapy in nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Cannon, C.P., Steinberg, B.A. & Sharis, P.J. (2011). Evidence-based cardiology. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.

Commit, W. (2008). Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomized placebo-controlled Trial; 356. Pp. 1-123.

Garavalia, N. (2010). discord: Exploring differences in perspectives for Discontinuing clopidogre. Web.

Geeganage, M et al. (2010). . Web.

Grech, E.D. (2010). ABC of interventional cardiology. Oxford: Wiley-Blackwell.

Hutchison, S. J. (2009). Complications of myocardial infarction: Clinical diagnostic imaging atlas. Philadelphia, PA: Saunders/Elsevier.

Iskandrian, A.E. & Garcia, E.V. (2008). Nuclear cardiac imaging: Principles and applications. Oxford: Oxford University Press.

Jacobson, K.A. & Linden, J.M. (2011). Pharmacology of purine and pyrimidine receptors. San Diego, CA: Academic Press.

Khan, M.I.G. (2007). Cardiac drug therapy. Totowa, N.J: Humana Press.

Topol, E.J. (2007). Textbook of cardiovascular medicine. Philadelphia: Lippincott Williams & Wilkins.

Myocardial Infarction in Australia Analysis

Introduction

Cardiovascular diseases (CVDs) are recognized as among the leading causes of health and economic burden, not only in Australia but also globally (O’Neil et al., 2012). CVD is a generic term describing a multiplicity of diseases that results from inadequate blood flow to the heart, primarily caused by the constriction of the coronary arteries due to atherosclerosis. Myocardial infarction (MI), according to Joynt et al (2009), is the most persistent form of CVD and occurs when a section of the heart muscle dies or is lastingly damaged due to insufficient supply of oxygen to that section triggered by a continued obstruction in a coronary artery. The present paper aims to explore and analyze how MI is currently affecting the Australian population.

Exploration & Analysis of MI in Australia

Population/Community affected by MI

Extant literature demonstrates that not only are men at a higher risk of MI than women, but they are more likely to become victims at a relatively younger age (BigPond, n.d.). Loughnan et al (2008) suggest that although men and women aged over 70 are at an elevated risk of being affected by MI, around 75 percent of recorded heart attacks are in male patients, but their predisposition diminishes with advancing age. In contrast, menopausal women record higher rates of MI than younger women due to lack of estrogen, which is known to reduce the build-up of plaques in blood arteries (Ioannides-Demos et al., 2010).

Extending work in this nascent area of research, Hunter (2010) claims that indigenous people of Australia (Aboriginals) have the greatest excess mortality and morbidity from MI. This fact is reinforced by an Australian report on CVD, which suggests that “…mortality from all cardiovascular diseases was highest in the Northern Territory at 3,900 and 2,426 deaths per million population for males and females respectively in 1994-96” (Overview of Current Trends, n.d., p. 9). The higher mortality rate in the Northern Territory, according to this report, can be attributed to the fact that aboriginals and other indigenous people form a large part of the population compared to other regions in Australia. Overall, according to Ioannides-Demos et al (2010), the Australian population mostly affected by MI is aged between 25 and 84 years.

Scope & Implications of MI in Australia

Acute myocardial infarction (AMI) can be delineated as the detection of elevated values of cardiac biomarkers (preferably troponin) above the 99th percentile of the upper reference limit (URL) with one or several of the following: a) ischemic symptoms, b) electrocardiographic (ECG) shifts indicative of new ischemia (new ST-T changes or the new left bundle branch block), c) development of pathological Q waves in ECG, and d) imaging evidence of new loss of viable myocardium or the new regional wall motion abnormality (Jaffe, 2008). MI, according to this author, can also be defined in terms of unexpected cardiac death, including cardiac arrest, with symptoms reminiscent “…of myocardial ischemia, accompanied by new ST elevation, or new LBBB [left bundle branch block], or definite new thrombus by coronary angiography but dying before blood samples could be obtained, or in the lag phase of cardiac biomarkers in the blood” (P. 1486). It is important to note that although AMI is a major contributor to ischemic heart disease mortality in Australia because it is responsible for 60 percent of ischemic-related deaths, mortality resulting from AMI has been declining slightly faster than ischemic heart disease at an annual rate of 5.5 percent and 4.7 percent for males and females respectively (Overview of Current Trends, n.d.).

In terms of scope, it is reported that the most recent guidelines recognize five distinct variants or types of MI (Jaffe, 2008). Type 1 is an impulsive MI due to severe plaque rupture or erosion, implying that it characterizes as the typical ST elevation or non-ST elevation MI (Jaffe, 2008). This particular author conceptualizes Type 2 MI as “…secondary to an imbalance between oxygen supply and demand which may occur when one has fixed coronary disease and tachycardia, due to anemia or drug overdose, and at times can be related to concurrent abnormalities in coronary vasomotion” (p. 1487).

Type 3 MI is demonstrated in an individual “…with a classic MI with verified thrombus by angiography or at autopsy who dies before a troponin measurement being obtained or, if obtained, before a rise can be observed” (Jaffe, 2008, p. 1487). Type 4 MI, according to recent guidelines, is directly linked to percutaneous coronary interventions either in terms of the procedure itself or hinged on subsequently verified stent thrombosis. Lastly, Type 5 is a heart condition that generally occurs as a direct result of coronary bypass graft surgery (Jaffe, 2008). Majority of patients who die from MI in Australia develop ventricular fibrillation, which occurs soon after the onset of ischemia but before they can seek medical attention (O’Neil et al., 2010).

MI has far-reaching implications for the affected population. In Australia, as in other countries, MI forms a massive burden of care, in terms of morbidity, mortality, and economic cost (Chew et al., 2007). Although the incidence of CVD has been decreasing in Australia going to data released by various government agencies, the predictions still indicate that CVD and MI will constitute the major burden of disease in the country in the foreseeable future (O’Neil et al., 2012). In 2003, as reported by Ioannides-Demos et al (2010), CVD contributed considerably to the mortality and morbidity of the Australian population, accounting for an estimated 18 percent of the total burden of disease. These authors further observe that in 2006, one-third of all deaths in Australia were directly related to cardiovascular incidences, whereas AMI and angina pectoris accounted for almost half of over 45,000 CVD deaths recorded in 2005. These statistics demonstrate that MI is not only a common health problem in Australia, but is a serious and life-threatening condition (BigPond Health, n.d.).

Most survivors of MI are rendered unproductive or underproductive due to the nature of the illness and the high risk of recurrent heart attacks (O’Neil et al., 2012). Apart from this loss of individual productivity, society, in general, suffers from loss of productive members and the economic costs of the disease burden (O’Neil et al., 2010), as the disease is known to kill most of its victims as it progresses (BigPond Health, n.d.). This implies that society is not only burdened with the cost of bringing up the children of people who succumbs to MI but is forced to develop mechanisms to sustain the surviving patients who have been rendered morbid by the condition. Furthermore, the costs involved in managing MI have skyrocketed over the years, with available literature demonstrating that the cost for a MI in 2004-2005 ranged between $A3047 and $A9154 (Ioannides-Demos et al., 2010). This implies that the affected people are often prevented from achieving social and economic advancement as they routinely use considerable sums of money for hospitalization and treatment. Lastly, MI is associated with increased stress and depression (O’Neil et al., 2012), implying that the affected population is forced to put up with low-quality life due to the depressive state of mind and emotional drain.

Social Determinants of Health

According to Lang et al (2011), social determinants of health are basically the social conditions in which people interact on daily occasions in their work and relationships, not mentioning that these conditions, which are much on an international and national level as on a local level, are greatly informed by the allocation of power, income and critical resources. Social determinants of MI, therefore, are mostly found outside the scope of healthcare and preventive healthcare systems (Anand et al., 2008), but within the management of traditional risk factors associated with the condition.

Accordingly, it can be argued that apart from the known traditional risk factors of MI such as high blood pleasure, poor eating habits, environmental factors, sexual activity, elevated cholesterol, smoking, diabetes, and physical inactivity (Muller-Nordhorn & Willich, 2007), as well as abnormal lipids, abnormal obesity, hypertension, diabetes, alcohol use, and psychosocial stress factors (Anand et al., 2008), there exist other social determinants of MI such as working conditions, housing, and interpersonal relationships (Lang et al., 2011). Indeed, these authors have proved that some social determinants, including stressful work, unemployment, job instability, social isolation, polluted geographic location, discrimination, and ethnicity, are directly or indirectly linked to the development of MI risk factors.

Conclusion

The paper sought to explore and analyze how MI is currently affecting the Australian population. It can be concluded that men, menopausal women, and aboriginals have a higher risk of MI. Although recent guidelines recognize five distinct types of MI, many victims of MI in Australia develop ventricular fibrillation, which occurs soon after the onset of ischemia but deteriorates before victims are able to seek medical attention. MI forms a massive burden of care in Australia in terms of morbidity, mortality, and economic cost. Lastly, the social determinants of MI include working conditions, unemployment, housing, interpersonal relationships, as well as discrimination, and ethnicity.

References

Anand, S.S., Islam, S., Rosengren, A., Franzosi, M.G., Steyn, K., Yusufali, A.H…Yusuf, S. (2008). Risk factors for myocardial infarction in women and men: Insights from the inner heart study. European Heart Journal, 29(2), 933-940.

BigPond Health. (n.d.). Web.

Chew, D.P., Amerena, J., Coverdale, S., Rankin, J., Astley, C., & Brieger, D. (2007). Current management of coronary syndromes in Australia: Observations from the acute coronary syndromes prospective audit. Internal Medicine Journal, 37(2), 741-748.

Hunter, E. (2010). Hearts and minds: Evolving understandings of chronic cardiovascular disease in Aboriginal and Torres Straight Islander Populations. Australian Aboriginal Studies, 12(1), 74-91.

Ioannides-Demos, L.L., Makarounas-Kirchmann, K., Ashton, E., Stoelwinder, J., & McNeil, J.J. (2010). Cost of myocardial infarction to the Australian community: A prospective, multicenter survey. Clinical Drug Investigation, 30(8), 533-543.

Jaffe, A.S. (2008). The clinical impact of the universal diagnosis of myocardial infarction. Clinical Chemistry & Laboratory Medicine, 46(11), 1485-1488.

Joynt, K.E., Huynh, L., Amerena, J.V., Brieger, D.B., Coverdale, S.G., Rankin, J.M…Chew, D.P. (2009). Impact of acute and chronic risk factors on use of evidence-based treatments in Australia with acute coronary syndromes. Heart, 95(17), 21-30.

Lang, T., Lepage, B., Schieber, A.C., Iamy, S., & Kelly-Irving, M. (2011). Social determinants of cardiovascular diseases. Public Health Reviews, 33(2), 1-22.

Loughnan, M.E., Nicholls, N., & Tapper, N.J. (2008). Demographic, seasonal, and spatial differences in acute myocardial infarction admissions to hospital in Melbourne Australia. International Journal of Health Geographics, 7(1), 1-15.

Muller-Nordhorn, J., & Willich, S.N. (2007). External triggers of onset of myocardial infarction – an update. Biological Rhythm Research, 38(3), 217-232.

O’Neil, A., Sanderson, K., & Oldenburg, B. (2010). Depression as a predictor of work resumption following myocardial infarction (MI): A review of recent research evidence. Health & Quality of Life Outcomes, 8(1), 95-105.

O’Neil, A., Williams, E.D., Stevenson, C.E., Oldenburg, B., & Sanderson, K. (2012). Co-morbid depression is associated with poor work outcomes in persons with cardiovascular disease (CVD): A large, nationally representative survey in the Australian population. BMC Public Health, 12(1), 47-55.

Overview of current trends. (n.d.). Web.

Myocardial Infarction: Diagnostic and Treatment

According to the World Health Organization, approximately seventeen million people die every year as a result of cardiovascular diseases. Out of these diseases, heart attack is the leading killer with astonishing statistics from the United States. The disease claims the lives of more than 0.2 million women every year. Treatment of this heart disorder has become an economic burden, costing more than USD60 million annually. Importantly, myocardial infarction is the leading cause of death in the U.S. (Mayo Clinic Staff 1).

Heart attack is also known as Myocardial Infarction, MI. It mainly occurs as a result of the blockage of the coronary artery, emanating from clot blocks (Kumar and Robbins 352). The coronary artery is a vital blood vessel since it feeds the heart muscle with blood. This implies that any form of blood-flow interruption can be a threat to the survival of the victims. Experts have revealed heart attack occurs when there is an imbalance between the supply and demand of oxygen.

Most cases of heart attack are never recognized since the manifestation of the disease is sometimes considered to be a different infection. As a result, wrong medication might be administered or one may consider seeking medication when it is too late. As one of the leading causes of death in the world, adoption of preventive measures is essential. It has been found out that a healthy lifestyle is key in lowering the chances of suffering from myocardial infarction. This includes regular exercising, eating a balanced diet and keeping stress at bay (Jevon 1).

Although there are several causes of myocardial infarction Atherosclerosis, has been noted as the commonest cause. This refers to a slow process through which small quantities of cholesterol collect in the walls of arteries, affecting the flow of blood to the heart. Deposits of cholesterol are also known to harden the walls of arteries, thus narrowing the lumen, which is important in allowing the flow of blood. Affected arteries may become malfunctioning and unable to supply the body with blood according to its needs (Jevon 15).

For example, when one has infected arteries in the leg, it would be manifested through pain in the legs, resulting from blood-flow interruption. This may also cause leg ulcers or delayed healing of wounds found. An interruption of blood-flow to the brain causes damage of the brain or stroke, arising from instant death of brain tissues.

While atherosclerosis is a major cause of myocardial infarction, it is important to note that it may fail to show signs and symptoms after a very long time. Additionally, symptoms could be manifested in teenage, even through severe health complications occur in adulthood due to narrowing of arteries. It is worth noting that certain factors contribute to the occurrence of atherosclerosis among people with family history of the condition. These include high levels of cholesterol, cigarette smoking, diabetes mellitus and high blood pressure.

These may therefore lead to quick manifestation of the disease (Jevon 5). Coronary atherosclerosis has been known to affect coronary arteries by causing them to become narrow and hard. It is also known as the coronary artery disease. In general, diseases which affect the supply and flow of blood to the heart are referred to as coronary heart diseases, CHD.

Myocardial infarction is manifested through an array of symptoms. Frequent pain in the chest that disappears after some minutes has been associated with this disorder. Additionally, more pain could be experienced in the shoulder, jaws, back or arms. Others include prolonged pain in the upper part of the abdomen, sweating, fainting and nausea.

These symptoms can be observed in men and women. However, heartburn, unusual fatigue, clammy skin and dizziness are commonly manifested in women alone. In analyzing the symptoms of heart attack, it is important to underscore the fact that these manifestations occur in varying degrees (Jevon 27). Most of the heart attacks are not as dramatic as those given media publicity. Importantly, some people do not show any symptom while the presence of many symptoms depicts a higher likelihood of developing the disease.

Myocardial infarction can occur anytime; whether at work, home, while walking or even resting. Even if there are sudden cases of this disease, most people show warning signs before the attack. Angina is considered as the earliest sign of the attack and is triggered by a small decrease in the supply of blood to the heart as required.

It is important to draw a line between myocardial infarction and cardiac arrest. The latter occurs as a result of an electric disturbance in the heart that alters the pumping mechanism, thus terminating the flow of blood to other parts of the body. Heart attack is the leading cause, even though there are other causes of cardiac arrest (Jevon 28).

Professional training is necessary for one to administer heart attack treatment. Cardiopulmonary Resuscitation (CPR) is the first step recommended since it allows the supply of oxygen to the brain and the rest of the body (Jevon 85). Chest compressions need to be administered, even from a person who has not been trained in CPR.

Those with skills are allowed to confirm the patient’s airways and apply rescue breaths at an interval of thirty seconds. The mode of treatment depends on the severity of the attack and the level of damage that may have been caused to the heart. From this, the doctor can consider either medication or surgery.

Commonly used drugs include aspirin, thrombolytics and superaspirins (Kumar and Robbins 865). Others are pain relievers, nitroglycerin, beta blockers and cholesterol-lowering drugs. Besides medication, heart attack patients may undergo Coronary angioplasty and stenting or coronary artery bypass surgery (Jevon 45).

The prognosis after a heart attack depends on a wide range of factors including severity of the condition, damage caused to the heart and some measures taken after the attack. Importantly, a heart attack may evolve from being fatal, chronic to full recovery. Moreover, people who may have suffered an attack have a higher risk of developing this disorder. Lastly, heart attack predisposes other heart-complications like stroke, heart valve damage and heart failure among others (Jevon 61).

There are several theories, which describe the relationship between heart attack and dental practice. Oral bacteria, is capable of affecting the functioning of the heart when it gets into the blood. This occurs through attachment to fatty plaques in arteries and forming clots. Additionally, the formation of plaques can be promoted by inflammation, resulting from periodontal disease. It has been found out that patients with periodontal infection have a higher chance of developing myocardial infarction. This relationship is therefore important for dentists as well as specialists in heart treatment.

Works Cited

Jevon, Phil. Angina and Heart Attack. Oxford: Oxford University Press, 2012. Print.

Kumar, Vinay, and Robbins Stanley. Basic Pathology. Philadelphia: Saunders/Elsevier, 2007. Print.

Mayo Clinic Staff. Heart Attack. Mayo Clinic, 2012. Web.

Acute Myocardial Infarction Treatment Plan

Introduction

The Eighth Joint National Committee (JNC 8) states that people between 30 and 59 years of age with blood pressure less than 150/90 mm HG do not require initiating therapy (James et al., 2014, p. 508). Sean M.’s BP is 136/84. It is higher than its ordinary norm which is 120/80. Still, it is hard to call Sean M. hypertensive at the moment.

Acute Myocardial Infarction

Acute myocardial infarction, unspecified (I21.9): is also known as heart attack, the condition when a person experiences a sharp and sudden chest pain (Thygesen et al., 2012, p. 2025). The main symptoms of a heart attack in addition to chest pain also include shortness of breath, sweat, fatigue, nausea, and dizziness. Sometimes, the signs could last for days and weeks. Sometimes, people experience the attack and forget about it in the next several days. Rationale: The patient got all those symptoms and admitted that the discomfort in the chest lasted for about three minutes. Then, the pain was gone and never repeated.

Treatment Plan

Diagnostics

ECG: to observe the electrical activities of the heart and analyze the impulses that could be displayed (Thygesen et al., 2012, p. 2029).

Chest X-ray: to identify if there are some changes in the heart and chest that could lead to another attack or serious problems.

Medication: Rx: Atorvastatin 80mg (Amarenco, 2014, p. 2974) Sig. orally once a day: Disp # 30. Refill: not required.

This medication helps to prevent heart attacks and improve the level of cholesterol. Sean has a high level of TC.

Conservative Measures

Treatment for people who have heart attacks should include the use of medications, surgical procedures in cases of emergency, changes in lifestyle, and cardiac rehabilitation that should help to relax (Brown, 2014). The patient should decrease the number of physical exercises and avoid possible emotional changes.

Education

The patient should understand that hypertension is one of the main reasons why heart attacks happen. It is not enough to stay calm but also treat for hypertension as the main complaint (Thygesen et al., 2012, p. 2020). Healthy eating and a healthy weight could also help to prevent heart problems.

Referrals

The help of a professional cardiologist and dietitian could be offered in addition to the suggestions given by a primary care provider or a therapist.

Follow-Ups

The patient should visit a doctor in one month to report the condition and describe if similar attacks happen to him.

Chest Pain

Chest pain, unspecified (R07.9): is the condition when a person experiences problems with heart or lungs or panic attacks. It is hard to understand true reasons for chest pain, and the researchers identify costochondritis as one of the possible outcomes (Raza, 2014, p. 191). Therefore, inflammation of joints could lead to fatigue and shortness of breath. Rationale: Sean M. claims that he had a 3-minute experience of chest pain with a further inability to work hard and find enough energy to do his routine exercise. Besides, he seems to be in a panic because of the inability to comprehend the reasons for such pain.

Treatment Plan

Diagnostics

CTCA (Computer tomography coronary angiography) could be used to define the nature of chest pain that is of unknown origin (Ciampi, Rigo, Grolla, Picano, & Cortigani, 2015).

Twelve-level electrocardiography is used to test ST-segment changes caused by chest pain in adults (McConaghy & Oza, 2013, p. 177).

Medication: Rx: Aspirin, 81 mg Sig.: orally daily Disp # 30. Refill: 2 (Smith, Negrelli, Manek, Hawes, & Viera, 2015, p. 286).

Conservative Measures

The family should provide the patient with help and support to avoid or, at least, reduce the chances of chest pain. The possible suggestion includes the necessity to relax (McConaghy & Oza, 2013, p. 179) and spend more time outside to breathe in the fresh air and to enjoy nature. Proper diets are also appreciated.

Education

Chest pain is the diagnosis that is given to the majority of patients, who address chest pain. Such diagnosis provides doctors with an opportunity to continue diagnosing and taking all necessary tests. Therefore, the patient should be explained that it is not enough to take pain relief and expect that the complaint cannot be repeated. It is important to continue investigating and define a true reason for chest pain. Besides, it is important to keep a healthy style of life, choose a healthy diet, and decrease the nature of physical experiences (Smith et al., 2015, p. 285).

Referrals

A pulmonologist should be addressed to check if chest pain has a lung-connected problem. A cardiologist should help to identify the changes in the heart that could be observed after the case of chest pain. Finally, a rheumatologist should be visited to clarify if the patient has some problems with joints that could lead to problems with breathing for a certain period of time.

Follow-Ups

The next check-up should be done in one month in case no emergency makes the patient address the ER. It is enough to visit a therapist and report about the latest changes in the lifestyle and the outcomes of the medications offered.

References

Amarenco, P., Callahan, A., Campese, V. M., Goldstein, L. B., Hennerici, M. G., Messig, M.,… & Zivin, J. A. (2014). Effect of high-dose atorvastatin on renal function in subjects with stroke or transient ischemic attack in the SPARCL trial. Stroke, 45(10), 2974-2982.

Brown, C.H. (2014). Heart disease in women different than in men? US Pharmacist. Web.

Ciampi, Q., Rigo, F., Grolla, E., Picano, E., & Cortigani, L. (2015). Dual imagining stress echocardiography versus computed tomography coronary angiography for risk stratification of patients with chest pain of unknown origin. Cardiovascular Ultrasound, 13(21). Web.

James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J.,… & Smith, S. C. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). The Journal of the American Medical Association, 311(5), 507-520.

McConaghy, J.R. & Oza, R.S. (2013). Outpatient diagnosis of acute chest pain in adults. American Family Physician, 87(3), 177-182.

Raza, S. (2014). PT147 Measuring Serum Vitamin D level as a part of evaluating patients presenting with Atypical Chest Pain. Global Heart, 9(1), e194-e195.

Smith, J. N., Negrelli, J. M., Manek, M. B., Hawes, E. M., & Viera, A. J. (2015). Diagnosis and management of acute coronary syndrome: An evidence-based update. The Journal of the American Board of Family Medicine, 28(2), 283-293.

Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., & White, H. D. (2012). Third universal definition of myocardial infarction. Circulation, 126(16), 2020-2035.

Nursing Care of Myocardial Infarction Patients

Introduction

At Vila Health, heart diseases are some of the most common health issues that nurses, clinicians, and other health professionals have to deal with as they are frequently presented. In the United States, acute myocardial infarction (AMI) is associated with a mortality rate of about 30%, with more than 50% of deaths occurring before arrival at health facilities (Virani et al., 2021). Moreover, between 5% and 10% of those who survive die within the first year of the condition’s onset (CDC, 2021). Furthermore, approximately 50% of all patients are hospitalized within the first year of the initial event (Benjamin et al., 2019). Therefore, AMI is the leading cause of death among all the ischemic heart conditions and one of the diseases with the highest mortality rates in the country.

Therefore, there is a need for continuous progress and improvement in the care provided to AMI patients to ensure high quality of life for these individuals after their discharge from the health care facilities. Angina, the telltale sign of low blood flow to the heart, is normally symptomized by agonizing pain radiating from the chest down towards the left arm. Nurses must understand the complications of the condition and its management and have the ability to provide the appropriate counseling to those coming with the symptoms (Virani et al., 2021). In addition, nurses must have the capacity to provide the appropriate discharge planning to their patients after angina has induced a heart attack requiring hospitalization.

Based on this reason, a PICOT approach is necessary to design a question that will present an evidence-based practice (EBP) for managing PMI at Vila Health. Previous studies have shown that EBP programs improve care management significantly through positive lifestyle changes, such as careful blood pressure management, regular physical activities, cessation of smoking, and attendance at cardiac rehabilitation.

Specifically, the chosen PICOT question is, “What lifestyle effects does a post-myocardial infarction (PMI) program has on the lifestyle of heart attack survivors when given by an RN compared to those who do not receive the management within one year of discharge?” Based on the outline of this question, the components of the PICOT question are as follows:

  • P= Patients who have suffered an MI event;
  • I= the PMI program overseen by the RN;
  • C= patients of MI who do not receive counseling in the post-discharge PMI program;
  • O= positive changes in patients’ lifestyle based on adherence to frequent exercise, cessation of smoking, healthy diet, and careful blood pressure monitoring;
  • T= within one year of the patients’ discharge from the hospital.

Identification of Sources of Evidence

The post-myocardial infarction (PMI) program is an appropriate and highly effective method for reducing the recurrence of AMI among survivors of the disease following their discharge from health care facilities. Wang et al. (2020) conducted a study to examine the impact of lifestyle changes on clinical outcomes among AMI patients who had undergone percutaneous coronary intervention (PMI). Similarly, Dibao-Dina (2018) investigate adherence to lifestyle, therapeutic, and risk factor control recommendations among post-myocardial infarction patients over six years.

In their study, Sibel and Argon (2018) examine the effectiveness of a training program developed on the health promotion model and individual counseling to impact positive lifestyle changes among AMI patients following discharge. Ekblom et al. (2018) examined the impacts of adherence to physical activities (PA) program on the survival rates among post-myocardial infarction patients following their initial discharge. The study by Hanna et al. (2020) seeks to investigate the perceptions underlining health-related adherence behaviors among patients who had experienced a heart attack, including AMI. Birtwistle et al. (2020) explored the lived experiences of AMI patients and their families, their engagement with physical activity in post-myocardial infarction programs, and the impact of adherence on reducing the chances of recurrence.

Findings from the Articles

While the pharmacological approach remains the most commonly applied intervention for managing patients of MI infarction during and after discharge, it cannot completely reduce recurrence risks. Studies have shown that reducing the recurrence risks requires lifestyle changes that include physical exercise, cessation of smoking, proper and effective blood pressure control, monitoring, and a healthy diet (Bhatta & Glantz, 2019). The above studies prove that adherence to lifestyle changes plays a great role in reducing the risks of occurrence following discharge. These studies support the view that positive changes in lifestyle reduce the chances of AMI recurrence by more than 80%. Consequently, it is imperative to review some of the most recent studies that provide evidence on the effectiveness of PMI programs.

Relevance of the Articles

The study by Wang et al. (2020) was chosen because it examines the specific topic of interest. The research studies by Dibao-Dina (2018) and Ekblom et al. (2018) are relevant to the concept of adherence to recommendations for AMI patients. Regarding the impacts of the training program on the patients discharged after hospitalization with myocardial infarction, Sibel and Argon (2018) seek to evaluate the effectiveness of such an intervention. Birtwistle et al. (2021) examine the lived experiences of the patients of myocardial infarction and their families as they strive to adhere to the guidelines after discharge.

Conclusion

The examined studies prove that EBP programs can significantly improve care management through positive lifestyle changes. The changes include careful blood pressure management, regular physical activities, cessation of smoking, and attendance at cardiac rehabilitation. The PICOT has incorporated these aspects as the intervention in the program to help improve the outcomes at the hospital. The RN will oversee the comprehensive program as an intervention proposal in a change model delivered to the hospital’s cardiac department.

References

Benjamin, E. J., et al. (2019). . Circulation, 139(10), e56-e528. Web.

Bhatta, D. N., & Glantz, S. A. (2019). Electronic cigarette use and myocardial infarction among adults in the US population assessment of tobacco and health. Journal of the American Heart Association, 8(12), e012317. Web.

Birtwistle, S. B., Jones, I., Murphy, R., Gee, I., & Watson, P. M. (2021). . Disability and rehabilitation, 1-10. Web.

CDC. (2021). Heart disease facts. Web.

Dibao-Dina, C., et al. (2018). . PloS one, 13(9), e0202986. Web.

Ekblom, O., et al. (2018). . Journal of the American Heart Association, 7(24), e010108. Web.

Hanna, A., Yael, E. M., Hadassa, L., Iris, E., Eugenia, N., Lior, G., Carmit, S., & Liora, O. (2020). It’s up to me with a little support”–adherence after myocardial infarction: A qualitative study. International journal of nursing studies, 101, 103416. Web.

Virani, S. S., et al. (2021). . Circulation, 143(8), e254–e743. Web.

Wang, Y., Xian, Y., Chen, T., Zhao, Y., Yang, J., Xu, B., & Li, W. (2020). Effect of lifestyle changes after percutaneous coronary intervention on revascularization. BioMed research international, 2020(24), 17-23. Web.

Experiences of Elderly Men Regarding Acute Myocardial Infarction

This study aims to examine senior men’s experiences with acute myocardial infarction before, during, and after clinical diagnosis. Additionally, it suggests funding for the development of male health problem preventative techniques and helping reduce the adverse effects of cardiovascular disease hospitalizations. The goal was to analyze elderly men’s reactions to acute myocardial infarction before, during, and after clinical diagnosis. The study’s methods are descriptive and qualitative. The study was conducted at two hospitals in the Brazilian state of Bahia’s town of Feira de Santana. Participants in the trial were elderly males with a confirmed medical diagnosis of acute myocardial infarction. A semi-structured script guided the interview technique, which was used to gather data. All talks were legally recorded, completely typed down, and organized using the discourse of the collective subject. The scientific literature on acute myocardial infarction and the theoretical framework of gender from the standpoint of hegemonic masculinity supported the data interpretation.

The Discourse of the Collective Subject revealed that hegemonic masculinity was embedded in elderly men’s experiences of acute myocardial infarction before, during, and after diagnosis. This prevented them from understanding the gravity of the symptoms and the necessity of seeking medical attention. The statements show that emotional conflicts characterized the entire sickness and post-diagnosis therapy processes since older adults had to adjust their lifestyles and accept their fragility. Given that gender markers have a significant impact on the health of elderly men, the findings highlight the importance of gender markers for health practitioners to understand and take into account during the prevention and treatment of cardiovascular illnesses.

In conclusion, Using DCS demonstrated that senior men’s experiences with acute myocardial infarction before, during, and after diagnosis were tainted with hegemonic masculinity indicators, making it difficult for them to understand the gravity of the symptoms and the need to seek medical attention. The results highlight the importance of gender markers for health practitioners to recognize and consider preventative and therapeutic measures for cardiovascular diseases. Such gender markers have a significant impact on men’s health treatment.

Reference

Sousa, A. R., Silva, A. F., Estrela, F. M., Magalhães, J. R. F., Oliveira, M. A. S., Mota, T. N., Teixeira, J. R. B., & Escobar, O. J. V. (2021). Experiences of elderly men regarding acute myocardial infarction. Acta Paul Enferm., 34, eAPE00902.

Myocardial Infarction

Introduction

Myocardial Infarction is a disease of the heart that is caused by occlusions in the coronary arteries. The circulation of blood through the ventricles is reduced and the capacity of the heart to absorb oxygen is diminished. Artherosclerosis is mainly implicated with myocardial infarction.

MI is primarily evaluated using the ECG readings in which the ST-segment is usually elevated. By, analyzing the morphology of the ECG inconjuction with other tests, the condition can be correctly evaluated. The coronary occlusions can be dissolved using thrombolytic therapy.

In this case study, the close collaboration between nursing and other interventions illustrates the clinical procedure for handling patients with myocardial infarction in a hospital setting. It also gives insight into the complications of MI that may occur in a patient together with the necessary interventions from the nursing staff. The study questions are answered sequentially as follows;

Mr. Jones gradually developed symptoms of myocardial infarction. He started by experiencing excruciating chest pain that radiated to his jaw and left arm, shortness of breath (dyspnea) and diaphoresis (sweating), which culminated in sudden unconsciousness (syncope). These are the typical signs and symptoms of myocardial infarction.

They do not present immediately but gradually. The classic symptom of myocardial infaction is usually chest pains, which radiate to other parts of the body such as the left and right arms, lower jaw, neck, back, and the epigastrium, which resemble the heartburn.

Often, MIs are caused by accumulation of atherosclerotic plaque, which stimulates the forming of intracoronary thrombus. Intracoronary thrombus results in the occlusion of the coronary artery. This gives rise to insufficient circulation of blood through the ventricles hence myocardial infarction. The level of occlusion determines the severity of MI (Cotran, Kumar & Robbins, 1994).

Many other conditions that are uncommon can cause the coronary artery to block and thereby cause a myocardial infarction. They include rare inflammation of coronary arteries, a blood clot in another place of the body other than the ventricle e.g., in the heart chamber, a wound near the heart through a stab, the spasmal effects of taking cocaine on the coronary artery, and complications arising from heart surgery and/ or another rare heart conditions.

An ECG is performed to compare cardiac activities in the ventricular areas. The ST segment elevation is used to indicate on the ECG. Mr. Jones’ ECG signal indicated that there was an ST-segment elevation in leads II, III, and aVf on the ECG, which is indicative of MI. however, the ECG alone cannot be used to reliably diagnose myocardial infarction. It should be noted that the ECG also evaluates other heart conditions.

Consequently, the morphology and the principal components of the signal may give contradictory diagnosis. For instance, myocardial infarction is evaluated by observing the characteristics of the ST segmement. An elevation of the segment is indicative of possible myocardial infarction. However, the ST segment elevation is also indicative of the inherited type of cardiac arrhythmia called Brugada Syndrome. Consequently, other tests are necessary including laboratory tests, urine and blood sample analysis etc..

Cardiac enzymes are used as biomarkers that are evaluated to determine the heart function. There are particularly useful in evaluation of myocardial infaction although they are essential in assessment of other conditions that may lead to increment in cardiac biomarker level (Rao, Miller, Rosenbaum, & Lakier, 1999).

Cardiac enzymes such as creatine kinase-MB are ordered when the severity of myocardial infarction needs to be determined. The level of cardiac proteins in the blood corresponds to the severity of the myocardial infarction in the patient. Therefore, by determining these enzymes it makes the work of risk stratification of patients with myocardial infarction easier.

Once admitted to the CCU, It is the prerogative of the nurses to measure the blood pressure, changes in the heart and respiratory rates related to the physical examination of the patient. The most common examination performed on patients with suspected myocardial infarction is an ECG, which often indicates the presence of abnormalities in the left ventricle. In addition, laboratory tests of blood proteins related to the heart is performed to indicate if degeneration of myocardial cells is present.

MI results in diminished supply of oxygen to the heart due to the degeneration of cardiac cells. Consequently, the capacity of the heart to extract oxygen from blood may be compromised. The significance of using oxygen to make sure that the red blood cells are saturated maximally to compensate for the heart’s diminished ability to extract the oxygen.

Mr. Jones’ oxygen demands clearly outstripped supply oxygen dosage ameliorated the situation before comprehensive diagnosis and treatment ensued (Cotran, Kumar & Robbins, 1994). Administration of oxygen supplements treatment of patients with MI. Mr. Jones had shortness of breath and an episode of syncope. As treatment ensued, his oxygen supply had to be stabilized through administration of supplemental oxygen.

Myocardial infarction may give rise to other cardiac conditions that may need proper medical attention. Such conditions include the Wenckebach (Type 1) and Type 2 disarrhythmias. Wenckebach or Type I block is an intermittent cardiac conduction failure. In Wenckeback, conduction reduces as conduction velocity progressively reduces until failure of cardiac electrical conduction occurs. The ECG pattern of the condition shows the PR interval getting progressively longer until the non-conducted wave occurs.

Thrombolytic therapy initiates cardiac hemorrhage in patients with myocardial infaction. It is initiated to dissolve the coronary clots thereby easing the flow of blood and supply of oxygen to the heart. However, this therapy is not suitable in certain conditions such as recent surgery, stroke in the recent past, high blood pressure e.t.c.

The thrombolytic drugs are known to cause hemorrhage elsewhere in the body that can be life threatening in scenarios where a patient underwent surgery recently or is hypertension is present. In the case of Mr. Jones, he became unconscious as soon as he arrived at the reception. In addition, he had very high pressure at 130/92, which made it inappropriate to initiate thrombolytic therapy (Marcus, et al, 2007).

Myocardial infarction is associated with complications such as angina, free wall rupture, reinfarction, extension of infarct, heart failure, aneurysms, cardiogenic shock, valve dysfunction, arrhythmias, central nervous system (CNS) or peripheral embolisation, pericarditis, and psychosocial complications. Mr. Jones developed arrhythmias which were corrected by administration of drugs.

The ECG is the common procedure for diagnosis of myocardial infarctions. However, other diagnostic tests can be carried out on Mr. Jones. They include blood and urine tests, swabs, diagnostic and lab tests, and pathology testing. Pathology testing is important as myocardial infarction could have been caused by a certain underlying pathogen. These tests are performed in order to confirm presence of myocardial infarction because an ECG cannot provide a comprehensive assessment of the condition.

References

Cotran R., Kumar V. & Robbins S. (1994). Robbins Pathologic Basis of Disease. 5th Ed. Philadelphia, PL: WB Saunders Press.

Marcus, et al. (2007). The utility of gestures in patients with chest discomfort American Journal of Medicine, 120(1), 83–9.

Rao P., Miller S., Rosenbaum R., & Lakier J. (1999). Cardiac troponin I and cardiac enzymes after electrophysiologic studies, ablations, and defibrillator implantations. American Journal of Cardiology, 84(4), 470.