NCLEX - Myocardial Infarction Symptoms, Diagnosis, & Treatments

Here are key facts for NCLEX (National Council Licensure Examination) from the Myocardial Infarctions: Diagnosis & Treatment tutorial, focusing on the nursing process, patient care, and clinical judgment essential for licensure. See the tutorial notes for further details and relevant links.

• --

1. Definition: Myocardial infarction is defined as myocardial injury with ischemia. 2. Epidemiology: Incidence is declining in high-income countries but rising in middle- and low-income countries. 3. Population differences: Within the United States, MI incidence after age 35, from highest to lowest: Black males > Black females > White males > White females. 4. Gender differences: First MI occurs approximately 10 years earlier in men than women. 5. Mortality pattern: Despite overall declining rates, mortality remains higher in women than men, especially for young and/or minority women. 1. Major modifiable risk factors:

• Dyslipidemia
• Diabetes mellitus
• Hypertension
• Smoking (including e-cigarettes)
• Obesity
• Psychosocial stress
• Alcohol consumption
• Poor diet (low in fruits and vegetables)

2. Patient education needs: Many patients, especially women, are unaware of risk factors and symptoms. 3. Disease progression: MI is an important cause of heart failure, which is itself a significant cause of death. 4. Preventive measures: Risk factor modification through diet, exercise, and lifestyle changes. 5. Health literacy gap: Unawareness is a significant obstacle to prevention and treatment of myocardial infarction. 1. Presentation timeline:

• Prodromal symptoms: Days, weeks, or months prior to the heart attack
• Acute symptoms: Experienced at the time of the event
• Silent MI: No noticeable symptoms

2. Classic symptoms: Chest pain/angina variably described as dull, sharp, squeezing, pressure, or discomfort. 3. Pain radiation: Some patients experience pain in arms, neck, jaw, or back, which may radiate from the chest. 4. Associated symptoms:

• Gastrointestinal issues (nausea, vomiting, indigestion)
• Extreme fatigue, exhaustion, or sleep disturbances
• Headaches, dizziness, lightheadedness
• Shortness of breath (dyspnea)
• Anxiety or sense of impending doom

5. Atypical presentations: Not all patients experience angina—absence of chest pain and/or young age often leads to missed or delayed diagnosis. 1. ECG timing: Should be obtained as soon as possible when MI is suspected and repeated frequently to observe evolution. 2. ECG classification: Distinguishes between ST-segment elevated (STEMI) or Non-ST elevated (NSTEMI) myocardial infarctions. 3. Q-wave significance: May indicate size/location of current MI, or may indicate a prior MI. 4. Biomarker assessment:

• Cardiac troponin is key to diagnosis
• Helps distinguish NSTEMI (elevated troponin) from unstable angina (normal troponin)
• Both cardiac troponin I and CK-MB peak within 24 hours of MI

5. ECG localization: Different lead changes correlate with specific coronary territories (see detailed section below). 1. Time-sensitive care: Treatment should begin as soon as possible to reduce myocardial necrosis. 2. Immediate interventions:

• Oxygen administration when oxygen saturation is less than 90%
• Aspirin administration for antiplatelet effects
• Nitrates for chest pain (morphine if nitrates ineffective)

3. Reperfusion monitoring: Patients may undergo percutaneous coronary intervention (angioplasty), coronary bypass grafting, or receive fibrinolytic drugs. 4. Medication administration:

• Antiplatelets (aspirin, clopidogrel, others)
• Anticoagulation drugs (unfractionated or low molecular weight heparin)
• Beta-blockers or calcium-channel blockers
• Statins
• ACE-inhibitors

5. Ongoing management: Support risk factor modification through improved diet, exercise, and medication adherence.

• --

1. Atypical presentation recognition: Many patients, especially women, elderly, and diabetics, present without classic chest pain. 2. Prodromal assessment: Ask about symptoms in days/weeks before presentation (fatigue, sleep changes, vague discomfort). 3. Comprehensive symptom evaluation: Assess for gastrointestinal, neurological, and psychological symptoms that may mask cardiac origin. 4. Pain assessment: Document location, radiation, quality, severity, duration, and alleviating/aggravating factors. 5. Risk factor identification: Evaluate presence of modifiable and non-modifiable risk factors to guide prevention strategies. 1. STEMI recognition: ST-segment elevation indicates need for immediate reperfusion. 2. NSTEMI patterns: ST depression or T-wave inversions may be present. 3. Lead groupings and significance:

• Lateral infarction: Leads I and aVL; left circumflex artery
• Apical infarction: Leads V5 and V6; left circumflex or right coronary arteries
• Anterior infarction: Leads V3 and V4; left anterior descending artery
• Anteroseptal infarction: Leads V1 and V2; proximal left anterior descending artery
• Inferior infarction: Leads II, aVF, and III; right coronary artery or left circumflex artery

4. Additional lead sets: Right ventricular (V3R-V6R) and posterior (V7-V9) infarctions require special lead placement. 5. Serial ECG importance: Facilitate repeat ECGs to monitor evolution of changes. 1. Troponin significance: Primary biomarker for MI diagnosis; document timing of elevation. 2. Collection timing: Facilitate serial measurements to track rise and fall pattern. 3. Integration with symptoms: Correlate biomarker results with clinical presentation. 4. NSTEMI vs. unstable angina: Only NSTEMI shows rising/falling troponin levels. 5. Patient education: Explain purpose of blood tests and what results indicate. 1. Immediate assessments: Vital signs, pain level, respiratory status, oxygen saturation. 2. Cardiac monitoring: Continuous ECG monitoring for arrhythmias or evolving changes. 3. Medication administration: Prompt delivery of ordered medications (oxygen, aspirin, nitrates, analgesics). 4. IV access: Establish and maintain reliable venous access. 5. Patient positioning: Semi-Fowler's position to improve breathing and reduce cardiac workload. 1. Symptom awareness: Teach recognition of MI symptoms, especially atypical presentations. 2. Risk factor modification: Provide specific guidance on diet, exercise, smoking cessation, and stress management. 3. Medication adherence: Explain purpose, dosage, schedule, and side effects of prescribed medications. 4. Follow-up care: Emphasize importance of cardiac rehabilitation and outpatient appointments. 5. When to seek help: Clear instructions on when to call provider vs. when to seek emergency care.

• --

Below is information not explicitly contained within the tutorial but important for NCLEX preparation. 1. Assessment: Focused cardiovascular assessment techniques and documentation. 2. Nursing diagnoses: Common diagnoses for MI patients including Acute Pain, Decreased Cardiac Output, Activity Intolerance. 3. Planning: Prioritizing interventions based on patient condition and presentation. 4. Implementation: Evidence-based nursing interventions for MI care. 5. Evaluation: Expected outcomes and signs of improvement vs. deterioration. 1. Thrombolytics: Administration protocols, contraindications, and nursing considerations. 2. Antiplatelet agents: Mechanisms, dosing, side effects, and monitoring parameters. 3. Anticoagulants: Administration guidelines, reversal agents, and bleeding precautions. 4. Beta-blockers: Effects on heart rate and blood pressure, contraindications. 5. ACE inhibitors/ARBs: Monitoring renal function and potassium levels. 1. Arrhythmias: Recognition and response to common post-MI dysrhythmias. 2. Heart failure: Assessment for pulmonary edema and decreased cardiac output. 3. Cardiogenic shock: Early recognition and emergency interventions. 4. Mechanical complications: Signs of papillary muscle rupture, ventricular septal defect, or free wall rupture. 5. Psychosocial complications: Anxiety, depression, and fear after MI. 1. Phase I (inpatient): Early mobilization protocols and activity progression. 2. Phase II (outpatient): Monitored exercise and continuing education. 3. Exercise prescription: Guidelines for safe activity resumption. 4. Return to activities: Evidence-based guidance for driving, work, and sexual activity. 5. Lifestyle modification support: Strategies for successful behavior change. 1. Elderly patients: Modified presentation, comorbidity management, and medication adjustments. 2. Women: Recognition of unique symptom patterns and higher mortality risk. 3. Diabetic patients: Higher risk for silent MI and complications. 4. Post-surgical patients: Recognition of perioperative MI. 5. Culturally sensitive care: Addressing health disparities and tailoring interventions across diverse populations.