Myocardial Infarction

WHAT YOU SHOULD KNOW:

Your heart muscle needs a constant supply of oxygen-rich blood. The blood vessels that supply blood to your heart muscle are called coronary arteries. Sometimes one or more of the coronary arteries become too narrowed, completely blocked, or spasms (tightens). This causes part of the heart muscle to not get enough oxygen-rich blood that it needs to do its work. If the muscle goes too long without oxygen, it starts to die. This is called a myocardial (meye-oh-KAR-dee-al) infarction (in-FARK-shun), which is also called an MI or a heart attack. Treatments for an MI may include heart medicines, oxygen, and special procedures such as angioplasty or heart surgery.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

The risks of having an MI may depend on what part of your heart was damaged and how much was damaged. The sooner you receive treatment, the less damage you may have to your heart. Even with treatment, you may die from an MI. Some emergency treatments may save your life, but cause other problems. Clot busters and blood thinning medicines may cause bleeding problems. CPR may cause you to have bruising, pain, and even broken bones in your chest. Defibrillation may cause burns on the skin of your chest or back. Talk to your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Activity: Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.

Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Tests: You may need one or more of the following tests. The results of these tests help caregivers plan the best way to treat you.

• Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Blood gases: This test is also called an arterial blood gas or ABG test. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
  
  
• Cardiac catheterization: This is a test to see how well your heart is working. Your arteries (blood vessels) may also be checked to see if they are blocked. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• CVP line: A CVP line is also called a central line. It is an IV catheter or tube. It is put into a large blood vessel near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg. The CVP line may be used to give medicines or IV fluids. It may also be hooked up to a monitor to take pressure readings. This information helps caregivers check your heart.
  
  
• Echocardiogram:
  
  
  • This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.
    
    
  • This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.
  
  
• Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
  
  
• Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
  
  
• Pulmonary artery line: A pulmonary artery line, or PA cath, is a kind of central line catheter. It is a thin tube put in a vein near your collarbone, or in your neck or groin. The tube is then guided through your heart and into a blood vessel that goes to your lungs. One end of this catheter is hooked to a machine called a monitor. The monitor shows numbers that tell caregivers how your heart and lungs are doing. The part of this catheter that is inside you may be used to give you medicine. You will need a chest x-ray after the PA line is placed, to be sure the line is where your caregiver wants it. You may have stitches on your skin where the line comes out. This holds the line in place.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
  
• Exercise stress test: This test helps caregivers see the changes that take place in your heart during exercise. It checks for blockages in the arteries of your heart. An EKG is done while you ride an exercise bike or walk on a treadmill. Caregivers will ask you how you are feeling during the test. They want to know if you have chest pain or trouble breathing.
  
  
• Medicine stress test: This is a test that does not use exercise but still lets caregivers see heart changes. You are given medicine in your IV that makes your heart beat faster and opens heart arteries. An EKG is taken at the same time. Be sure to tell your caregiver how you are feeling during the test.
  
  
• Urine sample: A sample of your urine is collected and sent to a lab for tests. Your caregiver may give you a special wipe and clean cup. Use the wipe to clean the skin around the opening where you pass urine. Urinate into the clean cup. Put the lid on the cup. Do not touch the inside of the cup or the lid. Give the urine sample to your caregiver.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

Treatment options: Your treatment may change if your health problem is not being controlled. This is often decided after you have tests. You may have some of the following treatments alone or together.

• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pressure stockings: These tight elastic stockings help to keep blood from staying in the legs and causing clots. The stockings are also called Ted Hose® or Jobst Stockings®.
  
  
• Angioplasty and other procedures: Heart catheterization is an angiogram of the heart arteries to look for blockages. If there are blockages an angioplasty and other procedures may be performed. During an angioplasty, your caregiver makes a small puncture hole into one or more blood vessels (usually in the groin area). A small wire with a balloon on the end is sent up into a blocked artery in your heart. The caregiver inflates the balloon to push the fatty deposits against the artery wall. This makes more room for blood to flow. Sometimes a stent is put in. A stent is a metal mesh tube that is placed in the artery to help it stay open after an angioplasty. Angioplasty and stenting is done during a cardiac catheterization. An arthrectomy may also be done to remove plaque from your coronary arteries.
  
  
• Coronary artery bypass graft (CABG) surgery: This surgery is also known as heart bypass surgery, open-heart surgery, or a "cabbage". A CABG can improve blood flow to the heart by sending blood around a blocked part of an artery. This surgery may also decrease your risk of having an MI (heart attack) in the future.
  
  
• Emergency treatment:
  
  
  • A life-threatening problem that may happen during and after an MI is called arrhythmias. Arrhythmias are irregular heartbeats or heart rhythms. Arrhythmias that happen due to an MI can cause sudden death. Your caregivers will watch your heart monitor for arrhythmia problems. Some arrhythmias may be treated with medicine, but some need even faster treatment. Emergency arrhythmia treatment may include defibrillation. This procedure uses an electric shock that is given to the heart. The shock is usually given through paddles or sticky patches placed on your chest or back. The shock may help your heart return to a normal beat. You may need this more than once.
    
    
  • If your heart rhythm is very bad, you may not have a heartbeat (pulse). If you stop breathing or do not have a pulse, you may need CPR. CPR is when caregivers give you breaths and sometimes chest compressions. This may help your body get oxygen and some blood flow while you do not have a pulse or are not breathing on your own.
  
  
• Intra-aortic balloon pump: An intra-aortic balloon pump, or IABP, is a long catheter that is inserted into your groin. It has a balloon on the end that rests just outside of your heart. This balloon inflates and deflates in time with your heartbeat. An IABP can help increase blood flow through your body, while decreasing how hard your heart has to work. It may also help increase blood flow to the heart muscle itself. You will need to stay in bed with your leg straight while you have an IABP.
  
  
• Temporary pacemaker:
  
  
  • This is a machine that helps your heart beat at a normal speed and in a regular rhythm. A temporary pacemaker may use large patches placed on your chest and back. These are connected to a special monitor. Sometimes, your caregiver may need to put small wires through your skin and into your heart muscle instead. The wires may then be connected to a small pacemaker box outside of your body.
    
    
  • The temporary pacemaker "reads" what your heart is doing. If your heart is beating in a different way than it should, the pacemaker takes over and controls your heartbeat. It does this by sending small electric signals to the heart muscle. This tells your heart when to beat. You may feel these signals, especially if your temporary pacemaker uses large patches on the skin. If this causes pain, use your call light and tell your caregiver. Do not get out of bed without first asking your caregiver if it is OK. You may need a pacemaker just for a short time. In some cases, you may need it for the rest of your life. If so, your caregiver may replace your temporary pacemaker with a permanent one.
  
  
• Permanent pacemaker:
  
  
  • A permanent pacemaker is a small device that helps control your heart rate. A permanent pacemaker is about the size of a wristwatch, and is implanted under your skin. You may need a pacemaker to slow your heartbeat down, speed it up, or make it more regular.
    
    
  • A pacemaker is made up of leads and a generator (battery). Getting a pacemaker involves having a procedure done. Most pacemakers work only when they are needed. These are called demand pacemakers. Other pacemakers work all the time. Your caregiver will decide which pacemaker is right for you.
  
  
• Implanted cardioverter defibrillator:
  
  
  • An implanted cardioverter defibrillator is also called an ICD. It is a small device that monitors your heart rate and rhythm. If your ICD senses that your heart is beating in an unhealthy rhythm, it will give your heart a small electrical shock. This helps your heart start beating normally again.
    
    
  • An ICD is made up of a generator and leads (thin, flexible wires that attach to your heart). The generator and the leads will be placed inside you during a procedure. The generator has a metal shell with a battery and a small computer inside.
  
  
• Cardiac rehabilitation: Cardiac rehabilitation, or cardiac rehab, is a program that helps you feel better after having a heart problem. Cardiac rehab may also decrease your risk of having heart problems in the future. During cardiac rehab, you learn how to live a more heart-healthy lifestyle. You may also learn how to exercise safely to strengthen your muscles and heart.

Medicines:

• Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up).
  
  
• Aspirin: This is medicine that may be given to help thin the blood to keep blood clots from forming.
  
  
• Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
  
  
• Blood thinners: This medicine helps stop clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners may make it easier to bleed or bruise. While taking this medicine, use a soft toothbrush to prevent bleeding gums. If you shave, use an electric shaver.
  
  
• Diuretics: This medicine is often called "water pills". Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
  
  
• Cholesterol medicine: This type of medicine is given to help decrease (lower) the amount of cholesterol (fat) in your blood.
  
  
• Clot busters: This medicine helps break apart blood clots, which may increase blood flow to your heart muscle. It is given in your IV and may be given at the same time as other blood thinners. This medicine may decrease the amount of damage to your heart muscle, and may even save your life. You will bleed and bruise more easily after getting clot busters.
  
  
• Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.
  
  
• Nitroglycerin: This medicine may also be called nitro. Nitroglycerin opens the arteries to your heart so the heart gets more oxygen. Nitroglycerin can be given in an IV, by mouth, or put on your body as a patch or paste.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Tell caregivers right away if you start feeling discomfort, pressure, burning, or tightness in your chest. Tell caregivers right away if you start sweating, have trouble breathing, or feel discomfort in your arm, back, neck, or jaw. Any of these may be a sign that your heart is not getting enough oxygen, and may need medicine to help.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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