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. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. 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:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

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 to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.
  
  
• 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 a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• 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 device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• 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: For this test you need to urinate into a small container. You will be given instructions on how to clean your genital area before you urinate. Do not touch the inside of the cup. Follow instructions on where to place the cup of urine when you are done.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

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 if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots. You may need to wear pressure stockings before or after surgery or if you have poor circulation (blood flow).
  
  
• 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 prevent vomiting.
  
  
• Aspirin: This medicine may be given to help thin the blood to keep blood clots from forming. This medicine makes it more likely for you to bleed or bruise.
  
  
• Blood pressure medicine: This is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.
  
  
• Blood thinners: This medicine helps prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
  
  
• Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.
  
  
• 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 is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart 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.

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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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