Myocardial Infarction

WHAT YOU SHOULD KNOW:

• A myocardial infarction (MI) is a heart attack. A heart attack happens when the blood vessels that supply blood to your heart (coronary arteries) are blocked. This causes areas of your heart muscle to die.
  
  
• Chest pain is the most common symptom. Your chest may feel tight or heavy. You may feel pressure, crushing, squeezing, or burning. The discomfort may spread to your neck, jaw, shoulders, back, or arms. You may also have heartburn, shortness of breath, and you may feel sweaty. Women, older adults, and people with diabetes or a history of heart failure may not have typical chest pain or pressure. They may have shortness of breath and no other symptoms. Some people have no symptoms at all. This is called a silent MI.

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:

Damage to your heart can lead to an abnormal heart rhythm. You may go into cardiogenic shock which means your heart cannot get enough blood to your organs. You may develop heart failure. The damage from the MI may cause your heart to rupture (burst open). An MI can be life-threatening. Clot busters and blood thinning medicines may cause bleeding problems.

WHILE YOU ARE HERE:

Informed consent

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.

Activity:

Your caregiver will tell you when it is okay to get out of bed. Call a caregiver before you get out of bed. Do not try to get out of bed by yourself. Tell your caregiver if you feel weak, dizzy, or like you are going to faint.

An IV (intravenous)

is a small tube placed in your vein that is used to give you medicine or liquids.

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.

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).

Heart medicines:

• 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.
  
  
• Angiotensin-converting enzyme inhibitors: These medicines are called ACE inhibitors. They help relax your blood vessels so your heart can get the blood it needs. You may need angiotensin II receptor blockers (ARBs) if you cannot take ACE inhibitors.
  
  
• Aldosterone antagonists: These medicines helps remove extra fluid from your body and protects your heart from more damage.
  
  
• Beta blockers: These medicines help you have a steady and regular heartbeat.
  
  
• Calcium channel blockers: These medicines help slow your heartbeat. They also help open up small blood vessels. This can relieve chest pain, control an abnormal heartbeat, and decrease blood pressure.

Other medicines:

• 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.
  
  
• 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.
  
  
• 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.
  
  
• Cholesterol medicine: This medicine may help decrease the amount of plaque in your blood.

Monitoring:

• 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.
  
  
• 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.
  
  
• Echocardiogram: This test is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
  
  
• Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. An arterial line may be used to measure your blood pressure or to take blood.
  
  
• 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 CVP line is used to give medicines or IV fluids. It may also be hooked up to a monitor to take pressure readings.
  
  
• Pulmonary artery catheter: This is a balloon-tipped catheter (thin tube) inserted through a vein in your neck or groin. The pulmonary artery (PA) catheter goes into the right side of your heart and continues to your pulmonary artery. The balloon is inflated to wedge the catheter in place. The PA catheter has a device in it that measures the pressure in your heart and lungs. The catheter is attached to a monitor that shows the pressure measurements. The measurements can also show caregivers how your heart responds to certain heart medicines.

Tests:

You may need any of the following tests to help caregivers plan your treatment:

• Blood tests: You may need blood tests to check the function of your heart and other organs, such as your kidneys. 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.
  
  
• Angiogram: This is a test to look for blockage in your coronary arteries, such as plaque or blood clots. It is also called a cardiac catheterization. During an angiogram, a catheter (long, thin, bendable tube) is put into an artery, usually in your groin. Sometimes the catheter is put into a different artery, such as one in your arm. Special dye is put through the catheter and x-ray pictures are taken of the blood flow.
  
  
• Stress tests: These tests help caregivers see the changes that take place in your heart during exercise or with medicine. Stress tests check for blockages in the arteries of your heart. During an exercise stress test, 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. During a medicine stress test, you are given medicine in your IV that makes your heartbeat faster and opens heart arteries. An EKG is taken at the same time. Be sure to tell a caregiver how you feel during the test.

Treatments:

Ask your caregiver for more information about these or other treatments you may need:

• Angioplasty: A percutaneous coronary angioplasty may be done to open an artery blocked by plaque. A special tube with a balloon on the end is threaded into the blocked artery. Once the tube is in the artery, the balloon is filled with contrast dye. As the balloon fills, it presses the plaque against the artery wall. Pressing the plaque against the artery wall opens the artery so blood can flow through it more easily.
  
  
• Coronary intravascular stent placement: This is also called coronary artery stenting. The stent is a small mesh wire that is inserted into an artery to keep it open so blood can flow through it. When the stent is expanded by the balloon, it attaches to the artery wall and keeps the artery open.
  
  
• 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.
  
  
• 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.
  
  
• Pacemaker: This is a machine that helps your heart beat at a normal speed and in a regular rhythm. The pacemaker can read your heart rhythm. If your heart does not beat as it should, the pacemaker sends small electric signals to your heart. This tells your heart when to beat. You may feel these signals, especially if your temporary pacemaker uses large patches on the skin. You may have a temporary pacemaker, or it may be permanent.
  
  
  • Temporary: Large patches are 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.
    
    
  • Permanent: A permanent pacemaker is about the size of a wristwatch. It is implanted under the skin of your chest.
  
  
• Coronary artery bypass graft (CABG) surgery: This surgery is also known as heart bypass surgery or open-heart surgery. 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.

Learn more about Myocardial Infarction (Inpatient Care)