1. Nursing Instruction
  2. Overview
  3. Cardiology
[Major points]
  1. Myocardial infarction is a serious and acute heart condition.
  2. Common symptoms include chest pain, difficulty breathing, and dizziness.
  3. Treatment options may involve medications, cardiac catheterization, or coronary artery bypass surgery.
  4. Patients should quit smoking, take medications on time, and maintain a healthy diet and lifestyle after suffering from myocardial infarction.

What is myocardial infarction?
Myocardial infarction is a serious and acute heart condition primarily caused by the accumulation of cholesterol, platelets, and other substances in the coronary arteries. This accumulation leads to atherosclerosis, stenosis, obstruction, and plaque formation. A myocardial infarction occurs when a plaque ruptures, leading to blood clotting that blocks blood vessels. This blockage interrupts blood flow, depriving the myocardium of oxygen and causing hypoxia, damage, and tissue necrosis.

What are the risk factors for myocardial infarction?
The risk factors for myocardial infarction include age (men over 45 years old and women over 55 years old), personal or family history of cardiovascular disease, hypertension, diabetes, hyperlipidemia (e.g., high LDL cholesterol), obesity, smoking, personality traits (such as high motivation , impatience, proneness to stress), and poor lifestyle choices (lack of exercise, lack of sleep, excessive stress), etc.

What are the symptoms of myocardial infarction?
Typical symptoms of myocardial infarction include varying degrees of chest tightness and chest pain. The pain may radiate to the left arm, left shoulder, neck, jaw, teeth, back, or upper abdomen, and may be accompanied by weakness, dizziness, cold sweats, palpitations, difficulty breathing, poor digestion, nausea, and vomiting. Symptoms can intensify during physical exertion, after eating, or with emotional stress. If chest pain lasts for more than 30 minutes or if symptoms persist or worsen despite taking three nitroglycerin tablets at five-minute intervals, seek medical attention immediately.

How to treat myocardial infarction?
  1. Medications: Patients may be prescribed anticoagulants, platelet inhibitors, vasodilators, hypolipidemic agents, and analgesics based on their physician's evaluation. Those taking anticoagulants and platelet inhibitors should monitor for signs of bleeding, such as bloody stools, hematuria, bleeding gums, and unexplained bruising.
  2. Pain control: Pain increases myocardial oxygen consumption, so nitroglycerin (sublingual tablets or intravenous injections) is used to relieve pain caused by myocardial ischemia. If pain persists, intravenous morphine may be administered.
  3. Oxygen therapy: Medical and nursing staff will assess the patient’s condition and administer oxygen therapy if arterial oxygen saturation drops below 90% or if there are signs of heart failure, pulmonary edema, or shock.
  4. Interventional therapy: Treatments such as percutaneous coronary intervention (balloon angioplasty), coronary stent placement, and coronary atherosclerosis curettage are performed using cardiac catheterization. If vascular obstruction is severe and unmanageable by catheterization, coronary artery bypass surgery may be considered.

What should you do after a myocardial infarction?
  1. Take medications regularly: Patients should follow their physician's instructions regarding medication. Do not adjust dosages or discontinue medication without consulting a doctor to avoid exacerbating the condition. Regular follow-ups and keeping nitroglycerin sublingual tablets on hand are also important.
  2. Quit smoking and stay away from second-hand smoke: Avoid smoking and second-hand smoke. Nicotine and tobacco chemicals can damage the heart's blood vessels and increase the risk of reinfarction.
  3. Cardiac rehabilitation: Patients should engage in a cardiac rehabilitation program that includes warming up and cooling down for 5 to 10 minutes before and after exercise. Aim to exercise about 2 hours after eating, adjust intensity based on personal condition, and maintain proper breathing. Stop exercising immediately if discomfort occurs.
  4. Maintain healthy eating habits:
    1. Patients should consume fresh fruits and vegetables (≥200g per day), beans, whole grains, nuts (30g per day) and deep-sea fish rich in Omega-3 polyunsaturated fatty acids. Limit saturated fat to less than 10% of total daily caloric intake. It is recommended to replace red meat (such as pork, beef, lamb, chicken legs, tuna, and mackerel) with white meat (such as chicken breast, duck, most fish, shrimp, and shellfish) and plant-based protein.
    2. Patients should follow a low-salt, low-sugar, and low-oil diet, reduce the intake of refined carbohydrates such as white rice, pasta, cakes, and bread. Avoid foods that are pickled, processed, or made with ghee and margarine.
    3. Patients should reduce the intake of caffeinated drinks, such as coffee, tea, and cola to no more than 300 mg/day.
    4.  Patients should reduce their alcohol intake to no more than 10 g per day for women and 20g per day for men. For example, women should consume no more than 318 ml of beer (4% alcohol) per day, and men no more than 636 ml per day.
  5. Patients should avoid obesity: Obesity is a risk factor for myocardial infarction, and a large waist circumference means that excess visceral fat can easily harm cardiovascular health. Patients should maintain the ideal Body Mass Index (BMI) within the normal range of 18.5kg/m2 to 24 kg/m2. The calculation formula for BMI is weight (kg)/ divided by height squared (m2). The waist circumference should not exceed 90 cm for men and 80 cm for women.
  6. Patients should maintain a healthy lifestyle: Patient should get enough sleep, relax, and avoid excessive stress.
  7. Patients should avoid excessive temperature differences: Water temperature for bath should be moderate, avoid a very cold or a very hot bath. Patients should take care to stay warm. Large temperature fluctuations can cause blood vessels to contract and spasm, increasing local blood vessel pressure and potential leading to vascular plaque rupture and myocardial infarction.

Reference
  1. Knuuti, J., Wijns, W., Saraste, A., Capodanno, D., Barbato, E., Funck-Brentano, C., Prescott, E., Storey, R. F., Deaton, C., Cuisset, T., Agewall, S., Dickstein, K., Edvardsen, T., Escaned, J., Gersh, B. J., Svitil, P., Gilard, M., Hasdai, D., Hatala, R., Mahfoud, F., … ESC Scientific Document Group (2020). 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal, 41(3), 407-477. https://doi.org/10.1093/eurheartj/ehz425
  2. Li, Y. H., Lee, C. H., Huang, W. C., Wang, Y. C., Su, C. H., Sung, P. H., Chien,S. C., & Hwang, J. J. (2020). 2020 focused update of the 2012 guidelines of the Taiwan society of cardiology for the management of ST-segment elevation myocardial infarction. Acta Cardiologica Sinica, 36(4), 285-307. https://doi.org/10.6515/ACS.202007_36(4).20200619A
  3. Vogel, B., Claessen, B. E., Arnold, S. V., Chan, D., Cohen, D. J., Giannitsis, E., Gibson, C. M., Goto, S., Katus, H. A., Kerneis, M., Kimura, T., Kunadian, V., Pinto, D. S., Shiomi, H., Spertus, J. A., Steg, P. G., & Mehran, R. (2019). ST-segment elevation myocardial infarction. Nature reviews. Disease primers, 5(1), 39. https://doi.org/10.1038/s41572-019-0090-3
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
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    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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