NCM 112 - Care of Clients

CASE PRESENTATION

Paulo Cruz, a
45 year old Male, married and a businessman who was admitted due to chest pain,
describing it as "It's as if there's a big rock on my chest". Paulo complains of crushing
substernal chest pain radiating to his neck, back and left side of the arm. Symptoms started
1 hour ago while he's driving to work. Suddenly, he noticed that he became diaphoretic and
pale and started to become anxious. He reports nausea and light headedness after the onset
of the "crushing" chest pain and mild shortness of breath. He admits that he experienced
one pervious that he experienced one previous episode of chest pain three weeks ago that
lasted for about 10 minutes. He has no fever and chills. He was diagnosed with hypertension
since 35 years old and was prescribed Losartan 5 mg 1 tab once a day but no taking it
religiously. He is known diabetic for 5 years now and takes Metformin 500mg 1 tablet 2x a
day. He reports a family history of having cardiovascular problems. He has occasional
alcohol intake and consumes half packs of cigarette per day. Paulo's vital signs showed PR =
115 beats/min; BP = 90/60 mmHg; Temp = 35.5; RR = 24 cycles/min and 02 saturation of
91%. He was immediately hooked to 02 support at 21pm via nasal cannula and was given
Isordil 5 mcg 1 tab sublingual. He is still alert and oriented with no signs of decrease in
Sensorium. Upon auscultation he has systolic apical murmur grade 2 and diffuse rales in all
lung fields. He has no signs of cyanosis and edema. Electrocardiogram was performed and
reveals T-wave inversion and ST- segment elevation. His Troponin 1 (0.9) results show an
increase level. He was given Aspirin 80 mg, Clopidogrel 75 mg per orem and Arixtra 0.5 ml
given subcutaneously. Paulo was diagnosed with Acute Myocardial Infarction.

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 NCM 112 - Care of Clients

ASSESSMENT DIAGNOSIS PLANNING

NURSING CAREINTERVENTION
PLAN RATIONALE EVALUATION
Subjective: Acute chest pain related STG : Within 1 hour of INDEPENDENT: INDEPENDENT: STG: Within 1 hour
to myocardial ischemia nursing interventions, 1. Assess 1. Pain is indication of nursing intervention,
The client complains of resulting from coronary the client will have characteristics of chest of MI. assisting the the client had improved
crushing substernal artery occlusion with improved comfort in pain, including location, client in quantifying comfort in chest, as
chest pain radiating to loss/restriction of blood chest, as evidenced by: duration, quality, pain may differentiate evidenced by:
his neck, back and left flow to an area of the •States a decrease in intensity, presence of pre-existing and •States a decrease in
side of the arm. “It's as myocardium and necrosis the rating of the chest radiation, precipitating current pain patterns as the rating of the chest
if there's a big rock on of the myocardium. pain. and alleviating factors, well as identify pain.
my chest” as verbalized •Is able to rest, displays and as associated complications. •Is able to rest, displays
by the patient. reduced tension, and symptoms, have client 2. This provides reduced tension, and
sleeps comfortably. rate pain on a scale information that may sleeps comfortably.
Objective: •Requires decrease of 1-10 and document help to differentiate •Requires decrease
analgesia or findings in nurse’s current pain from analgesia or
nitroglycerin. notes. previous problems and nitroglycerin. Goal was
Vital Signs: 2. Obtain history complications. met.
PR = 115 beats/min; BP LTG: The client will have of previous cardiac pain 3. Respirations may be
= 90/60 mmHg; Temp = an improved feeling of and familial history increased as a result of LTG: The client had an
35.5 C control as evidenced by of cardiac problems. pain and associate anxiety. improved feeling
RR = 24 cycles/min verbalizing a sense of 3. Assess respirations, 4. To reduce oxygen of control as evidenced
02 saturation = 91%. control over present BP and heart rate with consumption and by verbalizing a sense
situation and future each episodes of chest demand, to reduce of control over present
- Facial grimacing outcomes within 2 days pain. competing stimuli and situation and future
- Fatigue of nursing 4. Maintain bed rest reduces anxiety. outcomes within 2 days
- Pallor interventions. during pain, with 5. Pain control is of nursing intervention.
- Mild shortness position of comfort, apriority, as it indicates Goal was met
of breath maintain relaxing ischemia.
environment to
promote calmness. 6. To decrease myocardial
5. Prepare for the oxygen demand and
administration work load on the heart.
of medications, and 7. To promote knowledge
monitor response to and compliance with

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drug therapy. Notify therapeutic regimen

physician if pain does and to alleviate fear
not abate. of unknown.

6. Instruct patient in DEPENDENT:

nitroglycerin SL 1. Serial ECG and stat ECGs
administration after record changes that
hospitalization. Instruct can give evidence of
patient inactivity further cardiac damage
alterations and and location of MI.
limitations. 2. Morphine is the drug
7. Instruct of choice to control MI
patient/family in pain, but other
medication effects, analgesics maybe used
side-effects, to reduce pain and
contraindications and reduce the workload on
symptoms to report. the heart.
DEPENDENT: 3. To block sympathetic
1. Obtain a 12-leadECG stimulation, reduce
on admission, then heart rate and lowers
each time chest pain myocardial demand.
recurs for evidence of 4. To increase coronary
further infarction as blood flow and collateral
prescribed. circulation which can
2. Administer decrease pain due to
analgesics as ordered, ischemia
such as morphine
sulfate, meferidine
of Dilaudid N.
3. Administer beta-
blockers as ordered.
4. Administer calcium-
channel blockers as

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 NCM 112 - Care of Clients

ordered

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Activity Intolerance STG: Within 3 days of INDEPENDENT: 1. Changes in VS assist
Subjective: related to cardiac nursing interventions, 1. Monitor heart rate, with monitoring STG: Within 3 days
The client reports dysfunction, changes in the client will be able to rhythm, respirations physiologic responses of nursing interventions,
of increased work oxygen supply and tolerate activity and blood pressure for to increase in activity. the client tolerated
of breathing associated consumption as without shortness of abnormalities. Notify 2. Alleviation of factors activity without
with feelings of evidenced by shortness breathing and will be physician of significant that are known to excessive shortness of
weakness and of breathing. able to utilize breathing changes in VS. create intolerance can breath and had been
tiredness. techniques and energy 2. Identify causative assist with able to utilize breathing
conservation factors leading to development of an techniques and energy
Objective: techniques effectively intolerance of activity. activity level program. conservation techniques
3. Encourage patient to 3. To help give the effectively. Goal was met.
Vital Signs: LTG: Within 5 days of assist with planning patient a feeling of self- LTG: Within 5 days
PR = 115 beats/min; nursing interventions, activities, with rest worth and well-being. of nursing
BP = 90/60 mmHg; the client will be able to periods as necessary. 4. To decrease energy interventions, the client
Temp = 35.5 C increase and achieve 4. Instruct patient in expenditure and increased and achieved
desired activity level, energy conservation fatigue. desired activity level,
RR = 24 cycles/min
progressively, with no techniques. 5. To improve respiratory progressively, with no
02 saturation = 91%.
intolerance symptoms 5. Turn patient at least function and prevent intolerance symptoms
noted, such as every 2 hours, and prn. skin breakdown. noted, such as
•Increased heart rate
respiratory 6. Instruct patient in 6. To improve breathing respiratory
•Increased respiratory
compromise. isometric and breathing and to increase activity compromise. Goal was
rate
exercises. level. met
•Pallor
7. Provide 7. To promote self-worth
•Fatigue and weakness
patient/family with and involves patient
•Decreased oxygen
exercise regimen, with and his family with self-
saturation
written instructions. care.

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DEPENDENT:
1.Assisst patient with 1. To gradually increase the
ambulation, as ordered, body to compensate for
with progressive the increase in overload.
increases as patient’s
tolerance permits

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 NCM 112 - Care of Clients

DRUG STUDY

DRUG NAME DOSAGES THERAPEUTIC INDICATIONS ADVERSE EFFECTS CONTRAINDICATIONS NURSING

ACTIONS CONSIDERATION
Generic name: Dosage: Blocks binding of CNS: Dizziness, Fatigue, Hypersensiti vity to Monitor patients
Losartan Potassium 50 mg/ angiotensin II to many Losartan is used for Headache, Anemia losartan who are also taking
tab tissues& Angiotens treating CV: Hypotension Pregnancy diuretics
Brand name: in is a potent hypertension, le EENT: Nasal Congestion [ c a t e g o r y   C   ( fi r s t for symptomatic
Cozaar Route: vasoconstrictor ft ventricular GI: Diarrhea, trimester), category D hypotension.
Oral and if it is inhibited hypertrophy and Indigestion, Nausea, (second and third
Drug Class: then it'll result diabetic nephropathy Vomiting trimesters)] Assess patient’s
Frequenc to reduced blood (kidney disease) MS: Back pain, Leg pain, Lactation renal function
Angiotensin II y: pressure muscle spasms
Receptor OD RESP: cough Tell patient to
Blockers avoid salt
substitutes

DRUG NAME DOSAGE THERAPEUTIC INDICATIONS ADVERSE EFECTS CONTRAINDICATIONS NURSING

ACTIONS CONSIDERATION
Generic Name: Dosage: Exact mechanism is Adjunct to diet to Endocrine: Contraindicated with Assessment
500 mg/ not understood; lower blood glucose Hypoglycemia, lactic allergy to metformin; CHF;
Metformin tab possibly increases type 2 (non-insulin acidosis diabetes complicated by - History: Allergy to
hydrochloride peripheral dependent) diabetes fever, severe infections, metformin;
Route: utilization of mellitus in patients GI: Anorexia, nausea, severe trauma, major diabetes
Trade Name: Oral glucose, decreases vomiting epigastric surgery, ketosis, acidosis, complicated by
 Glucophage, hepatic glucose discomfort, heartburn, coma (use insulin); type1 fever, severe
Glucophage XR Frequenc production and diarrhea, flatulence (insulin-dependent), infections, severe
y: alters intestinal serious hepatic trauma, major
Drug Class: BID absorption of impairment, serious renal surgery, ketosis,
Antidiabetic glucose. impairment, uremia, acidosis, coma;
thyroid or endocrine type 1 diabetes,
impairment, glycosuria, serious hepatic or
hyperglycemia associated renal impairment,

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 NCM 112 - Care of Clients

with primary renal disease. uremia, thyroid or

endocrine
impairment,
glycosuria,
hyperglycemia
associated with
primary renal
disease, CHF,
pregnancy,
lactation
- Physical: Skin
color, lesions; T,
orientation,
reflexes, peripheral
sensation; R,
adventitious
sounds; liver
evaluation, bowel
sounds; urinalysis,
BUN, serum
creatinine, LFTs,
blood glucose, CBC

Interventions

- Monitor urine or
serum glucose
levels frequently to
determine
effectiveness of
drug and dosage.
- WARNING:
Arrange for

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transfer to insulin
therapy during
periods of high
stress (infections,
surgery, trauma).
- WARNING: Use IV
glucose if severe
hypoglycemia
occurs as a result of
overdose.

Teaching points

- Do not
discontinue this
medication without
consulting your
health care
provider.

- Monitor urine or
blood for glucose
and ketones as
prescribed.

- Swallow
extended-release
tablets whole; do
not cut, crush, or
chew.
- Do not use this
drug during
pregnancy; if you

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 NCM 112 - Care of Clients

become pregnant,
consult with your
health care
provider for
appropriate
therapy

- Avoid using
alcohol while taking
this drug

- Report fever, sore

throat, unusual
bleeding or
bruising, rash, dark
urine, light-colored
stools, hypo- or
hyperglycemic
reactions.

DRUG NAME DOSAGES THERAPEUTIC INDICATIONS ADVERSE EFFECTS CONTRAINDICATIONS NURSING

ACTIONS CONSIDERATION
Relaxes vascular  Dinitrate:  CNS: Headache,  Contraindicated with Assessment
Generic Name :  Dosage: smooth muscle Treatment and apprehension, allergy to nitrates,
isosorbide 5 mg/tab with a resultant prevention of restlessness, severe anemia, head  History: Allerg
nitrates , decrease in venous angina pectoris weakness, vertigo, trauma, cerebral y to nitrates,
isosorbide Route: return and  Mononitrate: dizziness, faintness hemorrhage, severe
dinitrate , Sublingual decrease in arterial Prevention of  CV: Tachycardia, hypertrophic anemia, GI
isosorbide BP, which reduces angina pectoris retrosternal cardiomyopathy, hypermobility,
mononitrate left ventricular  Unlabeled use discomfort, narrow-angle head trauma,
workload and (dinitrate): Used palpitations, glaucoma, postdural cerebral
Brand Name: decreases with hydralazine hypotension, hypotension hemorrhage,
Apo-ISDN (CAN), myocardial oxygen in patients with syncope, collapse,  Use cautiously with hypertrophic

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 NCM 112 - Care of Clients

Dilatrate SR, consumption. advanced CH orthostatic pregnancy, lactation, cardiomyopat

Isordil, hypotension, acute MI, CHF. hy, pregnancy,
Isordil angina, rebound lactation
Titradose ,Imdur, hypertension,  Physical: Skin
ISMO, Isotrate atrial fibrillation, color, T,
ER, Monoket postural lesions;
hypertension orientation,
Classification:  Dermatologic: reflexes,
Antianginal, Rash, exfoliative affect; P, BP,
Nitrate, dermatitis, orthostatic BP,
Vasodilator cutaneous baseline ECG,
vasodilation with peripheral
flushing perfusion; R,
 GI: Nausea, adventitious
vomiting, sounds; liver
incontinence of evaluation,
urine and feces, normal
abdominal pain, output; CBC,
diarrhea Hgb
 GU: Dysuria, Interventions
impotence, urinary
frequency  Give
 Other: Muscle sublingual
twitching, pallor, preparations
perspiration, cold under the
sweat, arthralgia, tongue or in
bronchitis the buccal
pouch;
discourage the
patient from
swallowing.
 Create a
nitrate-free

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period to
minimize
tolerance.
 WARNING:
Give chewable
tablets slowly,
only 5 mg
initially,
because
severe
hypotension
can occur;
ensure that
patient does
not chew or
crush
sustained-
release
preparations.
 Give oral
preparations
on an empty
stomach, 1 hr
before or 2 hr
after meals;
take with
meals if
severe,
uncontrolled
headache
occurs.
 WARNING:
Keep life

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 NCM 112 - Care of Clients

support
equipment
readily
available if
overdose
occurs or
cardiac
condition
worsens.
 WARNING:
Gradually
reduce dose if
anginal
treatment is
being
terminated;
rapid
discontinuatio
n can lead to
problems of
withdrawal.
Teaching points

 Place
sublingual
tablets under
your tongue
or in your
cheek; do not
chew or
swallow the
tablet. Take
the isosorbide

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 NCM 112 - Care of Clients

before chest
pain begins,
when
activities or
situation may
precipitate an
attack. Take
oral isosorbide
dinitrate on
an empty
stomach, 1
hour before or
2 hours after
meals; do not
chew or crush
sustained-
release
preparations;
do not take
isosorbide
mononitrate
to relieve
acute anginal
episodes.
 You may
experience
these side
effects:
Dizziness,
lightheadedne
ss (may be
transient; use
care to change

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 NCM 112 - Care of Clients

positions
slowly);
headache (lie
down in a cool
environment,
rest; over-the-
counter
preparations
may not help;
take drug with
meals);
flushing of the
neck or face
(reversible).
 Report blurred
vision,
persistent or
severe
headache,
rash, more
frequent or
more severe
angina
attacks,
fainting.

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DRUG NAME DOSAGES THERAPEUTIC INDICATIONS ADVERSE EFFECTS CONTRAINDICATIONS NURSING

ACTIONS CONSIDERATION
Inhibition of  Mild to - Acute aspirin Assessment
Generic Dosage: platelet moderate pain toxicity: Respiratory - Contraindicated with - History: Allergy to
Name: Aspirin 80 aggregation is  Fever alkalosis, hyperpnea, allergy to salicylates or salicylates or
mg/tab attributable to the  Inflammatory tachypnea, NSAIDs (more common NSAIDs; allergy to
Brand Name: inhibition of conditions— hemorrhage, with nasal polyps, asthma, tartrazine;
Apo-ASA (CAN), Route: platelet synthesis rheumatic fever, excitement, confusion, chronic urticaria); allergy to hemophilia,
Aspergum, Oral of thromboxane rheumatoid asterixis, pulmonary tartrazine (cross-sensitivity bleeding ulcers,
Bayer, Easprin, A2, a potent arthritis, edema, seizures, to aspirin is common); hemorrhagic states,
Ecotrin, Empirin, vasoconstrictor osteoarthritis tetany, metabolic hemophilia, bleeding blood coagulation
Entrophen and inducer of  Reduction of risk acidosis, fever, coma, ulcers, hemorrhagic states, defects,
(CAN), platelet of recurrent TIAs CV collapse, renal and blood coagulation defects, hypoprothrombine
aggregation. This or stroke in respiratory failure (dose hypoprothrombinemia, mia, vitamin K
Classification: effect occurs at males with related, 20–25 g in vitamin K deficiency deficiency;
 Antipyretic, low doses and lasts history of TIA adults, 4 g in children) (increased risk of bleeding) impaired hepatic
Analgesic for the life of the due to fibrin - Aspirin function; impaired
(nonopioid), platelet (8 days). platelet emboli intolerance: Exacerbatio - Use cautiously with renal function;
Antiinflammator Higher doses  Reduction of risk n of bronchospasm, impaired renal function; chickenpox,
y, inhibit the of death or rhinitis (with nasal chickenpox, influenza (risk influenza; children
Antirheumatic, synthesis of nonfatal MI in polyps, asthma, rhinitis) of Reye’s syndrome in with fever
Antiplatelet, prostacyclin, a patients with - GI: Nausea, dyspepsia, children and teenagers); accompanied by
Salicylate potent vasodilator history of heartburn, epigastric children with fever dehydration;
NSAID and inhibitor of infarction or discomfort, anorexia, accompanied by surgery scheduled
platelet unstable angina hepatotoxicity dehydration; surgery within 1 wk;
aggregation. pectoris - Hematologic: Occult scheduled within 1 wk; pregnancy;
Aspirin is effective  MI prophylaxis blood loss, hemostatic pregnancy (maternal lactation
in reducing the  Unlabeled use: defects anemia, antepartal and - Physical: Skin
blood clots that Prophylaxis - postpartal hemorrhage, color, lesions; T;
are blocking a against cataract Hypersensitivity: Anaph prolonged gestation, and eighth cranial nerve
coronary artery formation with ylactoid reactions to prolonged labor have been function,
during an acute long-term use anaphylactic shock reported; readily crosses orientation,
heart attack. - Salicylism: Dizziness, the placenta; possibly reflexes, affect; P,

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 NCM 112 - Care of Clients

tinnitus, difficulty teratogenic; maternal BP, perfusion; R,

hearing, nausea, ingestion of aspirin during adventitious
vomiting, diarrhea, late pregnancy has been sounds; liver
mental confusion, associated with the evaluation, bowel
lassitude (dose related) following adverse fetal sounds; CBC,
effects: low birth weight, clotting times,
increased intracranial urinalysis, stool
hemorrhage, stillbirths, guaiac, LFTs, renal
neonatal death); lactation. function tests

Interventions
- BLACK BOX
WARNING: Do not
use in children and
teenagers to treat
chickenpox or flu
symptoms without
review for Reye’s
syndrome, a rare
but fatal disorder.
- Give drug with
food or after meals
if GI upset occurs.
- Give drug with full
glass of water to
reduce risk of
tablet or capsule
lodging in the
esophagus.
- Do not crush, and
ensure that patient
does not chew SR
preparations.

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 NCM 112 - Care of Clients

- Do not use aspirin

that has a strong
vinegar-like odor.
-
WARNING: Institut
e emergency
procedures if
overdose occurs:
Gastric lavage,
induction of
emesis, activated
charcoal,
supportive therapy.

Teaching points
-Take extra
precautions to
keep this drug out
of the reach of
children; this drug
can be very
dangerous for
children.
-Use the drug only
as suggested; avoid
overdose. Avoid
the use of other
over-the-counter
drugs while taking
this drug. Many of
these drugs contain
aspirin, and serious
overdose can

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occur.
-Take the drug with
food or after meals
if GI upset occurs.
-Do not cut, crush,
or chew sustained-
release products.
-Over-the-counter
aspirins are
equivalent. Price
does not reflect
effectiveness.
-You may
experience these
side effects:
Nausea, GI upset,
heartburn (take
drug with food);
easy bruising, gum
bleeding (related to
aspirin’s effects on
blood clotting).
-Report ringing in
the ears; dizziness,
confusion;
abdominal pain;
rapid or difficult
breathing; nausea,
vomiting, bloody
stools.

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 NCM 112 - Care of Clients

DOSAGE THERRAPEUTIC INDICATIONS ADVERSE EFFECTS CONTRAINDICATIONS NURSING

DRUG NAME ACTIONS CONSIDERATION
Dosage: Clopidogrel works Indicated to patients Adverse effects of Contraindicated to patients -May cause GI
Generic Name: 75 mg by who are suffering Clopidogrel includes: with: bleeding,
clopidogrel blocking platelets f from heart attacks, neutropenia,
Route: rom sticking strokes and persons - Hypersensitivity to the hypercholesterole
Brand Name:
Oral together and with heart - Chest pain drug mia
Plavix
prevents them disease (recent heart -Headache
Drug Class: from forming attack), recent stroke, -Flulike syndrome -Active pathologic bleeding -May increase risk
Antiplatelet harmful clots. It is or blood circulation di -Joint pain (e.g., peptic ulcer, for bleeding in
Agents, an antiplatelet sease (peripheral -Pain intracranial hemorrhage) warfarin, aspirin,
Cardiovascular; drug. It helps keep vascular disease). -Dizziness heparin
Antiplatelet blood flowing -Diarrhea
Agents, smoothly in your -Rash -Monitor for signs
Hematologic body -Runny or stuffy nose of bleeding
-Depression
-Urinary tract infection -Monitor bleeding
-ncreased bleeding times
-Nosebleeds
-Itching -Monitor CBC and
-Bruising platelet count

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DOSAGE THERAPEUTIC USE INDICATION ADVERSE EFFECTS CONTRAINDICATIONS NURSING

DRUG NAME CONSIDERATION
Dosage: The antithrombotic - Prevention of Anemia, bleeding, Hypersensitivity, active Do not administer
Generic Name: 0.5 ml activity of venous purpura; edema. clinically significant IM.
Fondaparinux fondaparinux thromboembolic bleeding, acute bacterial
sodium Route: sodium is the events (VTE) in endocarditis. Not to be given 24
subcutan result of patients undergoing hr prior to CABG
Brand name: eous antithrombin III major orthopedic surgery & may be
Arixtra (ATIII)-mediated surgery of the lower restarted 48 hr
selective inhibition limbs eg, hip fracture post-op.
Drug Class: of Factor Xa. By including extended
Anticoagulant selectively binding prophylaxis, knee & STEMI patients
to ATIII, hip replacement undergoing primary
fondaparinux surgery; abdominal PCI for reperfusion.
sodium potentiates surgery at risk of Monotherapy in
(about 300 times) thromboembolic UA/NSTEMI &
the innate complications; STEMI patients
neutralization of medical patients at undergoing non-
Factor Xa by ATIII. risk of primary PCI.
Neutralization of thromboembolic
Factor Xa complications due to Increased risk of
interrupts the restricted mobility hemorrhage in
blood coagulation  during acute illness. congenital or
cascade and thus Treatment of acute acquired bleeding
inhibits thrombin f DVT & pulmonary disorders, active
ormation embolism (PE), ulcerative GI
and thrombus dev unstable angina or disease, recent
elopment. non-ST segment intracranial
elevation MI hemorrhage,
Fondaparinux (UA/NSTEMI) acute shortly after brain,
sodium does not coronary syndrome spinal or ophth
inactivate for the prevention of surgery. Low body
thrombin death, MI & wt <50 kg.

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refractory ischemia; Spinal/epidural

(activated Factor II) ST segment elevation anesth or spinal
and has no known MI (STEMI) acute puncture.
effect on platelet coronary syndrome
function. At the for the prevention of History of heparin-
recommended death & myocardial induced
dose, fondaparinux re-infarction in thrombocytopenia
sodium does not patients who are & latex allergy.
affect fibrinolytic managed w/ Renal (CrCl <20 or
activity or bleeding thrombolytics or who 20-30 mL/min) or
time. initially are to receive severe hepatic
no other form of impairment.
reperfusion therapy.
Close monitoring is
recommended in
patients
concomitantly
taking products
enhancing the risk
of hemorrhage.

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 MYOCARDIAL INFARCTION
NCM 112 - Care of Clients
MODIFIABLE FACTORS NON MODIFIABLE FACTORS
Change in the condition of plaque in the
 Hypertension coronary artery  Family History of Acute Myocardial
 Smoking  Aging
 Increasing levels of triglyceride, total  Men and Postmenopausal Women
cholesterol and LDL levels Activation of Platelets
 Excessive intake of saturated fats,
carbohydrates or salt
 Sedentary lifestyle /Physical Inactivity Platelet aggregation, Adhesion, Build-up of
 Stress Platelet Mass (Thrombosis)
 Drug Abuse

Release of thromboplastin

Platelet release of thromboxane A2, serotonin,

Platelet Factors 3 & 4

Coagulation and vasopressin

Enlargement of thrombus

Thrombus formed in the wall of coronary artery

can block the blood flow which leads to
deprivation of oxygen supply for heart muscles.

PATHOPHYSIOLOGY OF Oxygen deprived heart muscles begin to

die which cause MI symptoms (e.g chest
MYOCARDIAL
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INFARCTION pain, shortness of breath, fatigue and light
headedness.