Non-Stemi Myocardial Infarction
Carla Robbins
Kent State University

Introduction
M.L. is an 87 year old female that was admitted 3/17/2013. She lives with her son. M.L. has 4 adult children and is widowed. M.L. has a history of Hypertension; Dementia; Carpal Tunnel Syndrome; Insulin Resistance syndrome; Arthritis; Cancer; Unspecified Cerebral Artery Occlusion with Cerebral Infarction; Other disorder of Ureter; Thyroid Disease; Rectal Bleeding. Surgical history includes Hysterectomy, Cholecystectomy, and Carotid endarterectomy. Patient has a history of irregular heart rates ranging from the 50’s to the 180’s. Patient is allergic to Penicillin’s and Sulfa drugs. M.L.’s family came in later in the morning to visit with her. They also met with social services about their options for rehabilitation and placement for M.L.
Primary diagnosis/Pathophysiology
M.L.’s admitting diagnosis is Non-Stemi myocardial infarction. A myocardial infarction is also called a heart attack. A myocardial infarction is caused when the blood cannot flow adequately through the arteries that lead to the heart. Blood flow can be restricted from flowing through the arteries from plaque or platelets that have clumped together and formed a clot. The plague is a build-up of fat and lipids over time in the arteries. In certain circumstances, such as activity, blood vessels have to dilate to allow more blood to flow to the heart. When the arteries cannot dilate properly, they do not allow enough blood to the heart. This causes the arteries going to the heart to die. In return the heart muscle begins to die. (Black & Hawks, 2009, p. 1488-1490).
There are two types of myocardial infarctions. They are stemi and non-stemi myocardial infarctions. A stemi is caused by a blood clot that blocks blood flow in an artery of the heart. A non-stemi is caused by different types of blood clots. The blood clots in non- stemi patients have proteins and platelets blood cells that are different from a traditional blood clot. The compositions in which these clots form are different. M.L. had a non-stemi myocardial infarction. ("Heart Attack Treatment Guidelines", 2013).
When a patient is suffering from a myocardial infarction, the patient will experience pain that can be in the left shoulder, down the left arm, back pain, neck pain, jaw pain, and epigastric pain. The patient is often short of breath or difficulty breathing. The patient can experience palpitation, cold sweats, or look pale. Women usually experience the less often seen signs such as the back or stomach pain which is why women are often misdiagnosed. M.L. was having difficulty breathing upon coming to the emergency department. She stated she had a little cough with clear sputum. Cough has gone away since she arrived at hospital. M.L.’s lungs are clear bilaterally.
A myocardial infarction can be diagnosed by performing an ECG and blood work. The doctor will order labs and an ECG. The nurse will perform an ECG on the patient to check the heart rhythm. The Nurse will also draw blood send to the lab in order to evaluate enzyme levels that would detect heart damage from a myocardial infarction. Troponin, Myoglobin CK-MB, LDH, and AST are a few of the cardiac markers in the lab work that will be performed after a heart attack. M.L. had high levels of CK- 767 (H), CK-MB – 15.2 (H), and Troponin – 0.24 (H). These were drawn the day after her myocardial infarction took place (3/18/2013), so her levels have not returned to normal. Cardiac marker levels usually take up to 7 – 10 days to return to normal.
Treating a myocardial infarction depends on what kind of infarction a patient has. Diagnosing has to be done quickly to stop the damage to the heart muscle. Once a patient arrives at the emergency department with a complaint of chest pain, if a heart attack is suspected, an aspirin should be given, an ECG should be performed and cardiac serum markers should be drawn all