What happens to the heart muscle after an MI?

When a coronary artery becomes 100% blocked the muscle cells die. Cell death is
irreversible after about 30 minute. The cells are gone forever and can never be
replaced.

 Early signs of an MI…no physical changes to heart muscle yet (until about 6-8
hours), but when the myocytes die cardiac enzymes are released: CK-MB (4 to 6
hours after MI), troponin (2-4 hours…most regarded) myoglobin (1 hours after
injury…show injury but not too specific).
 Within 24-36 hours inflammation sets in and neutrophils come on the scene and
congregate at the damaged tissue site. This causes complication of
possible pericarditis. In addition, within 24 hours the heart fails to pump efficiently
(cardiogenic shock) and arrhythmias can develop (atrial and ventricular
dysrhythmia along with AV blocks).
 Within 10 days, granulation occurs when the macrophages come on the scene.
They are WBCs who’ve came to clean up the dead cells and other components.
However, the new tissue formed from granulation is not well formed and is weak.
This increases the chance of cardiac rupture.
 Within 2 months scarring occurs, and the heart is affected in size and functionality
due to increased collagen.

Signs & Symptoms of Myocardial Infarction

Remember the mnemonic: CRUSHING

Chest pain (intense, heavy)

Radiating chest pain that goes to left arm, jaw, back

Unrelieved by nitroglycerin or rest (chest pain)

Sweating (cold)

Hard to breathe (shortness of breath)

Increased heart rate, blood pressure or irregular heart rate

Nausea with vomiting

Going to be anxious and scared

Note: Women can present differently by not having “heavy” chest pain. Their chest pain
may be felt in the lower part of the chest, experience shortness of breath, and feel
extremely fatigued. They may not seek immediate help because they think they are “just
ill” with a sickness.

Silent MIs: this is where the patient has no symptoms of chest pain. Mainly occurs in
diabetics due to diabetic neuropathy where the nerves that feel pain are damaged in the
heart.

Diagnosing with Cardiac Markers & Other Tools

When the heart muscle is injured it releases cardiac markers overtime. This will help the
health care provider know that something is going on along with a 12-lead EKG (and
other tools).

Blood Tests Cardiac markers:

 Troponins: gold standard now used by most hospitals in assessing for an MI. It is

a protein released from the heart when damage is present from a myocardial
infarction. They are drawn in a series (troponin levels will elevate 2-4 after injury).
They are usually drawn every 6 hours for 3 sets. The nurse’s role is to collect
levels and monitor them for an upward trend. If levels are increasing, the
physician will need to be notified.
 Myoglobin: an early cardiac marker released after heart injury (1 hour after
injury). However, not very cardiac specific…used in early detection..will need more
blood tests to further evaluate.
 CK: protein released when there is muscle damage (not specific to just the heart)
…so CK-MB may be ordered to tell if it is the heart since CK-MB represents
heart muscle (it elevates 4-6 hr after injury).
Other tools used:

 Echocardiogram: ultrasound of the heart to look at the heart to see if there is

damaged from an MI.
 Heart Cath: a procedure where a special dye is injected into the coronary arteries
and an X-Ray is taken to see if there are any blockages, their locations, and if
there is any muscle damage. If there is a blockage, the cardiologist will assess the
need for stent placement or other techniques used to open the artery.
 Stress test with Myocardial Perfusion Imaging: assesses how the heart
responses to stress and evaluate the blood flow to the myocardial muscle.
 EKG:

 Shows ischemia, injury, and infarction.

 Nurses role: obtaining EKG (or delegating it to be done) looking for any EKG
changes and notifing md of them
 Compare newly obtained EKG to previous EKGs