Myocardial Infarction

OT Dude Academy’s Free NBCOT® Exam Prep Course Cardiology Myocardial Infarction

Pathophysiology

  • Myocardial infarction (heart attack) reflects the death of cardiac cells due to prolonged ischemia.1 
  • An acute coronary syndrome which can occur during the natural course of coronary atherosclerosis.2 3 
  • Occlusion of the coronary artery interrupts the delivery of nutrients to the myocardium and is complicated by coronary vasoconstriction and thrombi microembolisation.4 
  • Occlusion that persists longer than 30 minutes causes irreversible damage to the myocardium and myocardial infarction might occur.5 
  • An area of the myocardium becomes necrotic after about 6 hours of continuous occlusion.4 
  • Strong risk factors supported by evidence include raised LDL cholesterol, decreased HDL cholesterol, smoking, and high blood pressure.6 

Symptoms7 

  • Angina – traveling from left arm to neck
  • Dyspnea
  • Sweating
  • Nausea
  • Vomiting
  • Abnormal heart beating
  • Anxiety
  • Fatigue
  • Weakness
  • Stress
  • Depression

Silent MI Predictive Factors8 

  • Increasing age
  • Hypertension
  • History of cardiovascular diseases
  • Diabetes duration

Diagnosis

Per the European Society of Cardiology/American College of Cardiology:

1) Typical rise and gradual fall (troponin) or more rapid rise and fall (creatine kinase-MB) of biochemical markers of myocardial necrosis with at least one of the following:
a) Ischaemic symptoms
b) Development of pathological Q-waves on electrocardiogram
c) Electrocardiogram changes indicative of myocardial ischaemia (ST-segment elevation or depression)
d) Coronary artery intervention (eg, coronary angioplasty)

2) Pathological findings of an acute myocardial infarction

Biomarkers for the Diagnosis of MI

Myocardial Damage:9 

  1. Myoglobin
  2. Creatine kinase MB (CK-MB)
  3. Glycogen phosphorylase BB (GPBB)
  4. Fatty acid binding protein – heart type (hFABP)
  5. Ischemia modified albumin (IMA)
  6. Free fatty acids (FFA)

Types of MI

  • Type I: Spontaneous MI
  • Type II: MI secondary to an ischemic imbalance
  • Type III: MI resulting in death when biomarker values are unavailable
  • Type IVa: MI related to percutaneous coronary intervention
  • Type IVb: MI related to silent thrombosis
  • Type V: MI related to CABG

Treatment7 

  • Taking aspirin – prevents blood from clotting
  • Nitro-glycerin – angina and decreased oxygen

Long-Term4 

  • Aspirin
  • Beta-blockers
  • ACE-inhibitors
  • Statins
  • Anticoagulant

Occupational Therapy Interventions

  • Developing a structured exercise program10 
  • Fatigue management
  • Energy conservation
  • Pacing strategies
  • Using Distraction
  • Promoting social activities
  • Eating healthy
  • Client-centered education on MI disease and its management11 
  • Addressing participation in work, family, community life, and sexual health.12 13 
  • Supporting client roles and associated occupations, e.g., homemakers and IADLs14 
  • “Depressive symptoms after MI, irrespective of whether they persist, subside, or newly develop in the first month after hospitalization, are associated with worse outcomes after MI.”15 
  • Stress Management Techniques: Implementing relaxation techniques, mindfulness, and stress management practices to reduce anxiety and improve overall heart health 16 .
  • Sleep Hygiene: Educating and promoting good sleep practices to ensure adequate rest and recovery 17 .
  • Smoking Cessation Support: Providing resources and support for quitting smoking, which is a critical risk factor for heart disease 18 .
  • Weight Management: Offering guidance on maintaining a healthy weight through diet and physical activity 19 .
  • Medication Management: Assisting clients in understanding and adhering to their medication regimens to prevent complications 20 .
  • Blood Pressure Monitoring and Control: Educating clients on the importance of monitoring and controlling blood pressure 21 .
  • Emergency Response Training: Teaching clients and their families how to respond in case of a cardiac emergency 22 .
  1. The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined: a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J 2000; 21: 1502–13.[↩]
  2. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (1). N Engl J Med 1992; 326: 242–50.[↩]
  3. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Engl J Med 1992; 326: 310–18.[↩]
  4. Boersma, E., Mercado, N., Poldermans, D., Gardien, M., Vos, J., & Simoons, M. L. (2003). Acute myocardial infarction. The Lancet, 361(9360), 847-858.[↩][↩][↩]
  5. Hermens WT, Willems GM, Nijssen KM, Simoons ML. Effect of thrombolytic treatment delay on myocardial infarct size. Lancet 1992; 340: 1297.[↩]
  6. Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyorala K. Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Atherosclerosis 1998; 140: 199–270.[↩]
  7. Lu, L., Liu, M., Sun, R., Zheng, Y., & Zhang, P. (2015). Myocardial infarction: symptoms and treatments. Cell biochemistry and biophysics, 72(3), 865-867.[↩][↩]
  8. Valensi, P., Lorgis, L., & Cottin, Y. (2011). Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: a review of the literature. Archives of cardiovascular diseases, 104(3), 178-188.[↩]
  9. Lackner, K. J. (2013). Laboratory diagnostics of myocardial infarction–troponins and beyond. Clinical chemistry and laboratory medicine, 51(1), 83-89.[↩]
  10. Tooth, L., & McKenna, K. (1996). Contemporary issues in cardiac rehabilitation: Implications for occupational therapists. British Journal of Occupational Therapy, 59(3), 133-140.[↩]
  11. Michalski, P., Kosobucka, A., Pietrzykowski, Ł., Kasprzak, M., Buszko, K., Obońska, K., … & Kubica, A. (2017). Effectiveness of therapeutic education in patients with myocardial infarction. Medical Research Journal, 2(3), 89-96.[↩]
  12. Wolf, T. J., Baum, C., & Conner, L. T. (2009). Changing face of stroke: Implications for occupational therapy practice. American Journal of Occupational Therapy, 63(5), 621-625. http://dx.doi.org/10.5014/ajot.63.5.621[↩]
  13. Young, K., Dodington, A., Smith, C., & Heck, C. S. (2020). Addressing clients’ sexual health in occupational therapy practice. Canadian Journal of Occupational Therapy, 87(1), 52-62.[↩]
  14. B. Aronsson, J. Perk, AS Norlén, B. H. (2000). Resuming domestic activities after myocardial infarction: A study in female patients. Scandinavian Journal of Occupational Therapy, 7(1), 39-44.[↩]
  15. Parashar, S., Rumsfeld, J. S., Spertus, J. A., Reid, K. J., Wenger, N. K., Krumholz, H. M., … & PREMIER Registry Investigators. (2006). Time course of depression and outcome of myocardial infarction. Archives of Internal Medicine, 166(18), 2035-2043.[↩]
  16. Gianaros, P. J., & Wager, T. D. (2015). Brain-body pathways linking psychological stress and physical health. Current Directions in Psychological Science, 24(4), 313-321. https://doi.org/10.1177/0963721415581476[↩]
  17. Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., … & Adams Hillard, P. J. (2015). National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health, 1(1), 40-43. https://doi.org/10.1016/j.sleh.2014.12.010[↩]
  18. Rigotti, N. A. (2012). Strategies to help a smoker who is struggling to quit. JAMA, 308(15), 1573-1580. https://doi.org/10.1001/jama.2012.13043[↩]
  19. Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastreboff, A. M., … & Phyllis, M. (2016). American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocrine Practice, 22(7), 842-884. https://doi.org/10.4158/EP161365.GL[↩]
  20. Vrijens, B., De Geest, S., Hughes, D. A., Przemyslaw, K., Demonceau, J., Ruppar, T., … & Urquhart, J. (2012). A new taxonomy for describing and defining adherence to medications. British Journal of Clinical Pharmacology, 73(5), 691-705. https://doi.org/10.1111/j.1365-2125.2012.04167.x[↩]
  21. Whelton, P. K., Carey, R. M., Aronow, W. S., Casey Jr, D. E., Collins, K. J., Dennison Himmelfarb, C., … & Wright Jr, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, 71(19), e127-e248. https://doi.org/10.1016/j.jacc.2017.11.006[↩]
  22. Nichol, G., Thomas, E., Callaway, C. W., Hedges, J., Powell, J. L., Aufderheide, T. P., … & Rea, T. (2008). Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA, 300(12), 1423-1431. https://doi.org/10.1001/jama.300.12.1423[↩]
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