NSG 530 Myocardial Infarction (MI) Case Study Assignment

NSG 530 Myocardial Infarction (MI) Case Study Assignment

Case Study Power Point Assignment

1. Case Study Power Point Presentation

Based on your readings throughout the course, choose a disorder/disease from your text and develop a power point presentation. The presentation must include:

incidence, prevalence (include to a global perspective), pathophysiology of the disease/disorder to the cellular level, existing prevention and therapeutic measures, current or future research relevant to the disorder/disease. The presentation must specifically address how this disorder/disease impacts ONE of the following age groups: infant/child, adult, or elderly.

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This presentation should be no more than 20 slides (excluding title and reference slide(s)). APA 6^th ed. is required. A minimum of 4 references excluding your text is required.

Criteria	Points
Topic Description: incidence, prevalence (include to a global perspective), pathophysiology of the disease/disorder to the cellular level, existing prevention and therapeutic measures, current or future research relevant to the disorder/disease. NSG 530 Myocardial Infarction (MI) Case Study Assignment	60
Application of disorder/disease: Specific to age group.	20
References: Use of 4 scientific references (excluding text).	5
Other Criteria: Length not to exceed 20 slides  (excluding title and reference slides). APA 6th ed. format required. Your PowerPoint should utilize graphics including but not limited to images, graphs, tables, etc. You may also audio record or voice over to provide an explanation of a slide.	15
Total Points	100

• Myocardial Infarction (MI)
• [Name] [Course] [Institution]
• Myocardial Infarction (MI)
• Definition
• Coronary heart disease (CHD)
• Ischemic heart disease (IHD)
• STEMI
• – Myocardial infarction (MI) is the occlusion of a coronary artery that supplies blood to the heart muscle (myocardium), leading to deprivation of oxygen and glucose to the heart muscle (Chadwick et al., 2018).- The myocardium requires a continuous supply of glucose and oxygen to carry out the work of pumping blood to the body.- Myocardial infarction is a form of coronary heart disease (CHD) and is the most common of all of them.- It is also referred to as ischemic heart disease (IHD) because it is a result of myocardial ischemia. NSG 530 Myocardial Infarction (MI) Case Study Assignment– There are two types of MI, ST-elevation MI (STEMI) and non-ST-elevation MI or NSTEMI (Chadwick et al., 2018).– STEMI is MI in which there is an accompanying abnormality (elevation) in the ST segment of the patient’s electrocardiogram.
• Myocardial Infarction (MI)
• NSTEMI
• Modifiable risk factors
• Non-modifiable risk factors
• Age bracket most affected
• – NSTEMI, on the other hand, is MI in which the patient’s ECG does not show ST-segment elevation but the patient’s blood cardiac enzymes like troponin are elevated.- the modifiable risk factors for MI include smoking, physical inactivity, alcohol consumption and diet without sufficient fruits and vegetables (Chadwick et al., 2018).- The non-modifiable risk factors include hypertension, diabetes mellitus, and congenital dyslipidemia (Chadwick et al., 2018).- MI commonly affects persons from the age of forty and above. Above age 75 years, its incidence increases manyfold.
• Incidence of Myocardial Infarction
• Definition
• Morbidity and mortality
• Geographical disparities
• Age dynamics
• – The incidence of a disease in epidemiology means the number of new cases of the disease in a given period of time. In the case of MI, this is the number of new acute MI cases recorded.- Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally. MI is a manifestation of CHD.- Data from studies shows that the incidence of MI is falling in developed countries but rising in developing countries. This has been attributed to better health care and education in the developed countries than in the developing ones (Chadwick et al., 2018).- MI is also rare in persons younger than forty years old. With increasing age, the risk of MI rises significantly.

• Incidence of Myocardial Infarction
• Incidence in the US
• Global incidence
• Black men
• White men
• – The global incidence of MI is 32.4 million MI cases per year (WHO, 2020).- The incidence in the United States is 525,000 per year, according to data from the American Heart Association (Chadwick et al., 2018).- in the US, data has shown that Black men are more affected than White men and women. The incidence among Black males in the US is 12.9 per 100,000 males.- The incidence in White males is 9.1 per 100,000 males (Chadwick et al., 2018).
• Incidence of Myocardial Infarction

This is the incidence of MI in the US by age, sex, and race. The data is for the year 2015 by the American Heart Association (Chadwick et al., 2018).

• Incidence of Myocardial Infarction
• Black women
• White women
• Black race a non-modifiable risk factor
• -The incidence in Black women is 10.2 per 100,000 females.- The incidence in White women is 7.8 per 100,000 females.- From these statistics, it follows that being Black or of Black origin is a non-modifiable risk factor. Race and therefore genetics obviously has a part to play in the epidemiology of myocardial infarction.
• Prevalence of Myocardial Infarction

This is a sample of age-specific prevalence of MI in the United Kingdom, with data from the year 2014 (Chadwick et al., 2018).

• Prevalence of Myocardial Infarction
• Definition
• The case of MI
• Sex disparity in prevalence
• Men
• – Prevalence of a disease condition like MI is the total number of cases of the disease existing among the population at a given point in time.- In the case of MI, the prevalence refers to all the acute MI cases (first MI attack for the patient) and all the MIs in persons that have already suffered a previous MI (Chadwick et al., 2018).- The prevalence of MI is higher in men than in women, in line with the incidence.- The prevalence of MI in men is 12% (Chadwick et al., 2018).

• Prevalence of Myocardial Infarction
• Women
• Acute MI
• Repeat MI
• -The prevalence of MI in women is less than half that of men at 5.5% (Chadwick et al., 2018).- All MIs that occur for the first time are referred to as acute MIs. A myocardial infarction is usually a medical emergency with time from the onset of symptoms being the most significant determinant of morbidity and mortality.- Repeat MI is a myocardial infarction that occurs in a person that has had a previous episode of MI that was successfully managed. NSG 530 Myocardial Infarction (MI) Case Study Assignment
• Pathophysiology of Myocardial Infarction

This is irreversible cardiomyocyte injury when the myocardium experiences ischemia (Frangogiannis, 2015).

• Pathophysiology of Myocardial Infarction
• Atherosclerosis
• Cardiomyocyte physiology
• Ischemia
• Infarction
• -MI is the end result of atherosclerosis. This is the deposition of fatty plaques on the tunica intima or inner lining of the coronary arteries . Over time, these fatty deposits become large enough to begin occluding the lumen of the coronary arteries.- As a result, enough blood does not reach the myocardium distal to the occlusion.- The cardiomyocytes that form the myocardium normally generate energy for the pumping force of the heart in the form of ATP (adenosine triphosphate).- ATP is generated by an intracellular process known as oxidative phosphorylation. This process requires oxygen and glucose together with a favorable pH for the enzymes involved to act efficiently. NSG 530 Myocardial Infarction (MI) Case Study Assignment– With partial occlusion, ischemia results and the myocardium is starved of both oxygen and nutrients.– With total occlusion, the cardiomyocytes die and infarction (tissue death) results (Frangogiannis, 2015).
• Pathophysiology of Myocardial Infarction
• Stoppage of ATP generation
• Anaerobic glycolysis
• Lactic acidosis (myocardial)
• Intracellular cardiomyocyte acidosis
• -The starvation of the cardiomyocytes of oxygen and glucose leads to the cessation of oxidative phosphorylation and the generation of ATP through the normal pathway.- To continue their function for a short while, the cardiomyocytes resort to anaerobic glycolysis (ATP generation without oxygen). These cells do this by utilizing the intracellular stores of glucose.- However, anaerobic glycolysis inevitably results in the generation of toxic lactic acid (lactate) in the myocardium. This raises the pH in the cardiomyocytes and intracellular acidosis occurs (Frangogiannis, 2015).
• Pathophysiology of Myocardial Infarction
• Enzyme denaturing in the glycolytic pathway
• Disturbance in ionic balance
• Removal of potassium (K+) from cardiomyocytes
• Rise in intracellular sodium
• -The low pH denatures the enzymes involved in the glycolytic pathway and the process of generating ATP even by anaerobic glycolysis stops.- There is also ionic balance disturbance in that potassium is expelled from the inside of the cardiomyocytes. NSG 530 Myocardial Infarction (MI) Case Study Assignment- When the cardiomyocytes die, more potassium is expelled.- The expelled potassium causes the heart’s electrical excitability to reduce.– The intracellular levels of sodium also rise affecting further the normal physiology of the myocardium (Frangogiannis, 2015).– The sum total of this pathophysiology is that the myocardium dies and the heart becomes unable to carry out its systolic function.
• Prevention of Myocardial Infarction
• Exercise
• Diet with fruits and vegetables
• Low fat diet
• Cessation of alcohol drinking
• – Regular exercise has the benefit of burning excess fat in the body hence reducing the risk of MI.- Eating food with enough fruits and vegetables has also been shown to reduce the chances of getting a MI.- Taking a diet low in fat reduces circulating low density cholesterol in the blood that would form atherosclerotic plaques in the coronary arteries. NSG 530 Myocardial Infarction (MI) Case Study Assignment- Stopping drinking of alcohol will also help protect against MI (WHO, 2020).
• Prevention of Myocardial Infarction
• Cessation of smoking
• Avoiding overweight and obesity
• Proper management of diabetes
• Proper management of hypertension
• – Stopping smoking will also prevent against MI.- One should also avoid overweight and obesity for the same reasons of reducing bodily fat.- If one has existing diabetes of hypertension, these conditions should be properly managed because they are risk factors to a myocardial infarction.
• Secondary Prevention of Myocardial Infarction
• Aspirin
• ACE inhibitors
• Statins
• Beta blockers
• -Aspirin or acetyl salicylic acid (ASA) has been shown by randomized controlled trial evidence to help in thinning the blood and prevent the possibility of a clot forming and causing a myocardial infarction.- Angiotensin converting enzyme inhibitors (ACEI) also have proven to be useful in preventing recurrent MI in persons who have had a previous MI.- Statins are drugs that lower the levels of low density cholesterol in the body. They are useful in preventing recurrence of MI.- Beta blockers also do help in preventing a second MI.
• Secondary prevention of Myocardial Infarction
• Antihypertensive treatment
• Managing preexisting conditions
• Regular check-ups with ECG taking
• -If one is already suffering from hypertension, it is essential that it is managed and kept under control.- Any other preexisting condition must also be treated for better prevention of MI.- Lastly, a habit of regular check-ups with the taking of ECG is essential for asssment of potential risk in persons with a history of MI. NSG 530 Myocardial Infarction (MI) Case Study Assignment
• Therapeutic Measures of Myocardial Infarction
• Percutaneous coronary intervention (PCI)
• Coronary artery bypass graft (CABG) surgery
• Medical thrombolysis
• Management of hypertension
• -PCI is an invasive procedure that is undertaken as an emergency procedure to restore perfusion. A wire is introduced aseptically through the skin and the coronary artery occlusion is relieved physically.- The other alternative remedy is medical thrombolysis in which the occluding clot is dissolved using special medication. This is done if the patient is still stable and not in imminent danger of mortality.- If the MI is recurrent, the option of surgery may be considered (CABG).- Lastly but not least, any existing hypertension must be managed properly as well.
• Current Research on Myocardial Infarction
• Weight gain and the risk of cardiovascular disease
• Thrombo-inflammation in myocardial infarction
• Cardioprotective medication adherence
• Neutrophils and cardiovascular inflammation
• – Research on weight gain and MI published in the European Journal of Clinical Nutrition.- Research on thrombosis and inflammation in MI published in Nature Communications journal.- Research on medication adherence published in Scientific reports journal.- Research on cardiovascular inflammation published in the journal Nature Reviews Cardiology (Springer Nature Limited, 2020). NSG 530 Myocardial Infarction (MI) Case Study Assignment
• References

Chadwick J.J., Davatyan, K., Subramanian, S.S., & Priya, J. (2019). Epidemiology of myocardial infarction. Intech Open. Doi:10.5772/intechopen.74768

Frangogiannis, N.G. (2015). Pathophysiology of myocardial infarction. Comprehensive Physiology, 5, 1841–1875. Doi:10.1002/cphy.c150006

Springer Nature Limited (2020). Myocardial infarction – latest research and reviews. Retrieved 26 March 2020 from https://www.nature.com/subjects/myocardial-infarction

World Health Organization [WHO] (2020). Cardiovascular disease. Retrieved 25 March 2020 from https://www.who.int/cardiovascular_diseases/priorities/secondary_prevention/country/en/index1.html

• NSG 530 Myocardial Infarction (MI) Case Study Assignment