The Relationship Between Hypertension And Myocardial Infarction
The relationship between Hypertension and Myocardial infarction is the excessive damage from high blood pressure can cause the coronary arteries supplying blood to the heart to slow down becoming narrow from the buildup of fatty substances and cholesterol that forms a plaque. This process is known as atherosclerosis. Coronary arteries that are hardened become blocked which inhibit the flow of blood to the heart muscles. The heart muscles is starved of oxygen and nutrients, the damage or death part of this muscles tissue leads to a heart attack, myocardial infraction. Symptoms of heart attack is pain and discomfort in the ram, neck or jaw, shortness of breath and dizziness. In order to explain the relationship between hypertension and myocardial infarction, risk factors that are shared by the two diseases should be considered such as insulin resistance, genetic factors and sympathetic hyperactivity. Hypertension leads to the development of atherosclerosis which in turn leads to the onset of myocardial infarction.
Hypertension is defined as a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg. Hypertension is known as a major risk factor for atherosclerosis cardiovascular disease and heart failure. Hypertension is a leading risk factor of cardiovascular disease and it affects 50 million people in the Unites States and approximately 1 billion people worldwide. Hypertension is more common in black men compared to white men. Hypertension can be primary or secondary. Primary hypertension occurs when the systolic is over 140 mmHg and Diastolic is 90 mm Hg and an increase in arteriolar vasoconstriction over a long period of time can lead to damage to arterial wall. Hypertension can be treated by lifestyle changes, reduction of sodium intake, weight loss and taking prescribed medication. Blood pressure can be defined as cardiac output multiplied by peripheral resistance. Hypertension occurs when there is an increase in cardiac output or an increase in peripheral resistance or both(Perkovic et al., 2007). When there is an increase in cardiac output, there is an expansion in vascular volume. Hypertension can also be inherited as well. Signs and symptoms of hypertension are severe headache, confusion, difficulty breathing, irregular heartbeat, dizziness and fatigue. Prolonged and untreated hypertension can lead to heart attack, heart failure stroke, dementia, blindness and kidney disease. Some blood pressure medication includes Metoprolol, a beta blocker which lowers blood pressure. Lisinopril, Enalapril are ACE inhibitors which lowers blood pressure and treat heart failure. They relax the blood vessels as well as reduce blood volume which lowers blood pressure. Hypertension can be classified as follows:
- Normal: systolic less than 120 mm Hg, diastolic less than 80 mmHg
- Prehypertension systolic: 120-139 mm Hg, diastolic 80-89mm Hg
- Stage 1: systolic 140-159 mm Hg, diastolic 90 to 99 mmHg
- Stage 2: systolic >160 mm Hg , diastolic >100 mm Hg
The laboratory test for high blood pressure are urinalysis to assess kidney function, lipid profile to evaluate total cholesterol and electrolyte panel to monitor potassium, sodium and chloride. Electrocardiogram diagnostic test can be ordered to evaluate heart rate, rhythm, and heart damage. Assessment of patient with hypertension includes family history of heart disease, obesity, history of diabetes, hyperlipidemia, smoking, use of other drugs and sedentary lifestyle. A thorough assessment and examination of risk factors includes asking the patient specific questions about the lifestyle and habit, history of heart disease and diabetes. Discharge planning includes monitoring the blood pressure at frequent intervals after administration of blood pressure medication to determine the effectiveness of medication therapy or treatment plan and medication education. Patient are advised not to stop medication abruptly because of risk of rebound hypertension. Lifestyle modification includes weight reduction, encouraging patients to monitor their blood pressure daily, adopting DASH eating plan with includes fruits and vegetables, dietary sodium reduction, exercise, limiting alcohol consumption.
Myocardial infarction is also known as heart attack. Myocardial infarction occurs when the heart tissues are starved of oxygen, the tissues die and this leads to myocardial infarction. The heart requires constant supply of oxygen and nutrients like nay other muscle in the body. There are four arteries that deliver oxygenated blood to the heart muscle. If one of the arteries become blocked, the heart is starved of oxygen. This leads to myocardial ischemia and if this lasts long, myocardial infarction occurs. Myocardial infarction leads to death so always seek help when it occurs. The classification of patient with myocardial infarction are evolving and the presence of coronary artery disease is one of the major risk factors of myocardial infarction(Adamson, Chapman, Mills 2016). The modifiable risk factors associates with CAD are high blood pressure, high cholesterol, anxiety, stress, vomiting, fatigue, obesity, diabetes, sedentary lifestyle and smoking. The signs and symptoms of myocardial infarction are shortness of breath, dizziness, nausea, syncope and chest pain which radiates from left arm to neck. Myocardial infarction usually starts with early episodes of angina, a reduced blood supply to the myocardial tissues(Adamson et al.,2016). In angina, pain recedes within a few minutes and the heart is not permanently damaged unlike myocardial infarction where the pain lasts longer and heart tissues die without prompt treatment.
Assessment of patient with myocardial infarction includes asking the patient subjective data about the onset of myocardial infarction and how long it lasted. In Myocardial infarction, chest pain suddenly occurs and it is not relived by rest of nitroglycerin. Most patients with Myocardial infarction have previous diagnosis of CAD. The nurse should access and be alert for the following chest pain, increased jugular vein distention may signify that myocardial infarction was caused by heart failure. Irregular pulse may also indicate atrial fibrillation. The presence of crackles may indicate pulmonary congestion and pulmonary edema.
The immediate treatment of myocardial infarction is the administration of supplemental oxygen, aspirin, nitroglycerin to relive chest pain and morphine to reduce pain and anxiety. The administration of morphine reduces the preload and afterload which in turn decrease the heart workload. A beta blocker can also be given to patient that develops myocardial infarction within 24 hours of admission. Heparin may also be given to prevent blood clot formation. In order to improve the quality of life, a patient that myocardial infarction should make lifestyle changes which includes, smoking cessation, avoid strenuous exercise that leads to chest pain and fatigue, weight loss, follow prescribed medical regime and develop a healthy eating habit.
The laboratory test use to detect the presence of myocardial infarction is to test for the presence of cardiac enzymes and biomarkers like troponin, creatine kinase and myoglobin. When myocardial tissue dies, cellular content are released into circulation which are carried by the blood and detected in a blood test. Creatine MB level begins to increase within 24 hours of infarction. Myoglobin begins to peak within 1-3 hours of myocardial infarction. Troponin begins to peak and it is often detect as long as 3 weeks after the onset of recent myocardial damage. Diagnostic procedure includes the use of electrocardiogram which is a 12-lead ECG placed on the patient chest assist in ruling out a diagnoses of acute MI. Electrocardiogram should be obtained within 10 minutes of admission of the Emergency department. Electrocardiogram is used to detect the location and resolution of myocardial infarction can be minored and recorded overtime.ST elevation and T wave depression on the ECG monitor are the expected changes to diagnose a patient with myocardial infraction. Echocardiogram test which measure the heart ejection fraction can be ordered.
The most effective way to ensure that patient follow the prescribe medical regime is to provide education after discharge, identify patient priorities and facilitate patient involvement in rehabilitation program. Patients are advised to take their medication at the same time and not to stop it abruptly because it can lead to another dysrhythmia. Patient are advised to weigh themselves in the same clothes and monitor their blood pressure daily. Chest pain should be reported to the primary provider as soon as possible.
References
- Adamson P.D., Chapman A.R., & Mills N.L.(2016).Assessment and classification of patients with myocardial injury and infarction in the clinical practice. British Medical Journal,103,10-18.
- Perkovic .V., Huxley .R., Wu .Y., Prabhakaran .D., & Macmahon . S. (2007). The burden of blood pressure related disease. The Journal of American Heart Association,50,991-997.
