1. Heart Attacks Signs and Symptoms for Men & Women, How to Prevent Exacerbations of Myocardial Infarction & to Treat an MI Created by: Casey Burritt Jenna Lambeth Nicole Lazarczyk

2. Learning Goals For healthcare professionals as well as the general population to understand the signs and symptoms of myocardial infarctions in men and women Use the steps of the nursing process to teach and help the staff to quickly identify and differentiate a myocardial infarction and other disease processes.

3. Objectives Understanding the differentiating signs and symptoms of an Myocardial infarction (MI) between men & women Diagnostic tools for diagnosing an MI quickly and differentiating between other diseases & SMART attack tool Treatment protocols of a heart attack Prevention of exacerbated MI and teaching the need to acquire healthcare assistance

4. Significance to Critical Care Non-healthcare professionals should know the signs and symptoms of a (MI) so that they know when to get help Healthcare providers should be able to accurately differentiate between an MI and other diseases Healthcare providers should be able to diagnoses and treat a heart attack Providers should also be able to teach about the prevention of heart disease that may cause a heart attack. The heart affects the ability of every body system to function correctly and adequately

5. Signs and Symptoms of Heart Attacks Shortness of breath Substernal chest pain Upper body discomfort Diaphoresis Lightheadedness Nausea Chest pain Anxiety Dizziness Tachycardia Nausea/Vomitting Upper body discomfort Edema Dyspnea Fatigue Indigestion Numbness Men Women (McDonald, Goncalves, Almaria, Krajewski, Cervera, Kaeser, Lillvik, Sajkowicz, Moose, 2006) ; (Allegro Medical, 2010)

6. Most Common Signs Chest pain Left arm pain Diaphoresis Dizziness Shortness of Breath Slow and mild pain at onset (Allegro Medical, 2010)

7. Heart Attack, SMART Attack Substernal chest pain Crushing feelings, unable to catch breath Meals When last mean was eaten, whether pain comes within 1-2 hours of meals Worsens when laying flat Type of meal – spicy, acidic, high salt contents Angina Pain relieved with rest from activity, nitroglycerine Radiating To other locations such as arms, neck, shoulder, jaw, back, stomach Time Frequency of pain, duration

8. Nursing Diagnoses Decreased Cardiac Output Impaired Tissue Perfusion Anxiety Ineffective Health Maintenance Acute Pain Activity Intolerance Disturbed Sleep Pattern Powerlessness Deficient Knowledge Ineffective Coping Risk for Altered Organ Functions Lough, Stacy, Urden, 2010

9. Diagnostic Tools Lab values CPK-MB (normal: 0%) Troponin T (normal: less than 0.2ng/mL Troponin I (normal: less than 0.03ng/mL Cardiac Catheterization EKG changes PQRST Pagana & Pagana, 2006

10. Treatment Protocols Troponin, CHEM-stat levels when walking in door Second Troponin at 6 hrs “STEMI-alert” Cardiac cath lab within 30 minutes (Sentara Protocol) Available open-heart operating room if necessary Stress test within 24hrs with a normal troponin level MONA Education Lough, Stacy, Urden, 2010

11. Patient Education – Risk Factors Gender Age Family History Personal Baselines for cholesterol, blood pressure Race SES Smoking Diabetes Lack of Exercise Dietary Changes Birth Control Pills Menopausal Hormone Replacement Uncontrolled HTN Stress SES Non-Modifiable Risks Modifiable Risks MedicineNet, 2010

12. Non-Modifiable Risk Factors Non-modifiable risk factors are things that cannot be changed no matter the circumstances Based on family and personal histories can allow a patient to remain healthy at higher than normal levels Regular healthcare appointments should be maintained so as to understand the risks that these factors may propose Those with excessively high non-modifiable risk factors should control their modifiable risk factors even better to prevent heart disease complications such as MIs MedicineNet, 2010

13. Patient Education – Life Factors Your 1-year mortality risk increases for every 30 minutes it takes you to get to the hospital In the year prior to your MI you are more likely to suffer from depression, have sleep disturbances, and experience stressful life events than healthy people, especially in women Low education levels in patients and their partners predicted longer delay and total pre-hospital delay for men, but this does not affect women Reducing pre-hospital delay can be accomplished by increasing knowledge of the MI process Lovlien, Shei & Torstein, 2008

14. Patient Education – Women with CAD Women with CAD delay seeking medical attention because their pattern of symptoms of an MI is different The symptoms they experience are very gradual and easily attributable to other causes such as a rough workout, stress, or extra physical work Their attributions to other causes and their personal perception of their health determines if and when they seek medical help and attention Albarran, Clarke & Crawford, 2006

15. Nursing Process Assessment Diagnosis Outcomes/Goals Planning Implementation Evaluation

16. Evaluation of Learning Objectives

17. References Albarran, J., Clarke, B., & Crawford, J. (2007). 'It was not chest pain really, I can't explain it!' An exploratory study on the nature of symptoms experienced by women during their myocardial infarction. Journal of Clinical Nursing, 16(7), 1292-1301. Retrieved from CINAHL Plus with Full Text database. AllegroMedical. (2010). Heart attack & stroke warning signs: Men vs women. Retrieved October 14, 2010, from http://www.allegromedical.com/blog/heart-attack-stroke-warning-signs- men-vs-women-510.html. Ignatvicus, D., Workman, M. (2010). Medical-Surgical Nursing: Patient Centered Collaborative Care. Missouri: Saunders. Løvlien, M., Schei, B., & Hole, T. (2008). Myocardial infarction: psychosocial aspects, gender differences and impact on pre-hospital delay. Journal of Advanced Nursing, 63(2), 148-154. Retrieved from CINAHL Plus with Full Text database. Lough, M., Stacy, K., Urden, L. (2010). Critical Care Nursing: Diagnosis and Management. Missouri: Mosby. McDonald, D., Goncalves, P., Almario, V., Krajewski, A., Cervera, P., Kaeser, D., et al. (2006). Assisting women to learn myocardial infarction symptoms. Public Health Nursing, 23(3), 216-223. Retrieved from CINAHL Plus with Full Text database. MedicineNet. (2010). Heart attacks: Women are different than men. Retrieved October 14, 2010, from http://www.medicinenet.com/script/main/art.asp?articlekey=10918. Pagana, K., Pagana, T. (2006). Mosbys’s Manual of Diagnostic and Laboratory Tests. Missouri: Mosby.