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PROGNOSIS

Myocardial infarction, also known as MI, refers to the process by which areas of

myocardial cells in the heart are permanently destroyed. Like unstable angina, MI is

usually caused by reduced blood flow in a coronary artery due to atherosclerosis and

occlusion of an artery by an embolus or thrombus. Other causes of an MI include

vasospasm (sudden constriction or narrowing) of a coronary artery; decreased oxygen

supply (eg, from acute blood loss, anemia, or low blood pressure); and increased

demand for oxygen (eg, from a rapid heart rate, thyrotoxicosis, or ingestion of cocaine).

In each case, a profound imbalance exists between myocardial oxygen supply and

demand. (Bare & Smeltzer, 2009).

 Acute myocardial infarction is associated with a 30% mortality rate; half of the

deaths occur prior to arrival at the hospital. An additional 5-10% of survivors die within

the first year after their myocardial infarction. Approximately half of all patients with a

myocardial infarction are rehospitalized within 1 year of their index event.

Survivors of a first, acute myocardial infarction (MI) face a substantial risk of

further cardiovascular events, including death, recurrent myocardial infarction, heartfailure, arrhythmias, angina, and stroke. Patients (and family members) often ask what

their future holds; thus, information regarding prognosis after MI is necessary for patient

care. (http://www.uptodate.com/contents/prognosis-after-myocardial-infarction)

 According to an article by Dr. Zafari, M, et.al, prognosis of clients with

myocardial infarction is highly variable and depends largely on the extent of the infarct,

the residual left ventricular function, and whether the patient underwent

revascularization.

Furthermore, she and her associates stated that better prognosis is associated

with factors namely successful early reperfusion, preserved left ventricular function and

short-term and long-term treatment with beta blockers, aspirin and ACE inhibitors.

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Meanwhile, poor prognosis is associated with increasing age, diabetes, previous

vascular disease, elevated thrombolysis, delayed or unsuccessful reperfusion, poorly

preserved left ventricular function, evidence of congestive heart failure, elevated B-type

natriuretic peptide levels, elevated high censitive C-reactive protein, and secretory-

associated phospholipase A2 activity. In addition, continued and uncontrolled

hyperglycemia and psychological depression can also pull down the client’s prognosis.

(http://emedicine.medscape.com/article/155919-overview#aw2aab6b2b7aa)  

On the other hand, Wilson, P. and his associate physicians stated in their article

published in http://www.uptodate.com/contents/risk-factors-for-adverse-outcomes-after-

non-st-elevation-acute-coronary-syndromes?source=see_link that the prognosis after

myocardial infarction may vary widely between individuals, according to the presence or

absence of risk factors before the MI. One of the biggest factors that affect the

prognosis is on the number of coronary heart disease risk factors such as hypertension,

smoking, dyslipidemia, diabetes, family history of premature CHD and atherosclerosis.

 According to a discussion seen in http://www.sparkpeople.com/resource/

health_a-z_detail.asp?AZ=221&Page=8 written by the Faculty of Harvard Medical

school, survival from myocardial infarction has improved dramatically over the last two

decades. However, some people experience sudden death and never make it to the

hospital. For most people that do reach the hospital soon after the onset of symptoms,

the prognosis is very good. Many people leave the hospital feeling well with limited

heart damage.

With the information gathered from different reliant references, the group gave

the client a poor prognosis. The factors took into consideration of the made prognosis

are as follows:

 As observed in the health history and laboratory and diagnostic results of the

client, his chances of fully recovering from the said disease has decreased.

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His health history reveals that the client is hypertensive. Furthermore, on the

year 2012, client was admitted to a local hospital due to difficulty of moving his ___ side.

He was then diagnosed with cerebrovascular accident. Furthermore, he is also

currently diagnosed with hypertensive cardiovascular disease (HCVD).

Meanwhile, results from his laboratory and diagnostic tests also reveal

abnormalities that further exacerbate his condition and dragging his prognosis down.

For one, it was revealed that his blood glucose was elevated. Moreover, his HDL

cholesterol was decreased. HDL is important because it functions as a transporter of

cholesterol n the blood and high levels are associated with a decreased risk of

atherosclerosis and coronary heart disease.  Also, his triglycerides level’s deviation from

the normal range was high. Thus, this further makes his prognosis poor because too

many triglycerides in one’s body puts him in a higher risk of further exacerbation of his

cardiovascular disease.

Most importantly, the client’s heart function has somehow failed due to the

enlargement of the left ventricle and dilation of the left atrium as revealed in the

echocardiography report and radiologic findings, respectively.

Even though client was immediately brought to the hospital upon feeling the

symptoms that led to the admission to the health care facility, the factors that were

stated above that were all based from related literature further supported the group’s

conclusion in lieu of the client’s prognosis – poor.