Magazine article American Nurse Today

Strategies for Preventing Another MI

Magazine article American Nurse Today

Strategies for Preventing Another MI

Article excerpt

According to the American Heart Association, each year an estimated 635,000 Americans have a new myocardial infarction (MI) and an estimated 300,000 of them have a recurrent attack. Secondary prevention is essential for reducing this number; recurrent MI puts patients at risk for reduced quality of life, heart failure, and death.

As a nurse working on a cardiac progressive care unit, I'm a member of the team that teaches the patients about what they can do to reduce their risk of having a future MI. Our team typically consists of the physician, nurse, and a member of the cardiac rehabilitation team. After talking with the physician, I am usually the first person who speaks with the patient and his or her family about secondary prevention. I am also the person who answers the questions they did not initially think to ask the physician.

In this article, I share key points to include as part of secondary prevention of MI.

Getting off to a good start

Secondary prevention should begin when the patient is diagnosed with an MI. Both verbal and written instructions are needed since at this point both patient and family will probably be unable to adequately understand and learn new material. They are simply overwhelmed with the new information they are receiving, all that they have experienced, and the inevitable lack of sleep. Be sure to document in the health record that patients have received both verbal and written educational materials.

Secondary prevention consists of two components: lifestyle modifications and medication therapy.

Lifestyle modifications

Lifestyle modification is the first-line treatment for preventing recurrent MIs. It includes smoking cessation, physical activity, diet, weight management, and management of diabetes, lipids, and blood pressure.

Smoking cessation

For those patients who smoke, quitting is a top priority. Some patients who smoke may be reluctant to make this change or refuse to quit, but others may be eager to do whatever is needed to reduce their risk of another MI.

Explain to patients that smoking reduces the amount of oxygen delivered to the heart, increases blood pressure and heart rate, and damages blood vessels. Patients should also know that second-hand smoke increases their risk for another MI by as much as 25% to 30%. In the United States alone, one in five deaths from heart disease is directly associated with smoking.

Physical activity

Physical inactivity is a major risk factor for recurrent MI. Aerobic and muscle strengthening activities has been reported to lower the all-cause mortality among adults who have had an MI or angina by up to 46%. Physical activity also promotes appropriate levels of high-density lipoprotein (HDL), Vitamin D, apolipoprotein B, and HbA1c, which helps reduce mortality.

The American Heart Association and American College of Cardiology Foundation (AHA/ACCF) guidelines recommend 30 minutes of moderate-intensity aerobic activity for at least five days a week and for the patient to increase their daily lifestyle activities such as gardening or household work. Patients should discuss activity plans with their primary care provider before starting.


Research indicates that a diet low in fat, salt, and red meat but high

in fruit, vegetables, and fiber can decrease the buildup of atherosclerosis and help prevent future MIs. The Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean diet are examples of heart healthy diets that can reduce blood pressure and improve glucose-insulin homeostasis. The Mediterranean diet also helps reduce inflammatory markers such as c-reaction protein (CRP), which are elevated in patients with heart disease.

Weight management

Obesity and being overweight put people at risk for heart disease and comorbidities such as diabetes. In association with diet modification, maintaining or achieving a beneficial weight is a key element in secondary prevention. …

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