Myocardial Infarction (Heart Attack): Nursing Care Guide + NORCET MCQs

Myocardial Infarction (MI): Evidence-Based Nursing Guide + NORCET-Style MCQs

Aligned with Indian nursing practice & exam patterns. Includes interactive MCQs with rationales, Table of Contents, sharing buttons, and FAQ schema.

NORCET AIIMS Nursing Quiz Informative Blog

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Contents

1. Introduction
2. Pathophysiology & Risk Factors
3. Clinical Presentation & Diagnosis
4. Nursing Management (Indian Context)
5. NORCET-Style MCQs (Interactive)
6. FAQ
7. Related Reading on GK Nursing

Introduction

Myocardial infarction (MI) is irreversible necrosis of cardiac muscle due to prolonged ischemia. For Indian nurses, rapid recognition, protocol-driven action, and accurate monitoring directly impact survival and recovery. This guide summarizes practical, evidence-based points for assessment, immediate care, monitoring, complications, discharge education and secondary prevention—followed by NORCET-style MCQs.

Pathophysiology & Risk Factors

• Mechanism: Atherosclerotic plaque rupture → platelet activation → thrombus → coronary occlusion.
• Types: STEMI (transmural), NSTEMI (subendocardial), silent MI.
• Risk factors (modifiable): Hypertension, diabetes, dyslipidemia, smoking, obesity, sedentary lifestyle, high salt/sugar/trans-fat intake.
• Risk factors (non-modifiable): Age, sex, family history, early CAD in relatives.

Clinical Presentation & Diagnosis

• Symptoms: Central chest pain/pressure (radiation to left arm/jaw/back), dyspnea, diaphoresis, nausea/vomiting, fatigue; atypical in women, elderly, diabetics.
• ECG: ST-elevation in contiguous leads (STEMI); ST-depression/T-inversion (ischemia/NSTEMI); new LBBB may indicate MI.
• Cardiac biomarkers: Troponin I/T rise 3–6 h, peak 12–24 h, remain elevated up to 7–14 days; CK-MB useful to detect reinfarction.
• Other: Echo (wall-motion), CXR, lipid profile, RBS/HbA1c, renal function, electrolytes.

Nursing Management (Indian Context)

1. Immediate actions: Alert team, attach monitor, IV access, aspirin loading per protocol, SL nitroglycerin (if no contraindication), analgesia. Prepare for reperfusion—PCI (door-to-balloon ≤ 90 min). If PCI delay expected and eligible, fibrinolysis (door-to-needle ≤ 30 min).
2. Oxygen: Give if SpO₂ < 90% or respiratory distress/hypoxemia; avoid routine oxygen when not indicated.
3. Monitoring: Vitals, rhythm/ECG, troponin trend, urine output, pain scale, mental status; watch for arrhythmias, acute HF, shock, mechanical complications.
4. Medications (as prescribed): DAPT, anticoagulant, statin, beta-blocker (avoid in shock/bradycardia/asthma), ACEI/ARB, nitrates, analgesia.
5. Support & education: Anxiety reduction, clear communication, early cardiac rehab (Phase I once stable).
6. Discharge & secondary prevention: Adherence to DAPT (as advised), high-intensity statin, BP/DM control, tobacco cessation, diet, graded activity, rehab follow-up.

NORCET-Style MCQs on MI (Click “Show Answer”)

1) Which ECG change is most typical in acute STEMI?

1. New left bundle branch block only
2. ST-segment depression in V1–V3
3. ST-segment elevation in contiguous leads
4. Peaked T waves only

Correct: C. STEMI is diagnosed by ST-elevation in anatomically contiguous leads.

2) A patient with ST elevation in V2–V4 (anterior wall MI) arrives. The most important immediate nursing action?

1. Give SL nitroglycerin and observe for 1 hour
2. Prepare for emergent PCI and expedite transfer to cath lab
3. Send lipid profile first
4. Begin ambulation

Correct: B. Early reperfusion is time-critical; activate the PCI pathway.

3) The most sensitive and specific biomarker for MI is:

1. CK-MB
2. Myoglobin
3. Cardiac troponin I/T
4. LDH

Correct: C. Troponins rise 3–6 h, peak 12–24 h, remain elevated up to 1–2 weeks.

4) Target door-to-balloon time for primary PCI is:

1. ≤ 120 minutes
2. ≤ 90 minutes
3. ≤ 60 minutes
4. ≤ 45 minutes

Correct: B. Benchmark target ≤ 90 minutes.

5) Door-to-needle time for fibrinolysis (if PCI delay expected & eligible) is:

1. ≤ 60 minutes
2. ≤ 45 minutes
3. ≤ 30 minutes
4. ≤ 15 minutes

Correct: C. Aim within 30 minutes of hospital arrival.

6) Oxygen should be administered in acute MI when:

1. SpO₂ ≥ 98%
2. All suspected MI, routinely
3. SpO₂ < 90%, or respiratory distress/hypoxemia
4. Only after PCI

Correct: C. Avoid routine oxygen in non-hypoxemic patients.

7) Inferior wall MI typically shows changes in which leads?

1. V1–V4
2. V5–V6, I, aVL
3. II, III, aVF
4. aVR only

Correct: C. These leads reflect inferior wall involvement.

8) Which is a contraindication to giving sublingual nitroglycerin?

1. Anterior STEMI with hypertension
2. Right ventricular infarction with hypotension or recent sildenafil use
3. Mild headache
4. Normal BP

Correct: B. Risk of profound hypotension.

9) Papillary muscle rupture after MI most commonly leads to:

1. Ventricular septal defect
2. Acute severe mitral regurgitation with pulmonary edema
3. Pericardial tamponade
4. Bradyarrhythmia

Correct: B. Mechanical complication 2–7 days post-MI.

10) Earliest rise of cardiac troponins after MI occurs at:

1. 0–1 hour
2. 3–6 hours
3. 24–48 hours
4. 72 hours

Correct: B. Rise 3–6 h, peak 12–24 h, persist up to 1–2 weeks.

11) First-line antiplatelet loading in suspected STEMI (no contraindication):

1. Clopidogrel alone
2. Aspirin loading dose (chewed) as per protocol
3. Warfarin
4. Wait until troponin positive

Correct: B. P2Y12 inhibitor is then added (DAPT) per protocol.

12) Which is a contraindication to early beta-blocker therapy?

1. HR 88/min, BP 138/82 mmHg
2. Mild anxiety
3. Cardiogenic shock, severe bradycardia, or SBP < 90 mmHg
4. Anterior STEMI

Correct: C. Avoid in shock, marked bradycardia/hypotension, acute decomp HF, severe asthma.

13) Which drug class primarily prevents further atherosclerotic events post-MI?

1. Aspirin
2. High-intensity statin
3. Loop diuretic
4. Nitrate

Correct: B. Statins reduce LDL-C and stabilize plaque.

14) Cardiac rehabilitation Phase I typically begins:

1. Immediately after thrombolysis while unstable
2. In-hospital once clinically stable (often within 24–48 h)
3. 6 months after MI
4. Only after stent removal

Correct: B. Early supervised mobilization & education improve outcomes.

15) The most common underlying cause of MI is:

1. Coronary spasm without atherosclerosis
2. Venous embolism
3. Atherosclerotic plaque rupture with thrombus
4. Myocarditis

Correct: C. Plaque rupture with thrombosis accounts for most acute MIs.

Frequently Asked Questions (FAQ)

MI is death of heart muscle due to prolonged ischemia from reduced blood flow, usually caused by a blocked coronary artery.

STEMI shows ST-segment elevation on ECG and indicates full-thickness ischemia; NSTEMI lacks ST-elevation but has positive troponin with ischemic symptoms/ECG changes.

Oxygen is recommended if SpO₂ is below 90% or if the patient has respiratory distress/hypoxemia. Routine oxygen in non-hypoxemic patients is not recommended.

PCI door-to-balloon ≤ 90 minutes; fibrinolysis door-to-needle ≤ 30 minutes when PCI is delayed and the patient is eligible.

Yes—fatigue, breathlessness, or epigastric discomfort may predominate rather than classic chest pain.

Do not stop antiplatelet medicines without cardiologist advice; adhere to rehab & medications.

Related Reading on GK Nursing

• Cardiovascular System: Key Concepts, Nursing Care & MCQs (NORCET 2025)
• Browse more NORCET AIIMS topics
• Practice more Nursing Quiz posts
• Informative blogs (guides & tips)

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