A 55 years old male patient who is diagnosed with an evolving myocardial infarction (MI) insists on going home. The nurse encourages the patient to be admitted because the greatest risk within the first 24 hours of sustaining an MI is:

Appeared in: OSSSC Nursing Officer-2023

Explanation

The most critical risk in the first 24 hours after a myocardial infarction is sudden cardiac death.
This is most commonly caused by lethal ventricular arrhythmias, particularly ventricular fibrillation (VF).
Myocardial ischemia and injury create an electrically unstable environment in the heart, predisposing it to chaotic rhythms.
The risk of VF is highest in the first hour and remains significantly elevated throughout the first 24 hours, necessitating immediate hospitalization for continuous ECG monitoring and access to defibrillation.

Option A: While heart failure is a serious complication of MI due to loss of muscle function, the risk of a fatal arrhythmia is more immediate and acute within the first 24 hours.
Option C: Pulmonary embolism is a complication of venous thromboembolism (e.g., DVT), which is associated with prolonged immobility. It is not an immediate complication of the MI itself.
Option D: A ventricular aneurysm is a late mechanical complication that develops weeks to months after an MI as the necrotic tissue is replaced by a thin, non-contractile scar.

Clinical Relevance

Nursing practice connection: Use the key finding related to Immediate complications of Myocardial Infarction (MI) to guide bedside assessment, documentation, and the next nursing action.
This concept is the cornerstone of emergency cardiac care. The nurse's primary role is to understand this immediate risk, educate the patient about the danger of leaving the hospital, and initiate continuous cardiac monitoring.
Immediate admission to a coronary care unit (CCU) or a monitored bed is standard protocol to detect and treat lethal arrhythmias promptly.
What if the patient was 5 days post-MI? The greatest risk would shift from arrhythmia to mechanical complications like myocardial rupture, which presents with sudden hypotension, new murmur, and potential cardiac tamponade.

How to Approach the Question

First, identify the core elements of the clinical scenario: the diagnosis is an 'evolving myocardial infarction' and the timeframe is the 'first 24 hours'.
The question asks for the 'greatest risk' within this specific, acute timeframe.
Recall the pathophysiology of MI. The initial phase is characterized by ischemia and electrical instability before significant structural changes occur.
Evaluate each option based on its typical onset after an MI.
Arrhythmias leading to sudden death are the most immediate electrical complication.
Heart failure, pulmonary embolism, and ventricular aneurysm are either functional consequences or later complications, making 'Sudden death' the most accurate answer for the first 24-hour window.

Concept Tested & Keywords

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E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 2 (215-514) p. 10-12

E6 Medicine Davidson Principles Practice 24e p. 516-518

E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 197-199

Practise the full OSSSC Nursing Officer-2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.