A fifty five-year-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

1. A

   Heart failure

2. B

   Sudden death

3. C

   Pulmonary embolism

4. D

   Ventricular aneurysm

Appeared in: JIPMER Nursing Officer-2017

Explanation

• The greatest risk in the initial 24 hours following a myocardial infarction is sudden death.
• This is primarily due to severe electrical instability in the ischemic and necrotic heart tissue, which can trigger lethal cardiac arrhythmias.
• Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are the most common arrhythmias responsible for sudden cardiac arrest in this period.

Why Other Options Were Wrong

• Option A: While heart failure is a major complication of MI, it is typically a result of the loss of pumping power from damaged muscle. The most immediate cause of death is an electrical problem (arrhythmia), not necessarily a pumping problem.
• Option C: Pulmonary embolism is a complication related to venous thromboembolism (VTE), which is most often a consequence of immobility during the recovery period, making it a later risk.
• Option D: A ventricular aneurysm is a late mechanical complication that develops weeks to months after an MI, as the scar tissue from the infarct thins and stretches.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Acute Complications of Myocardial Infarction to guide bedside assessment, documentation, and the next nursing action.
• This concept is the foundation for why patients with suspected or confirmed MI are immediately placed in a high-acuity monitored setting (like a CCU or ICU).
• The primary nursing responsibility is continuous cardiac monitoring to detect and rapidly respond to lethal arrhythmias. Immediate access to a defibrillator (crash cart) is non-negotiable.
• What if the patient survived the first 48 hours without a major arrhythmia? The greatest risk then begins to shift towards mechanical complications, such as acute heart failure, cardiogenic shock, or myocardial rupture, although arrhythmia risk remains elevated.

How to Approach the Question

• First, identify the key elements of the question: the condition (evolving MI), the timeframe ('first 24 hours'), and the question's focus ('greatest risk').
• Recall the pathophysiology of an acute MI. The immediate consequence of ischemia is cellular injury and electrical instability.
• Evaluate each option based on its typical time of onset after an MI.
• Recognize that arrhythmias are an electrical complication and are the most frequent cause of death in the very early phase (pre-hospital and first 24 hours).
• Contrast this with the other options: Heart failure is a pumping problem that can occur early but is also a progressive issue. Pulmonary embolism and ventricular aneurysm are distinctly later complications.
• Conclude that the most acute, life-threatening event is an arrhythmia leading to sudden death.

Concept Tested & Keywords

• Concept Tested: Acute Complications of Myocardial Infarction
• Stem keywords: myocardial infarction (MI), greatest risk, first 24 hours
• Lead-in keywords: greatest risk
• Clinical cues: The timeframe 'first 24 hours' is critical, as it points to the most immediate and life-threatening complications.

Question ID

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Copy ID

Reference Book

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