ST-Elevation Myocardial Infarction (STEMI) is a life-threatening cardiovascular emergency characterized by complete blockage of a coronary artery, resulting in myocardial ischemia and necrosis. One of the most prominent symptoms of STEMI is acute, severe chest pain that persists despite rest and nitrate administration. Effective nursing interventions play a critical role in reducing pain, preventing complications, stabilizing the patient’s condition, and improving clinical outcomes.
Understanding STEMI and Acute Pain
Definition of STEMI
STEMI occurs when unstable atherosclerotic plaque ruptures and causes thrombus formation in the coronary artery. This leads to a sudden decrease or complete cessation of blood flow to the myocardium, resulting in ST-segment elevation on the ECG. According to Pusponegoro (2015), STEMI commonly presents with severe chest pain lasting more than 20 minutes, occurring at rest, and unrelieved by nitrates.
Clinical Manifestations
Typical symptoms include:
- Severe, crushing chest pain that may radiate to the arm, jaw, or back
- Pale, cold, and clammy skin
- Increased blood pressure and pulse during early stages
- Potential drop in blood pressure as cardiac output decreases
- Nausea, vomiting, and fever (Lewis, 2011)
- Decreased urine output due to impaired kidney perfusion
- Signs of left ventricular dysfunction if condition persists
Complications of STEMI
Black & Hawks (2014) identified several life-threatening complications, such as:
- Dysrhythmias: SVT, heart block, ventricular tachycardia, ventricular fibrillation
- Cardiogenic shock
- Heart failure and pulmonary edema
- Recurrent myocardial infarction
- Pericarditis and Dressler syndrome
- Pulmonary embolism
Understanding Acute Pain in STEMI Patients
The Nature of Pain
Pain is a subjective, multifactorial experience influenced by emotional, psychological, and physiological factors. According to Potter & Perry (2009), no two individuals experience the same pain or respond identically to it. In STEMI patients, chest pain is caused by myocardial ischemia, inflammation, and metabolic disturbances.
Impact of Untreated Pain
Unmanaged pain in STEMI can:
- Increase sympathetic nervous system activity
- Raise heart rate and blood pressure
- Increase myocardial oxygen demand
- Worsen ischemia and infarct size
- Increase morbidity and mortality
Therefore, prompt and effective pain management is crucial for survival and recovery.
Goals of Nursing Care for Acute Pain in STEMI
- Reduce myocardial oxygen consumption
- Relieve chest pain and discomfort
- Prevent complications such as arrhythmias and cardiac arrest
- Promote physical and psychological comfort
- Improve tissue perfusion and hemodynamic stability
- Enhance patient understanding and cooperation in treatment
Comprehensive Nursing Interventions for Acute Pain in STEMI
1. Pain Assessment and Monitoring
Accurate pain assessment is essential in determining the severity and effectiveness of interventions. Nurses should:
- Use pain rating scales (0–10 numeric scale)
- Assess pain location, duration, quality, and radiation
- Monitor vital signs: BP, HR, RR, O2 saturation
- Assess precipitating factors (activity, stress, emotional triggers)
- Observe for nonverbal signs such as grimacing or guarding
2. Administer Oxygen Therapy
Increasing oxygen supply helps reduce myocardial ischemia and associated pain. Oxygen is typically administered when O2 saturation < 94% or in the presence of dyspnea.
3. Positioning for Comfort
The semi-Fowler or upright position helps reduce preload, enhance ventilation, and improve comfort. Reposition only if tolerated by the patient.
4. Pharmacologic Interventions
Nurses play a key role in administering medications prescribed by physicians to relieve pain and limit cardiac damage.
Analgesics
- Morphine sulfate is the drug of choice for severe chest pain. It relieves pain, reduces anxiety, and decreases cardiac workload.
Antiplatelet and Antithrombotic Therapy
- Aspirin
- Heparin
- Clopidogrel
Nitrates
- Nitroglycerin may relieve ischemic chest pain unless contraindicated.
Beta-blockers
- Reduce myocardial oxygen consumption and control arrhythmias.
5. Non-Pharmacological Pain Management
Music Therapy
Non-pharmacological interventions complement medications, promote relaxation, and reduce anxiety. Music therapy is widely used due to its effectiveness, affordability, and patient preference.
Research shows that music therapy can:
- Reduce perception of pain
- Lower heart rate and blood pressure
- Improve respiratory rate
- Decrease anxiety and stress
Oztunc & Ciftci (2015) found that music significantly improved vital signs of ICU patients and contributed to their comfort by reducing pain and anxiety.
How Nurses Can Implement Music Therapy
- Assess patient’s music preference
- Use calming, slow-tempo music (60–70 bpm)
- Provide headphones to limit noise
- Play music for 15–30 minutes
- Evaluate patient response
6. Providing Emotional Support
Fear and anxiety can worsen pain through sympathetic stimulation. Nurses should:
- Offer reassurance and clear explanations
- Encourage slow, deep breathing
- Provide a calm, quiet environment
7. Monitoring for Complications
Continuous monitoring is essential to detect early signs of worsening ischemia or complications. Nurses should monitor:
- ECG changes
- Arrhythmias
- Signs of cardiogenic shock
- Changes in urine output
- Breath sounds (for pulmonary edema)
8. Patient Education
Education improves patient cooperation and long-term outcomes. Nurses should teach patients:
- The importance of reporting new or recurring chest pain
- How to practice relaxation breathing
- Lifestyle modifications (diet, exercise, smoking cessation)
- Medication adherence
Example Scenario: Nursing Care for STEMI Pain
A 58-year-old male arrives in the ER with crushing substernal chest pain radiating to his left arm. His BP is 150/95 mmHg, HR 110 bpm, O2 saturation 90%. The nurse provides oxygen therapy, places the patient in semi-Fowler position, assesses pain (rated 9/10), obtains ECG, and prepares morphine as ordered.
During hospitalization, the nurse provides music therapy twice a day, monitors vital signs, reassesses pain intensity, and offers emotional support. After interventions, the patient reports pain reduction to 3/10 and appears more relaxed.
LSI Keywords
- Chest pain management
- Myocardial infarction nursing care
- Nursing interventions for cardiac patients
- Ischemic chest pain treatment
- Non-pharmacological pain management
- STEMI complications and monitoring
- Music therapy for pain relief
Conclusion
Acute pain in STEMI patients is a critical condition that requires rapid, comprehensive, and holistic nursing management. Nurses are responsible for assessing pain, administering medication, providing non-pharmacological interventions, monitoring complications, and offering emotional support. Music therapy has been shown to be a highly effective complementary intervention for reducing pain and stabilizing vital signs. By combining clinical skills with patient-centered care, nurses can significantly improve the outcomes and comfort of STEMI patients.
References
- Black, J. M., & Hawks, J. H. (2014). Medical-Surgical Nursing: Clinical Management for Positive Outcomes.
- Lewis, S. L. (2011). Medical-Surgical Nursing: Assessment and Management of Clinical Problems.
- Marrelli, T. (2007). Handbook of Home Health Standards: Quality, Documentation, and Reimbursement.
- Oztunc, G., & Ciftci, B. (2015). Effects of Music Therapy on Pain and Anxiety in ICU Patients.
- Potter, P. A., & Perry, A. G. (2009). Fundamentals of Nursing.
- Pusponegoro, P. (2015). Cardiovascular Emergency Management in Clinical Practice.
