Nursing Care of Acute Myocardial Infarction Patient with Cardiogenic Shock and Left Ventricular Thrombus: A Case Study

Abstract

       This study aimed to present nursing care for a patient with acute myocardial infarction complicated by cardiogenic shock and left ventricular thrombus, which are severe and complex complications with a mortality rate of 40-50% despite appropriate treatment. This case study employed systematic nursing process analysis based on nursing theories and evidence-based practice. Data were collected through observation, interviews, and medical record analysis during March25 - April24, 2025, at the Cardiac Care Unit, Nakhon Pathom Hospital.

       A 65-year-old Thai male patient was admitted for treatment with syncope, loss of consciousness, and chest tightness. Electrocardiogram examination revealed ST-segment elevation in V1-V5. Cardiac catheterization examination found complete occlusion at the mid-LAD position. He received treatment with PPCI combined with thrombus aspiration and DES insertion. The patient had severe complications including cardiogenic shock requiring inotropic medications and mechanical circulatory support device insertion. Echocardiographic examination revealed an EF of 23% and left ventricular thrombus. Nursing care was implemented according to 9 nursing diagnoses as follows: risk for cardiac arrest from decreased cardiac output per minute, impaired oxygenation, decreased gas exchange efficiency, pulmonary edema due to decreased cardiac efficiency, electrolyte imbalance due to decreased renal filtration efficiency, risk for ischemia at the procedural access site, risk for complications from mechanical cardiac support device insertion, risk for thromboembolism to brain and other parts of the body from left ventricular thrombus, discomfort due to restricted movement at the procedural site, risk for bleeding tendency from anticoagulation therapy and liver dysfunction. The patient and relatives had anxiety about the current condition due to lack of understanding and insufficient knowledge for self-care. The focus was on critical condition monitoring, hypoxemia management, prevention of complications from specialized equipment use, health behavior change promotion focusing on smoking cessation motivation and anxiety related to self-care management and psychosocial concerns. The results showed that the patient had good response to treatment, no severe complications occurred, received holistic care was provided and safe hospital discharge was achieved.

       The results of this study can be applied as practice guidelines for nursing care of patients with complex cardiovascular conditions, helping to develop quality of care and reduce complication rates for rapid and accurate treatment. Additionally, it serves as academic information for nursing personnel competency development and efficient interdisciplinary patient care planning.