Journal of Central Chest Institute of Thailand

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

pribpree hongsrithong — Fri, 12 Sep 2025 00:00:00 +0700

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.

Nursing Care for Patients with Chronic Obstructive Pulmonary Disease with Pneumothorax and Respiratory Failure: A Case Study

sarunya chulers — Thu, 22 Jan 2026 00:00:00 +0700

This study aimed to present nursing care for patients with COPD with pneumothorax and respiratory failure, nurses must understand the pathophysiology of the disease and provide effective, accurate, and appropriate nursing care. This can reduce the occurrence of complications, enable patients to safely overcome the crisis, and reduce mortality in patients with COPD with pneumothorax and respiratory failure. This study utilized a case-control study. Data were collected through observation, interviews, and analysis of medical records. analysis during 1-19 November 2024, at the Emergency Department, Central Chest Institute.

A 81-year-old Thai male patient with chronic obstructive pulmonary disease and a pneumothorax. And this time presented to the hospital with symptoms of shortness of breath and difficulty breathing two hours prior to admission. He was experiencing shortness of breath, using abdominal muscles for ventilation, and was restless. A chest X-ray showed a pneumothorax in the left pleural space. He was treated with an O₂ mask with bag at 10 liters per minute and a chest tube was inserted for drainage. The patient had severe complications including respiratory failure. Nursing care was implemented according to 5 nursing diagnoses as follows: The patient has a risk of life-threatening complications due to a pneumothorax in the pleural space, Risk of tissues in the body receiving insufficient oxygen due to reduced gas exchange efficiency due to pathological conditions of the disease, The patient was uncomfortable due to pain in the area where the left chest drainage tube was inserted, Risk of infection due to the insertion of the device into their body, Patients and their relatives are concerned about their disease, treatment with chest drainage, and behavior to prevent recurrence, The results showed that the patient had good response to treatment, no severe.

The results of this study can be applied as practice guidelines for nursing care for patients with complex respiratory diseases, helping to improve the quality of nursing care in an efficient, accurate, appropriate, rapid, and safe manner. It can reduce the occurrence of complications, help patients overcome the crisis, and reduce the mortality rate. It helps improve the quality of nursing care and can be used as academic information for developing nursing personnel competence and planning effective patient care in collaboration with interdisciplinary professionals.

The Mysterious Mass in Cardiac Chamber

Sura Boonrat — Fri, 12 Sep 2025 00:00:00 +0700

A 61-year-old woman presented with dyspnea on exertion. Her vital signs and physical examination findings were normal. Basic laboratory results were within normal limits. She underwent an echocardiogram to evaluate cardiac function. A transthoracic echocardiogram revealed a cystic mass attached to the posterior annulus of the mitral valve. Cardiac magnetic resonance imaging (CMR) was performed to detect residual myocardial ischemia and confirmed the diagnosis of caseous calcification of the mitral annulus, measuring 2 × 2.6 cm.

In this case, coronary angiography revealed multivessel disease with a mass-like blood supply shadow on the cineangiography view. She was scheduled for surgical revascularization as soon as possible.

Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification (MAC), a chronic degenerative process that typically occurs in elderly patients, particularly women. Hypertension, chronic kidney disease (CKD), and altered calcium-phosphate metabolism are also associated with this condition¹. CCMA is observed in approximately 0.067% of all echocardiographic examinations and is present in 0.63% of all patients with MAC². The mass-like calcification should be included in the differential diagnosis of cardiac masses when determining treatment options.

Caseous calcification is commonly asymptomatic; therefore, unnecessary treatment should be avoided, and monitoring the patient's progress is recommended in most cases³. Rarely, caseous calcification may cause mitral valve regurgitation, fistula formation, or systemic embolization⁴, in which case surgical removal of the mass should be considered.