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APA format for MSN degree 2 references from Walden University Library
 
A heart attack or Myocardial infarction (MI) is the leading factor of death in adults worldwide (Nicolai et al., 2018).  MI occur in patients when the blood flow to the heart is blocked due to increased built of plaque within the walls of the blood vessels. Patients can experience sharp, sudden pain or heaviness in their chest as the first sign when experiencing an MI.  This pain can be in the chest and move up to the jaw and down the left arm. When blood flow is decreased to the heart, there is an insufficient amount of oxygen supplied to the heart, and the electrolyte become imbalanced specifically potassium, calcium, and magnesium.  The heart can only handle the blood, oxygen, and electrolyte imbalances for twenty minutes before tissue begins to die, at this point is the damage is irreversible (Huether & McCance, 2017). As an advanced practice nurse, an Electrocardiogram (ECG) would be first in diagnosing techniques. Depending on the results of the ECG will help determine how to treat the patient. If the ECG showed ST elevation, this means the patient needs to get to a cardiac catheterization lab urgently. If the ECG results within reasonable limits, treating the chest pain would be the next appropriate step.  Medication used to treat stable chest pain are called nitrates. The most common name is nitroglycerin. The medication is placed underneath the tongue where it dissolves and should relieve the pain within one to five minutes (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).  When the ECG indicates a STEMI, a thrombolytic medication should be initiated to dissolve any blood clots in the arteries (Avoiding, 2005). A standard medication used in my patient care experience is heparin which is first based on weight for the first six hours of treatment. After six hours labs are drawn on the patient to determine whether the rate should be titrated up or down. After patient returns from cardiac catheterization lab, cardiology doctors can provide guidance on how to proceed with the proper medications for the patient.
Genetics and Ethnicity
             If your parents have had an MI, does it mean you will have one? Likely the answer is no; research has shown necessarily doesn’t say you will but have found a link among ethnicity in Europeans, South Asians, Southeast Asians, and Arabs (Joseph et al., 2016). Specifically, there’s no genetic link to an MI but rather coronary artery disease (CAD) which can lead to MI.  However modifiable risk factors, such as a healthy lifestyle, prove to be the most significant way to decrease the risk of an MI.
Self-Care
After a patient experiences an MI, usually, they are set up to attend a Cardiac rehabilitation program. This program helps the patient get back to a healthy lifestyle while incorporating changes to prevent an MI in the future. Advanced practice providers should closely watch patients with hypertension, diabetes, and hyperlipidemia. Research has shown if a patient has two out three diagnoses they are at higher risk for a heart attack (Avoiding, 2005). Encouraging physical activity, a healthy diet, and smoking cessation are critical factors in patient education. Studies suggest educating patients on doing at least thirty minutes of activity a day such as walking, gardening, or housework also to cut out fast food that is high in fat and sugary drinks (Advance et al., 2005). 
Reference
Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A.  (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA:  Lippincott Williams & Wilkins.
Avoiding heart attacks and strokes. [electronic resource]: don’t be a victim – protect yourself. (2005). Geneva: World Health Organization, c2005.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Joseph, P. G., Pare, G., Asma, S., Engert, J. C., Yusuf, S., & Anand, S. S. (2016). Clinical Research: Impact of a Genetic Risk Score on Myocardial Infarction Risk Across Different Ethnic Populations. Canadian Journal Of Cardiology, 321440-1446. doi:10.1016/j.cjca.2016.05.014
Nicolai, J., Müller, N., Noest, S., Wilke, S., Schultz, J., Gleißner, C. A., & … Bieber, C. (2018). To change or not to change – That is the question: A qualitative study of lifestyle changes following acute myocardial infarction. Chronic Illness, 14(1), 25-41. doi:10.1177/1742395317694700