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Myocardial Infarction

MI

Myocardial infarction, commonly referred to as heart attack, is a condition characterized by necrosis of the heart muscles due to development of ischemia that stays on for prolonged periods. Such a condition develops when the heart does not receive oxygen and blood due to blockage in the coronary arteries.


Presentation

Development of sudden chest pain is the most common symptom of heart attack. The pain may radiate down the left arm or neck in majority of the cases. The chest pain may be mild or severe. The characteristics of chest pain can be explained as follows:

  • Feeling of tight band that surrounds the chest.
  • Experiencing symptoms mimicking bad indigestion.
  • Feeling of some kind of heavy object on chest.
  • The pain often lasts for about 20 minutes. In addition to chest pain, individuals can also suffer from anxiety, shortness of breath, palpitations, sweating, cough and fainting.
  • It is always better to seek medical intervention at the earliest when an individual experiences any of these symptoms. Early intervention can help prevent onset of debilitating conditions.
  • In many cases, individuals may not experience any symptoms at all; or would just complain of dull or vague symptoms such as fatigue and shortness of breath. Such individuals are known to have developed silent heart attacks [6].
Coronary Artery Disease
  • Study group included STEMI patients with coronary artery disease; control group included patients without coronary artery disease. Levels of AGEs and sRAGE were tested on Days 0, 2, and 5 after STEMI.[ncbi.nlm.nih.gov]
  • Abstract Coronary artery disease (CAD) is a multifactorial disease in which inflammation plays a central role.[ncbi.nlm.nih.gov]
  • Coronary atherosclerosis (or coronary artery disease ) refers to the atherosclerosis that causes hardening and narrowing of the coronary arteries.[medicinenet.com]
  • […] for H. pylori in coronary artery disease.[dx.doi.org]
  • Are you being treated for coronary artery disease? This study is assessing anti-inflammatory drugs for their ability to slow down atherosclerosis and prevent new blockages in the coronary arteries of people with obstructive coronary artery disease.[nhlbi.nih.gov]
Congestive Heart Failure
  • Fifty of the patients had died in cardiogenic shock, the remainder from refractory congestive heart failure.[heart.bmj.com]
  • However, the role of aldosterone antagonists in patients with ejection fraction greater than 40% or without congestive heart failure is not well known.[doi.org]
  • Abstract Hypoxemia after myocardial infarction (MI) is usually explained by common culprits, including congestive heart failure, pre-existing lung disease, and pulmonary infection.[ncbi.nlm.nih.gov]
  • Adverse cardiac events (ACEs) are defined as cardiovascular death or worsening congestive heart failure in STEMI patients. The present study investigated the predictive role of fragmented QRS complex (fQRS) in risks of ACEs in STEMI.[ncbi.nlm.nih.gov]
  • Survival at one year in the operated and non-operated groups respectively was 94% vs 91%; angina within one year occurred in 3% vs 68%; congestive heart failure in 3% vs 6%; and 0% vs 32% were referred for later bypass grafting or coronary angioplasty[heart.bmj.com]
Fatigue
  • Fifty days after PCI the patient experienced progressive fatigue and chest pain with haemodynamic instability. Transthoracic echocardiography showed a covered LVFWR of the lateral wall.[ncbi.nlm.nih.gov]
  • If unexplained fatigue is present, clinicians should assess it in depth and explore the degree of fatigue, because some women previously described it as so severe that they could not make a bed without resting.[doi.org]
  • Instead, their most common symptoms are weakness, fatigue and dyspnea.[cvpharmacology.com]
  • “Instead they may experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness or fainting , upper back pressure or extreme fatigue.”[heart.org]
Fever
  • We report the case of 56 year old male, who presented with high grade fever and leukocytosis. On detailed evaluation, he was found to have a myocardial abscess with underlying LVA. Journal of the Association of Physicians of India 2011.[ncbi.nlm.nih.gov]
  • A 6-month-old female infant was referred with a 3-day history of low-grade fever, slight nasal congestion and rhinorrhoea. On admission, the clinical findings were unremarkable and she was discharged home.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Patients with fever, and significant risk factors for endocarditis, who develop ACS, need a prompt diagnostic work up, including trans-esophageal echocardiography.[ncbi.nlm.nih.gov]
  • Association of ABO Rh blood group with dengue fever and dengue hemorrhagic fever: a case-control study. J Appl Hematol. 2013; 4 :145–148. doi: 10.4103/1658-5127.127899. [ CrossRef ] [ Google Scholar ] 68.[ncbi.nlm.nih.gov]
  • Signs Cardiovascular examination findings can vary enormously: Low-grade fever, pale and cool, clammy skin. Hypotension or hypertension can be observed depending on the extent of the myocardial infarction.[patient.info]
Malaise
  • […] the chest Jaw pain, toothache, headache Shortness of breath Nausea Vomiting General epigastric (upper middle abdomen) discomfort Sweating Heartburn and/or indigestion Arm pain (more commonly the left arm, but may be either arm) Upper back pain General malaise[medicinenet.com]
  • Patients with typical acute MI usually present with chest pain and may have prodromal symptoms of fatigue, chest discomfort, or malaise in the days preceding the event; alternatively, typical ST-elevation MI (STEMI) may occur suddenly without warning.[emedicine.medscape.com]
  • Signs and symptoms Patients with typical MI may have the following symptoms in the days or even weeks preceding the event (although typical STEMI may occur suddenly, without warning): Fatigue Chest discomfort Malaise Typical chest pain in acute MI has[emedicine.medscape.com]
Dyspnea
  • PATIENT CONCERNS: A 51-year-old man was admitted to our hospital with exertional dyspnea that he had experienced for half a year. Woven coronary artery was found in coronary angiography.[ncbi.nlm.nih.gov]
  • Instead, their most common symptoms are weakness, fatigue and dyspnea.[cvpharmacology.com]
  • About 25% of patients seen by the physician in the ambulatory setting present with dyspnea.[web.archive.org]
  • It is characterized by a severe and rapid onset of symptoms that may include chest pain, often radiating to the left arm and left side of the neck, dyspnea, sweating, and palpitations. 410 Acute myocardial infarction 410.0 Acute myocardial infarction[icd9data.com]
Rales
  • Exceptions appeared for the two big RALES and EMPHASIS-HF trials [ 11 ][ 33 ], where interestingly enough, patients in the placebo groups had slightly higher rate of gynecomastia (RALES and EMPHASIS-HF) and of renal function degradation (EMPHASIS-HF).[doi.org]
  • There may be signs of congestive heart failure, including pulmonary rales, peripheral oedema, elevated jugular venous pressure.[patient.info]
  • In other patients abnormal heart sounds may be detected, or rales (signs of fluid in the lungs), an irregular pulse or a high or even low blood pressure.[serious-science.org]
  • The cases were stratified into the following classes: Killip I: 81 (33%) with no clinical signs of heart failure, Killip II: 96 (38%) with rales in the lungs, third heart sound (S3), and elevated jugular venous pressure, Killip III: 26 (10%) with acute[scielo.br]
Respiratory Distress
  • Trevisanuto D, Zaninotto M, Altinier S, Plebani M, Zanardo V (2000) High serum cardiac troponin T concentrations in preterm infants with respiratory distress syndrome. Acta Paediatr 89(9):1134–1136 CrossRef PubMed Google Scholar 80.[doi.org]
  • distress syndrome; COPD chronic obstructive pulmonary disease.[web.archive.org]
  • Causes of sudden-onset breathlessness generally involve the lungs or heart – including pulmonary edema, pneumonia, allergic reactions and asthma, and pulmonary embolus, acute respiratory distress syndrome and metabolic acidosis.[en.wikipedia.org]
  • In rare cases, crack users may develop adult respiratory distress syndrome and end-stage respiratory failure due to crack-associated interstitial pneumonitis and BOOP. Use of cocaine or heroin by inhalation can also lead to severe asthma [ 7 ].[doi.org]
Nausea
  • OTHER SIGNS may include breaking out in a cold sweat, nausea or lightheadedness.[heart.org]
  • Other signs such as breaking out in a cold sweat, nausea or lightheadedness. As with men, women’s most common heart attack symptom is chest pain or discomfort.[heart.org]
  • This pain may travel to the neck, jaw, arms, back, or even the teeth , and may be accompanied by shortness of breath, nausea , or a cold sweat.[medicinenet.com]
  • May include breaking out in a cold sweat, nausea, or light-headedness. Learn the signs–but also remember: Even if you're not sure it's a heart attack, you should still have it checked out. Fast action can save lives-maybe your own.[web.archive.org]
  • These symptoms include: Pain in the back, neck, jaw, or throat Indigestion Heartburn Nausea (feeling sick to the stomach) Vomiting Extreme fatigue (tiredness) Problems breathing (shortness of breath) Women are more likely than men to have heart attacks[womenshealth.gov]
Vomiting
  • CASE PRESENTATION: A 58 year old lady was admitted to our unit with acute onset epigastric pain and vomiting for 4 h duration. Following admission she complained of retrosternal tightening type of a chest pain.[ncbi.nlm.nih.gov]
  • But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.[heart.org]
  • These symptoms include: Pain in the back, neck, jaw, or throat Indigestion Heartburn Nausea (feeling sick to the stomach) Vomiting Extreme fatigue (tiredness) Problems breathing (shortness of breath) Women are more likely than men to have heart attacks[womenshealth.gov]
  • Meanwhile, morphine is associated with vomiting, hypotension, and respiratory depression. The study authors also reported that morphine may inhibit and delay oral antiplatelet drug absorption.[ajpb.com]
  • Chest pain with nausea and vomiting, marked sweating and/or breathlessness, or haemodynamic instability.[patient.info]
Epigastric Pain
  • CASE PRESENTATION: A 58 year old lady was admitted to our unit with acute onset epigastric pain and vomiting for 4 h duration. Following admission she complained of retrosternal tightening type of a chest pain.[ncbi.nlm.nih.gov]
  • 61 yo female with no previous medical history presenting with nausea, vomiting and epigastric pain that began approximately 4 hours after eating at a mexican restaurant.[web.archive.org]
  • Skip to content learn bedside ultrasound, one week at a time 61 yo female with no previous medical history presenting with nausea, vomiting and epigastric pain that began approximately 4 hours after eating at a mexican restaurant.[ultrasoundoftheweek.com]
  • pain, and nausea with or without vomiting rather than simply present with chest pain. 16 Compounding the problem for women is that women may not believe they're vulnerable to a heart attack, and may be less likely to identify their signs and symptoms[journals.lww.com]
  • pain, indigestion, stabbing or pleuritic pain, and increasing dyspnea in the absence of chest pain should raise concern for NSTE-ACS. 56 Psychiatric disorders (eg, somatoform disorders, panic attack, anxiety disorders) are noncardiac causes of chest[doi.org]
Abdominal Pain
  • Symptoms Common heart attack signs and symptoms include: Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back Nausea, indigestion, heartburn or abdominal pain Shortness of breath[mayoclinic.org]
  • Depending on the pain localization, there are several forms of myocardial infarction, such as: Typical form – chest pain Atypical form – abdominal pain Combined form – abdominal and chest pain Painless form – there is no pain syndrome (more common for[bookinghealth.com]
  • Patients “with NSTE-ACS may also present with diaphoresis, dyspnea, nausea, abdominal pain, or syncope. Unexplained new-onset or increased exertional dyspnea is the most common angina equivalent.[doi.org]
Hiccup
  • Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology.[ncbi.nlm.nih.gov]
Jaw Pain
  • But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.[heart.org]
  • 12 Heart Attack Symptoms and Early Signs Chest discomfort, manifest as pain, fullness, and/or squeezing sensation of the chest Jaw pain, toothache, headache Shortness of breath Nausea Vomiting General epigastric (upper middle abdomen) discomfort Sweating[medicinenet.com]
  • Atypical symptoms include abdominal discomfort or jaw pain; elderly patients may present with altered mental state. Signs Cardiovascular examination findings can vary enormously: Low-grade fever, pale and cool, clammy skin.[patient.info]
  • Those who have more vague or less typical "heart" symptoms have reported the following: Upper back or shoulder pain Jaw pain or pain spreading to the jaw Pressure or pain in the center of the chest Light headedness Pain that spreads to the arm Unusual[my.clevelandclinic.org]
Heart Failure
  • However, the role of aldosterone antagonists in patients with ejection fraction greater than 40% or without congestive heart failure is not well known.[doi.org]
  • Fifty of the patients had died in cardiogenic shock, the remainder from refractory congestive heart failure.[heart.bmj.com]
  • Knowledge gained from mammalian models of cardiac regeneration will allow for the development of therapeutic regimens in the treatment of heart failure.[dx.doi.org]
  • CONCLUSION: The data demonstrated that having myocardial infarction significantly increased the risk of subsequent cardiovascular death or hospitalisation for heart failure.[ncbi.nlm.nih.gov]
  • The evaluated outcomes were all-cause mortality, recurrent coronary events (ischemia or myocardial infarction), heart failure, and arrhythmias. Summary-adjusted risk ratios (RRs) were calculated by the random effects DerSimonian and Laird model.[ncbi.nlm.nih.gov]
Chest Pain
  • […] without chest pain/discomfort.[dx.doi.org]
  • Development of sudden chest pain is the most common symptom of heart attack. The pain may radiate down the left arm or neck in majority of the cases. The chest pain may be mild or severe.[symptoma.com]
Tachycardia
  • Abstract A 63-year-old man with an ischaemic cardiomyopathy, supported by the HeartWare left ventricular assist device (LVAD), presented with ventricular tachycardia and inferior ST-elevation myocardial infarction (STEMI) with associated acute right ventricular[ncbi.nlm.nih.gov]
  • ACEs, including hemodynamic instability, electrical instability (ventricular tachycardia event, ventricular fibrillation or atrioventricular heart-block) and death, were observed. The 12-lead ECG was used to obtain fQRS recordings.[ncbi.nlm.nih.gov]
  • We found that paired ventricular extrasystoles and ventricular tachycardia had more prognostic significance than R on T ventricular extrasystoles.[heart.bmj.com]
  • The pain and anxiety associated with myocardial infarction further activates the sympathetic nervous system, which causes systemic vasoconstriction and cardiac stimulation (this explains why some patients become hypertensive and have tachycardia).[cvpharmacology.com]
  • The terminal event is often a cardiac arrhythmia, either ventricular tachycardia deteriorating to ventricular fibrillation or extreme bradycardic arrest.[emedicine.medscape.com]
Pericardial Friction Rub
  • Significant physical findings, often absent, include an atrial gallop rhythm (4th heart sound) and a pericardial friction rub.[medical-dictionary.thefreedictionary.com]
  • A pericardial friction rub may be audible as a to-and-fro rasping sound; it is produced through sliding contact of inflammation-roughened surfaces.[emedicine.medscape.com]
  • Acute pericarditis is suggested by a pericardial friction rub. Cardiac tamponade can be reflected by pulsus paradoxus. Pneumothorax is suspected when acute dyspnea, pleuritic chest pain, and differential breath sounds are present.[doi.org]
Heart Murmur
  • The provider may hear abnormal sounds in your lungs (called crackles), a heart murmur , or other abnormal sounds. You may have a fast or uneven pulse. Your blood pressure may be normal, high, or low.[nlm.nih.gov]
  • Heart sounds are auscultated for S3 or S4 gallops or new heart murmurs. Patient care and other activities should be organized to allow for periods on uninterrupted rest.[medical-dictionary.thefreedictionary.com]
Upper Back Pain
  • However, women are more likely than men to have: shortness of breath jaw pain upper back pain lightheadedness nausea vomiting In fact, some women who have had a heart attack report that their symptoms felt like the symptoms of the flu .[healthline.com]
  • Generally, women are more likely to experience middle or upper back pain, 6 , 31 , 40 , 46 , 53 , 55 , 57 , 62 neck pain, 31 , 40 , 62 , 72 jaw pain, 40 , 62 shortness of breath, 46 , 53 , 55 , 71 , 72 paroxysmal nocturnal dyspnea, 57 nausea or vomiting[doi.org]
Shoulder Pain
  • The most common symptoms expected and experienced were chest pain, chest discomfort, loss of strength, fatigue, and radiating pain or shoulder pain.[doi.org]
  • Those who have more vague or less typical "heart" symptoms have reported the following: Upper back or shoulder pain Jaw pain or pain spreading to the jaw Pressure or pain in the center of the chest Light headedness Pain that spreads to the arm Unusual[my.clevelandclinic.org]
Kidney Failure
  • This is provided there is no evidence of worsening kidney failure, high potassium, low blood pressure, or known narrowing of the renal arteries.[en.wikipedia.org]
Dizziness
  • “Instead they may experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness or fainting , upper back pressure or extreme fatigue.”[heart.org]
  • Other possible symptoms of a heart attack include: Breaking out in a cold sweat Feeling unusually tired for no reason, sometimes for days (especially if you are a woman) Nausea (feeling sick to the stomach) and vomiting Light-headedness or sudden dizziness[web.archive.org]
  • Other symptoms which may also be present include: Shortness of breath Feeling lightheaded or dizzy Feeling nauseous Strong anxiety Sweating In some cases, a heart attack can occur without you being aware of the symptoms.[diabetes.co.uk]
  • The symptoms of collapse, dizziness, irregular heart beat, and loss of consciousness had significantly higher levels of expectation than experience.[doi.org]
  • Other signs of a heart attack include shortness of breath, dizziness , faintness, or nausea . The pain of a severe heart attack has been likened to a giant fist enclosing and squeezing the heart.[webmd.com]
Confusion
  • This anomaly, because it is rare, can be a source of confusion to clinicians, especially when acute coronary syndrome is present. The possible presence of this anomaly should, therefore, be kept in mind in daily practice.[ncbi.nlm.nih.gov]
  • Many women think the signs of a heart attack are unmistakable — the image of the elephant comes to mind — but in fact they can be subtler and sometimes confusing.[heart.org]
  • […] additional) symptoms: Sweating, cool, clammy skin, and/or paleness Shortness of breath Nausea or vomiting Dizziness or fainting Unexplained weakness or fatigue Rapid or irregular pulse Although chest pain is the key warning sign of a heart attack, it may be confused[lakelandhealth.org]
  • In addition, the patient may have confusion and diarrhoea. Mortality is reported as 10% to 15% [ 30 ].[doi.org]
  • Patterns of Anterior Infarction The nomenclature of anterior infarction can be confusing, with multiple different terms used for the various infarction patterns. The following is a simplified approach to naming the different types of anterior MI.[lifeinthefastlane.com]
Agitation
  • Current Issue Original Articles Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children: a double-blind, randomized clinical study Ji, Jae Young; Park, Jin Soo; Kim, Ji Eun; More Chinese Medical Journal. 132(7):757-764[cmj.org]
  • Hyperthermic complications Excessive cocaine use can result in hallucinations, agitation, and hyperthermia, and management is urgent.[doi.org]
  • […] medically determined that the person is no longer alcohol or drug dependent, (xiv) no established medical evidence of an intractable psychoneurotic disorder having particular regard for sustained hostile, aggressive, paranoid, or suicidal tendencies and agitated[gov.ns.ca]
  • […] patients with severe cardiovascular toxicity. β-Blockers (phentolamine), benzodiazepines (lorazepam, diazepam), calcium channel blockers (verapamil), morphine, and sublingual nitroglycerin may be used as needed to control hypertension, tachycardia, and agitation[doi.org]
Altered Mental Status
  • In addition, some patients may have an altered mental status caused by medications or impaired cerebral perfusion.[emedicine.medscape.com]
  • Therefore, patients with altered mental status were not eligible to participate in the trial.[doi.org]
  • mental status, slow shallow breaths, miosis, bradycardia, hypotension, hypothermia, decreased bowel sounds Opiates Epileptogenic Hyperthermia, hyperrreflexia, tremors, seizures Cocaine, phencyclidine Conclusion Because drug use is widespread and increasing[doi.org]

Workup

A preliminary physical examination to determine the heart sounds, blood pressure and pulse rate will be quickly carried out. Following this, an electrocardiogram will be done to evaluate the extent of heart damage. A blood test will be conducted which would determine heart tissue damage. This test would also confirm heart attack.

Coronary angiogram would either be done immediately or after stabilizing the condition of the patient. In this test, a specialized dye is inserted which allows to evaluate areas of blockage. In addition, other tests such as nuclear stress test and exercise stress test would also be conducted [7].

Dyslipidemia
  • […] with statin therapy between the patients who first presented with ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina pectoris (UA) based on the target achievement according to the current dyslipidemia[ncbi.nlm.nih.gov]
  • There were 83 (46.4%) patients having hypertension, 61 (34.1%) diabetes mellitus, 75 (41.9%) smokers, 75 (41.9%) patients having positive family history, 11 (6.1%) having dyslipidemia, and 73 (40.8%) obese patients in this study.[ncbi.nlm.nih.gov]
  • […] vascular disease associated with chronic kidney disease and renal failure [7] Accelerated atherogenesis after treatment for childhood cancer Inflammatory conditions such as viral and eosinophilic myocarditis [8] and systemic lupus erythematosus (SLE) - Dyslipidemia[emedicine.medscape.com]
  • It was relatively uncommon for first MI patients to have only dyslipidemia, diabetes, or family history alone as a sole risk factor at hospitalization (each of these 3 groups represents about 3%-5% of the overall first MI population).[dx.doi.org]
Inferior Q Wave
  • Q waves - not Old Inferior Wall Myocardial Infarction (MI) ECG Old Inferior Wall Myocardial Infarction (MI) ECG (Example 1) Old Inferior Wall Myocardial Infarction (MI) ECG (Example 2) References: 1.[healio.com]
ST Elevation
  • KEYWORDS: Cardiac arrest; ST elevation myocardial infarction; cardiac catheterization lab; hypothermia; morbidity; mortality.[ncbi.nlm.nih.gov]
  • In this case, ECG suggested LAD region infarction with ST elevation in aVR, commonly associated with left main stenosis (LMS) involvement.Thrombus aspiration in LAD and LCX yielded hemodynamic improvement.[ncbi.nlm.nih.gov]
  • Acute myocardial infarction has traditionally been divided into ST elevation or non-ST elevation myocardial infarction; however, therapies are similar between the two, and the overall management of acute myocardial infarction can be reviewed for simplicity[ncbi.nlm.nih.gov]
  • We aimed to compare the compliance with statin therapy between the patients who first presented with ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina pectoris (UA) based on the target achievement[ncbi.nlm.nih.gov]
  • An electrocardiogram performed on admission revealed ST-elevation in the precordial leads.[ncbi.nlm.nih.gov]
Complete Left Bundle Branch Block
  • The exclusion criteria included an inability to provide informed consent, dementia, complete left bundle-branch block, cardiogenic shock, and a higher-than-normal risk of bleeding 8-10 .[dx.doi.org]
  • ., complete left bundle branch block, paced rhythm, accessory pathway, left ventricular hypertrophy, digitalis use, and resting ST-segment abnormalities). 4 From a prognostic standpoint, an inability to exercise and exercise-induced ST-segment depression[web.archive.org]
T Wave Inversion
  • The classic electrocardiogram findings: ST segment elevation, followed by T wave inversion and Q waves, are associated with transmural infarction. ST segment depression and T wave inversion are associated with subendocardial infarction.[histopathology-india.net]
  • Abnormal Q waves and T-wave inversion in I and aVL. The pattern indicates prior infarction of the anteroseptal and lateral walls.[lifeinthefastlane.com]
  • Features may initially be normal but abnormalities include new ST-segment elevation; initially peaked T waves and then T-wave inversion; new Q waves; new conduction defects. Do not exclude an ACS when people have a normal resting 12-lead ECG.[patient.info]
  • When the ECG showed ST-segment depression, T-wave inversion, or nonspecific findings in serial tracings along with the increased levels of myocardial necrosis biomarkers, AMI diagnosis without persistent ST-segment elevation was confirmed.[scielo.br]
Ischemic Changes
  • Furthermore, the electrocardiograms were independently reviewed by a physician for the presence of ischemic changes. Chest pain in the absence of electrocardiographic changes was considered non-ischemic.[dx.doi.org]
  • Cardiac death with symptoms suggestive of myocardial ischemia and presumed new ischemic changes or injury or new BBB on ECG, but death occurred before cardiac biomarker levles were obtained, or before cardiac biomarker values would be increased.[emedicine.medscape.com]
Electrocardiogram Change
  • A case was diagnosed as AMI if two out of the three criteria (clinical symptoms, electrocardiogram changes and raised enzyme levels) were positive.[dx.doi.org]
  • AMI was defined as: (1) a typical increase and gradual decrease of biochemical markers of myocardial necrosis and at least 1 of the following: ischemic symptoms, development of pathologic Q waves on electrocardiogram, electrocardiogram changes indicative[doi.org]

Treatment

Heart attacks require emergency treatment. Once the patient arrives he is immediately admitted to the intensive care unit and is constantly monitored through heart monitor and is put on an external oxygen supply [8]. He is given medications such as nitroglycerin and morphine intravenously for reducing chest pain [9].

In addition, aspirin would also be given to prevent blood from clotting. In case, the individuals is having arrhythmias he would be given medications to bring the heart rate back to normal. Once the patient’s vital signs are stabilized he is prepared for angioplasty which is employed to open blocked blood vessels [10].

In case of greater degree of blockages, a bypass surgery may be recommended. In many cases, individuals are given drugs to breaks the clots. These drugs work best when given within 3 hours of chest pain. Such a type of method is known as thrombolytic therapy.

Prognosis

Prognosis of myocardial infarction greatly depends on the extent of damage the infarct has caused to the heart muscles as well as the left ventricular function. The prognosis of the condition is not very favorable in most of the cases. It has been reported that acute myocardial infarction causes mortality in 30% cases. In addition to this, about 5 to 10% individual who survive the condition, eventually die within the first year of suffering an attack. To add to this, about 50% of patients need to be hospitalized again within a year of suffering from myocardial infarction. Individuals with diabetes or hypertension are known to have a poor prognosis [5].

Etiology

Development of blockage in the coronary arteries that prevents the blood and oxygen from reaching the heart causes myocardial infarction. Occurrence of atherosclerosis is known to be major causative factor for development of most of the acute coronary syndromes. It has been reported that 90% cases of myocardial infarction occurs due to atherosclerotic coronary artery. Individuals with chronic disorders such as hypertension, diabetes and obesity are an increased risk of developing myocardial infarctions. Those in habit of smoking or living a sedentary lifestyle are also highly susceptible to heart attack [2].

Epidemiology

It has been estimated that about 1.5 million individuals suffer from myocardial infarctions each year in the US. Cardiovascular disease is the leading cause of mortality in the US causing 500,000 to 700,000 deaths each year. Worldwide, about 12 million deaths occur each year due to cardiovascular diseases. Male are more prone to contract myocardial infarctions than women [3].

Sex distribution
Age distribution

Pathophysiology

Buildup of plaque in the coronary arteries causes the arteries to block preventing the oxygen rich blood to reach the heart. The plaque is essentially made up of cholesterol and other cells. When plaque slowly and gradually builds up in the arteries, it causes them to narrow so much so that they gradually get blocked.

A heart attack can also occur when the plaque tears, causing the blood platelets along with other substances to form a clot. The clot is formed at the site which prevents the blood and oxygen to reach the heart causing an attack. Lack of oxygen supply, gradually reduces the muscular contractions and systolic wall motion in the affected area [4].

Prevention

Adopting certain lifestyle changes can help prevent onset of myocardial infarction. Exercising regularly and eating diet low in cholesterol and sodium will help in preventing the onset of chronic degenerative disorders and plaque formation. Individuals should also quit smoking in order to decrease their chances of developing heart attacks.

Summary

Individuals with acute myocardial infarction suffer from sudden onset of chest pain which is felt behind the sternum and in many cases the pain travels down the left arm. However, there are times when individuals experience absolutely no or some vague symptoms. This is known as silent myocardial infarctions. Heart attack requires immediate medical intervention to prevent development of irreversible damages [1].

Patient Information

Definition

Myocardial infarction is characterized by necrosis of heart cells due to blockage of the coronary arteries that supply blood and oxygen to the heart. It is a common occurrence affecting about 1.5 million individuals in US.

Cause

Heart attack occurs primarily due to plaque tear or narrowing of the arteries due to gradual deposition of the plaque in them. Formation of plaque in the coronary arteries cause it to block as a result of which blood and oxygen no longer reach the heart muscles.
Symptoms

Symptoms of myocardial infarction consist of sudden onset of chest pain that is characterized by feeling of tightness in the chest. The pain can even radiate along the left arm and neck. In addition, other symptoms include lightheadedness, nausea, cough, sweating and shortness of breath.

Diagnosis

A quick preliminary examination of the vital signs is made following blood tests to reveal extent of damage to the heart. In addition, electrocardiogram is also carried out to determine heart damage.

Treatment

Treatment begins with intravenous administration of nitroglycerine and morphine to decrease the chest pain. Medications to correct the blood clot are also given. Following this, angioplasty or bypass surgery is done depending on the extent of blockages.

References

Article

  1. Siddiqui MA, Tandon N, Mosley L, Sheridan FM, Hanley HG.Interventional therapy for acute myocardial infarction. J La State Med Soc. Jun 2001;153(6):292-9.
  2. McCord J, Jneid H, Hollander JE, et al. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation 2008; 117:1897.
  3. Rosamond WD, Chambless LE, Folsom AR, et al. Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994. N Engl J Med 1998; 339:861.
  4. Busko M. High-risk plaque predicts ACS in ER patients with chest pain. Heartwire [serial online]. July 18, 2014;Accessed July 21, 2014.
  5. Yan AT, Tan M, Fitchett D, et al. One-year outcome of patients after acute coronary syndromes (from the Canadian Acute Coronary Syndromes Registry). Am J Cardiol 2004; 94:25.
  6. Bahit MC, Cannon CP, Antman EM, et al. Direct comparison of characteristics, treatment, and outcomes of patients enrolled versus patients not enrolled in a clinical trial at centers participating in the TIMI 9 Trial and TIMI 9 Registry. Am Heart J 2003; 145:109.
  7. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am CollCardiol. Aug 14 2007;50(7):e1-e157. 
  8. Cabello JB, Burls A, Emparanza JI, et al. Oxygen therapy for acute myocardial infarction. Cochrane Database Syst Rev 2013; 8:CD007160.
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Last updated: 2018-06-22 02:13