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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].
Dyspnea
  • 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. The patient was diagnosed with mitral regurgitation and woven coronary.[ncbi.nlm.nih.gov]
  • Instead, their most common symptoms are weakness, fatigue and dyspnea.[cvpharmacology.com]
  • Cardiological rehabilitation has the following aims: Restoration of heart muscle normal function Elimination of symptoms (for example, chest pain, dyspnea, etc.)[bookinghealth.com]
  • The victim should be kept lying down, and all tight clothing should be loosened to relieve dyspnea and promote comfort.[medical-dictionary.thefreedictionary.com]
  • In NSTEMI, ECG manifestations might include ST-segment depression and/or T-wave inversions - these findings are often transient, and tend to parallel the development of symptoms (chest pain, dyspnea, nausea, diaphoresis).[clinicaladvisor.com]
Rales
  • 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]
  • Chest Rales or wheezes may be auscultated; these occur secondary to pulmonary venous hypertension, which is associated with extensive acute left ventricular MI. Unilateral or bilateral pleural effusions may produce egophony at the lung bases.[emedicine.medscape.com]
  • Killip classification is widely used in patients presenting with acute MI for the purpose of risk stratification, as follows [ 42 ] : Killip class I includes individuals with no clinical signs of heart failure Killip class II includes individuals with rales[emedicine.medscape.com]
Respiratory Distress
  • distress syndrome and metabolic acidosis . [77] There are many different causes of fatigue, and myocardial infarction is not a common cause. [80] Management [ edit ] A myocardial infarction requires immediate medical attention.[en.wikipedia.org]
  • Physical Examination Physical examination findings for myocardial infarction (MI) can vary; one patient may be comfortable in bed, with normal examination results, whereas another patient may be in severe pain, with significant respiratory distress and[emedicine.medscape.com]
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]
  • Overview of Myocardial Infarction (Heart Attack) Myocardial infarction (heart attack) is a serious result of coronary artery disease .[imaginis.com]
  • At angiogram, a graft study showed severe native coronary artery disease.[ncbi.nlm.nih.gov]
  • This trial will help us understand whether coronary artery disease risk derived from genetic information would have a significant impact on patients' perception of coronary artery disease risk and motivate healthy lifestyle modifications that reduce their[clinicaltrials.gov]
  • A 70-year-old man with acute inferoposterolateral myocardial infarction and single-vessel coronary artery disease underwent emergency percutaneous coronary intervention (PCI).[ncbi.nlm.nih.gov]
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]
  • Instead, their most common symptoms are weakness, fatigue and dyspnea.[cvpharmacology.com]
  • […] for several days In a multi-center study of 515 women who had an acute myocardial infarction (MI), the most frequently reported symptoms were unusual fatigue, sleep disturbances, shortness of breath, indigestion and anxiety.[my.clevelandclinic.org]
  • 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.[symptoma.com]
  • […] symptoms such as: Pain around the shoulder blades, arm, chest, jaw, left arm, or upper abdomen A painful sensation described as having a "clenched fist in the chest" Discomfort or tightness in the neck or arm Indigestion or heartburn Nausea and vomiting Fatigue[verywell.com]
Congestive Heart Failure
  • 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]
  • congestive heart failure heart failure myocardial infarction tachycardia heart attack noun . heart failure acute myocardial infarction angina pectoris cardiac arrest cardiovascular disease chest pains congestive heart failure coronary coronary infarction[thesaurus.com]
  • 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]
  • Downside of improved survival after AMI is the increase of both incidence and prevalence of congestive heart failure (CHF).[encarebiotech.com]
  • heart failure, and an increased risk for another MI.[physio-pedia.com]
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.[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]
  • 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]
  • 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]
  • […] an aseptic fever caused by liberation of pyrogens from damaged tissue. intestinal infarction a common occurrence in horses due to occlusion of arteries by larvae of Strongylus vulgaris.[medical-dictionary.thefreedictionary.com]
Severe Pain
  • Some people have mild pain; others have more severe pain. Some people have no symptoms; for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you're having a heart attack.[mayoclinic.org]
  • It involves the administration of the following drugs: Clopidogrel Nitroglycerin Morphine in case of severe pain syndrome Thrombolysis (sometimes performed even during the pre-hospital phase) A person is admitted to the department of cardiology.[bookinghealth.com]
  • Some begin suddenly with severe pain or other symptoms, while others have a slower onset with only mild pain or discomfort. Pain toward the center of the chest is the most common symptom experienced by patients.[physio-pedia.com]
  • Physical Examination Physical examination findings for myocardial infarction (MI) can vary; one patient may be comfortable in bed, with normal examination results, whereas another patient may be in severe pain, with significant respiratory distress and[emedicine.medscape.com]
Nausea
  • Chest pain with nausea and vomiting, marked sweating and/or breathlessness, or haemodynamic instability.[patient.info]
  • 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.[symptoma.com]
  • ., referred pain), a sense of substernal heaviness, squeezing or pressure, shortness of breath (dyspnea), fatigue, fainting (syncope), nausea, sweating (diaphoresis), anxiety, sleeplessness, hypertension or hypotension (depending in part on the extent[cvpharmacology.com]
  • 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]
  • 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]
Vomiting
  • 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. She had elevated serum amylase and cardiac troponin.[ncbi.nlm.nih.gov]
  • Chest pain with nausea and vomiting, marked sweating and/or breathlessness, or haemodynamic instability.[patient.info]
  • 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]
  • 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]
  • […] generalized symptoms such as: Pain around the shoulder blades, arm, chest, jaw, left arm, or upper abdomen A painful sensation described as having a "clenched fist in the chest" Discomfort or tightness in the neck or arm Indigestion or heartburn Nausea and vomiting[verywell.com]
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]
Epigastric Pain
  • 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. She had elevated serum amylase and cardiac troponin.[ncbi.nlm.nih.gov]
  • 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]
  • Most evident in the palms and on the face) Sweating Tachycardia Presentation of a ‘silent MI’ (no cardiac pain / chest tightness) – usually in diabetic and/or elderly patients Syncope Pulmonary oedema Epigastric pain Vomiting Acute confusional state Stroke[almostadoctor.co.uk]
Hiccup
  • Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology.[ncbi.nlm.nih.gov]
Jaw Pain
  • 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]
  • 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]
  • Women typically experience other symptoms such as SOA, nausea and vomiting, and neck or jaw pain. [3] Associated Co-morbidities Associated Co-morbidities for Myocardial Infarction include: Hypertension Coronary Artery Disease (CAD) Congestive Heart Failure[physio-pedia.com]
Chest Pain
  • 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]
  • Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown.[ncbi.nlm.nih.gov]
  • For diagnosing AMI from ACS patients, MPO was the most efficient marker than others markers with efficiency 82.5% within 0-6 hr after the onset time of chest pain.[ncbi.nlm.nih.gov]
Heart Failure
  • The data demonstrated that having myocardial infarction significantly increased the risk of subsequent cardiovascular death or hospitalisation for heart failure.[ncbi.nlm.nih.gov]
  • After adjustments also for previous myocardial infarction, previous heart failure and body mass index, insulin-like growth factor-binding protein 1 was still associated with all-cause mortality (1.38; 1.01-1.89, p   0.046).[ncbi.nlm.nih.gov]
  • […] congestive heart failure heart failure myocardial infarction tachycardia heart attack noun . heart failure acute myocardial infarction angina pectoris cardiac arrest cardiovascular disease chest pains congestive heart failure coronary coronary infarction[thesaurus.com]
  • 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]
  • A 77-year-old man was admitted due to heart failure and advanced atrioventricular block who was previously diagnosed with cutaneous sarcoidosis and old myocardial infarction (MI) with angiographical evidence.[ncbi.nlm.nih.gov]
Tachycardia
  • Relevance A-Z Length - Synonyms for myocardial infarction noun heart attack cardiac arrest congestive heart failure heart failure myocardial infarction tachycardia More words related to myocardial infarction cardiac arrest noun . heart attack asystole[thesaurus.com]
  • 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]
  • […] myocardial infarction (STEMI), among whom 2,182 patients underwent emergent or urgent coronary angiography.Pre-procedural TIMI flow grade 3 was related to post-procedural TIMI flow grade 3 (P 0.001), lower enzymatic infarct size (P 0.001), lower ventricular tachycardia[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]
  • 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]
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.[medlineplus.gov]
  • During the early hours of a heart attack, heart murmurs and other abnormal heart sounds may be heard through a stethoscope. Diagnosis Electrocardiography Blood tests ECG and certain blood tests can usually confirm the diagnosis within a few hours.[merckmanuals.com]
  • 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]
Systolic Murmur
  • On day 2, however, the patient's vital signs deteriorated to a state of shock and systolic murmur appeared at the apical region. TTE showed a left-to-right shunt in the apical septal region, and ventricular septal perforation was diagnosed.[ncbi.nlm.nih.gov]
  • Third and fourth heart sound, systolic murmur if mitral regurgitation or ventricular septal defect develops, pericardial rub.[patient.info]
  • Signs Signs of impaired myocardial function 3 rd / 4 th heart sounds Pan systolic murmur Pericardial rub Pulmonary oedema – crepitations in the lungs Hypotension Quiet first heart sound Narrow pulse pressure ( difference of ) Raised JVP Signs of sympathetic[almostadoctor.co.uk]
Shoulder Pain
  • 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]
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]
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 . [59] Those who cannot tolerate ACE inhibitors may be treated with an angiotensin II receptor antagonist[en.wikipedia.org]
Dizziness
  • 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]
  • 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]
  • […] arm, chest, jaw, left arm, or upper abdomen A painful sensation described as having a "clenched fist in the chest" Discomfort or tightness in the neck or arm Indigestion or heartburn Nausea and vomiting Fatigue or sudden exhaustion Shortness of breath Dizziness[verywell.com]
  • […] 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 Cold sweat Fatigue Lightheadedness or sudden dizziness[mayoclinic.org]
  • […] increases in intensity Chest pain that is not relieved by rest or by taking nitroglycerin Chest pain that occurs with any/all of the following (additional) symptoms: Sweating, cool, clammy skin, and/or paleness Shortness of breath Nausea or vomiting Dizziness[lakelandhealth.org]
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]
  • […] 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]
  • 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]
Altered Mental Status
  • In addition, some patients may have an altered mental status caused by medications or impaired cerebral perfusion.[emedicine.medscape.com]

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]
  • The research design ignored risk factors for acute myocardial infarction, including, but not limited to, age, gender, hypertension, diabetes, dyslipidemia, smoking, and chronic kidney disease.[eurekalert.org]
  • Missed targets: gender differences in the identification and management of dyslipidemia. J Cardiovasc Nurs . 2006;21(5):342–346. 3. Hughes S, Hayman LL. News from the field of women's heart health. J Cardiovasc Nurs . 2006;21(1):68–69. 4.[journals.lww.com]
  • […] of premature coronary heart disease Male-pattern baldness Modifiable risk factors for atherosclerosis include the following [22] : Smoking or other tobacco use Hypercholesterolemia and hypertriglyceridemia, including inherited lipoprotein disorders Dyslipidemia[emedicine.medscape.com]
Lateral Q Wave
  • Typical picture of changes ST elevation – then later, T inversion – , then later, Q wave appears Other patterns of ECG change: ST- depression Reciprocal change – sometimes seen in STEMI.[almostadoctor.co.uk]
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
  • 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]
  • ST elevation myocardial infarction) and implementing the appropriate and timely therapeutic strategy, which will require close chain of survival co- ordination and the services of the cardiac catheterization lab.[ncbi.nlm.nih.gov]
  • An electrocardiogram performed on admission revealed ST-elevation in the precordial leads.[ncbi.nlm.nih.gov]
  • In the elderly ( 60 years), patients with non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) had significantly higher NLR than did those with unstable angina (UA) and stable angina pectoris (SAP) (P 0.01).[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]
T Wave Inversion
  • 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]
  • In NSTEMI, ECG manifestations might include ST-segment depression and/or T-wave inversions - these findings are often transient, and tend to parallel the development of symptoms (chest pain, dyspnea, nausea, diaphoresis).[clinicaladvisor.com]
  • The electrocardiogram shows ST-segment elevation (later changing to depression) and T-wave inversion in leads reflecting the area of infarction. Q waves indicate transmural damage and a poorer prognosis.[medical-dictionary.thefreedictionary.com]
  • On admission, ECG findings were ST segment depression ( n 27, 25%), T wave inversion ( n 37, 34.3%), and ST segment elevation ( n 27, 25%).[care.diabetesjournals.org]
Ischemic Changes
  • 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]

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.
  9. Meine TJ, Roe MT, Chen AY, et al. Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. Am Heart J 2005; 149:1043.
  10. Cantor WJ, Fitchett D, Borgundvaag B, Ducas J, Heffernan M, et al. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med. Jun 25 2009;360(26):2705-18

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Last updated: 2018-06-22 02:13