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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].
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]
  • […] disease chest pains congestive heart failure coronary coronary infarction coronary thrombosis myocardial infarction tachycardia heart disease noun disease of the heart angina cardiac infarction congenital heart disease congestive heart failure coronary[thesaurus.com]
  • 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]
Fatigue
  • She denied any chest pain, shortness of breath, fatigue, lightheadedness, palpitations, nausea or diaphoresis. Her initial laboratory Troponin I resulted 35.9 ng/mL.[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]
Coronary Atherosclerosis
  • The severity of coronary atherosclerosis was independent of the presence of angina prior to MI. Our results indicated that the incidence of asymptomatic MI in diabetics is not as high as previously believed.[doi.org]
  • Coronary atherosclerosis, cross sections, gross. Coronary atherosclerosis, minimal, gross. Coronary atherosclerosis, severe, gross. Coronary atherosclerosis, composite, microscopic. Coronary atherosclerosis, intimal plaque, microscopic.[library.med.utah.edu]
  • Diseases caused by the reduced blood supply to the heart muscle from coronary atherosclerosis are called coronary heart diseases (CHD).[medicinenet.com]
  • Pathogenesis: Commonest cause (at least 90%) is due to coronary atherosclerosis with occluding thrombus.[histopathology-india.net]
  • K2 (a designer drug with synthetic cannabinoid effects) has reportedly been associated with MI in an adolescent, [5] as has the combination of ethanol and Adderall (amphetamine/dextroamphetamine). [6] Accelerated coronary atherosclerosis due to juvenile[emedicine.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. Journal of the Association of Physicians of India 2011.[ncbi.nlm.nih.gov]
  • Clinical stability was defined as a lack of fever, improved signs and symptoms associated with CAP, and improved leukocyte count [ 17 ].[doi.org]
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.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]
Rales
  • This patient had a clear history of carbon monoxide poisoning, acute respiratory distress, bilateral lung dry and moist rale, chest X-ray showed bilateral pulmonary edema, Electrocardiograph indicated general depression of the ST segment of the leads[ncbi.nlm.nih.gov]
  • 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]
Respiratory Distress
  • This patient had a clear history of carbon monoxide poisoning, acute respiratory distress, bilateral lung dry and moist rale, chest X-ray showed bilateral pulmonary edema, Electrocardiograph indicated general depression of the ST segment of the leads[ncbi.nlm.nih.gov]
  • Favorites PDF Get Content & Permissions Open SDC Correspondence Veno-venous extracorporeal membrane oxygenation for patient with a history of open cholecystectomy and acute respiratory distress syndrome caused by coinfection of avian influenza A (H7N9[cmj.org]
  • 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]
  • 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]
  • distress syndrome; COPD chronic obstructive pulmonary disease.[clevelandclinicmeded.com]
Nausea
  • OTHER SIGNS may include breaking out in a cold sweat, nausea or lightheadedness.[heart.org]
  • She denied any chest pain, shortness of breath, fatigue, lightheadedness, palpitations, nausea or diaphoresis. Her initial laboratory Troponin I resulted 35.9 ng/mL.[ncbi.nlm.nih.gov]
  • 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]
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]
  • 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]
  • 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]
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]
  • 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]
  • 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]
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]
Dyspepsia
  • Possible Differential Diagnoses of a MI include: Acute Coronary Syndrome Dissection, Aortic Myopericarditis Angina Pectoris Dyspepsia Pancreatitis Anxiety Endocarditis Pericarditis and Cardiac Tamponade Anxiety Disorders Esophageal reflux Pericarditis[physio-pedia.com]
  • In patients with dyspepsia, you should also consider giving a PPI with aspirin to reduce the risk of ulceration. β – blocker this has antihypertensive effects, by encouraging peripheral vasodilation, and it also reduces cardiac output, by reducing the[almostadoctor.co.uk]
  • […] plasma level with age, especially 75 y Bleeding risk; not reversible CrCl 15–30 mL/min: 75 mg BID with caution; CrCl 30–49 mL/min: 75 mg BID; CrCl 50 mL/min: 150 mg BID Monitor pt and renal function frequently; longest for effect to wane with CrCl; risk dyspepsia[doi.org]
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]
  • All patients admitted to the emergency department with chest pain and ST elevation on electrocardiography should be asked about allergic insults.[ncbi.nlm.nih.gov]
Tachycardia
  • The tachycardia rate is typically between 140 and 180 beats/min and the QRS is relatively narrow, with a duration of 120 to 150 ms.[ncbi.nlm.nih.gov]
  • SEE DEFINITION OF myocardial infarction as in coronary infarction as in heart disease as in cardiac arrest as in heart attack Synonyms for myocardial infarction cardiac arrest congestive heart failure heart failure tachycardia MOST RELEVANT Roget's 21st[thesaurus.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.[nlm.nih.gov]
  • During the early hours of a heart attack, heart murmurs and other abnormal heart sounds may be heard through a stethoscope. People who have a heart attack may also have complications that can be long-lasting.[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]
Pericardial Friction Rub
  • Abstract Fifty-two (6·8%) of 779 patients admitted to a coronary monitoring unit with acute myocardial infarction developed a pericardial friction rub. A diagnosis of postmyocardial infarction syndrome was made in three of these.[ncbi.nlm.nih.gov]
  • 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]
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]
  • Ventricular Septal Rupture Ventricular septal rupture usually is heralded by a loud systolic murmur and HF or shock, depending on the size of the defect and the degree of RV and LV dysfunction.[doi.org]
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]
  • 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]
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, 40, 53, 62,[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]
Panic Attacks
  • More likely are euphoria, numbness, 'out of body' sensations, confusion, disorientation, and panic attacks.[doi.org]
Dizziness
  • A 73-year-old woman complained of dizziness and fatigue with shortness of breath after carbon monoxide intoxication.[ncbi.nlm.nih.gov]
  • “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]
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]
Altered Mental Status
  • The man was bitten on the left index finger and subsequently developed localized edema followed by hypotension, chest pain, and altered mental status. His initial electrocardiogram revealed ST-segment elevation in the inferior and lateral leads.[ncbi.nlm.nih.gov]
  • 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]
Agitation
  • 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]

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].

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]
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]
ST Elevation
  • KEYWORDS: Cardiac arrest; ST elevation myocardial infarction; cardiac catheterization lab; hypothermia; morbidity; mortality.[ncbi.nlm.nih.gov]
  • Myocardial infarction; MI; Acute MI; ST - elevation myocardial infarction; Non-ST - elevation myocardial infarction; NSTEMI; CAD - heart attack; Coronary artery disease - heart attack Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline[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
  • Electrocardiography showed a sinus rhythm with Q-wave formation in the inferior wall leads (II, III, aVF), T-wave inversion in the same leads, and borderline QT prolongation (QTc of 490 ms).[ncbi.nlm.nih.gov]
  • 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]
Ischemic Changes
  • MSIMI was defined by the aforementioned ischemic changes during 1 or more of the 3 mental stress tasks.[ncbi.nlm.nih.gov]
  • 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.
  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: 2019-07-11 20:56