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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
  • Instead, their most common symptoms are weakness, fatigue and dyspnea.[cvpharmacology.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]
  • Chest pain described as a pressure sensation, fullness, or squeezing in the midportion of the thorax Radiation of chest pain into the jaw or teeth, shoulder, arm, and/or back Associated dyspnea or shortness of breath Associated epigastric discomfort with[clevelandclinicmeded.com]
  • "Dyspnea" . www.clevelandclinicmeded.com . Cleveland Clinic. Archived from the original on 11 July 2017 . Retrieved 24 May 2017 . Lilly, Leonard S. (2012). Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty .[en.wikipedia.org]
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 [ 38 ] : 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
  • Overview of Myocardial Infarction (Heart Attack) Myocardial infarction (heart attack) is a serious result of coronary artery disease .[imaginis.com]
  • 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]
  • It is also unknown whether hyperhomocysteinaemia is associated with reduced fibrinolytic responses in patients with coronary artery disease.[clinsci.org]
  • A blood clot is the most common cause of a blocked coronary artery (see also Overview of Coronary Artery Disease ).[merckmanuals.com]
  • While the step-by-step process leading to a heart attack is not fully understood, major risk factors for coronary artery disease are well-known.[webmd.com]
Fatigue
  • 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]
  • […] 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]
  • […] 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 or fainting Unexplained weakness or fatigue[lakelandhealth.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]
Congestive Heart Failure
  • 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]
  • There may be signs of congestive heart failure, including pulmonary rales, peripheral oedema, elevated jugular venous pressure.[patient.info]
  • The recommended duration of supplemental oxygen administration in a MI is 2 to 6 hours, longer if congestive heart failure occurs or arterial oxygen saturation is less than 90%.[clevelandclinicmeded.com]
  • Complications can include: Arrhythmias and conduction defects, with possible "sudden death" Extension of infarction, or re-infarction Congestive heart failure (pulmonary edema) Cardiogenic shock Pericarditis Mural thrombosis, with possible embolization[library.med.utah.edu]
Fever
  • 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]
  • Temperature Fever is usually present within 24-48 hours, with the temperature curve generally parallel to the time course of elevations of creatine kinase (CK) levels in the blood.[emedicine.medscape.com]
  • Causes fever, pericardial effusions, anaemia, raised ESR, enlarged heart on CXR, pericardial rub (on auscultation). may be similar to PE – another post-MI complication. It is often self-limiting, and symptoms last a few days.[almostadoctor.co.uk]
  • Fever in myocardial infarction: is it still common, is it still predictive?. Cardiol J . 2012. 19 (4):369-73. [Medline] . Risøe C, Kirkeby OJ, Grøttum P, Sederholm M, Kjekshus JK.[emedicine.medscape.com]
Pallor
  • Gross morphologic changes evolve over time as follows: Time from Onset Gross Morphologic Finding 18 - 24 Hours Pallor of myocardium 24 - 72 Hours Pallor with some hyperemia 3 - 7 Days Hyperemic border with central yellowing 10 - 21 Days Maximally yellow[library.med.utah.edu]
  • The pain is often excruciating – look at the patients face / expression / pallor to determine the seriousness of the pain There are two different mechanisms.[almostadoctor.co.uk]
  • Pallor, profuse perspiration, and other signs of shock are present. There may be nausea and vomiting, leading to the mistaken impression that the victim is suffering from acute indigestion.[medical-dictionary.thefreedictionary.com]
  • Extremities Peripheral cyanosis, edema, pallor, diminished pulse volume, delayed rise, and delayed capillary refill may indicate vasoconstriction, diminished cardiac output, and right ventricular dysfunction or failure.[emedicine.medscape.com]
Nausea
  • Chest pain with nausea and vomiting, marked sweating and/or breathlessness, or haemodynamic instability.[patient.info]
  • ., 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]
  • […] atypical symptoms Only about half of women with an MI present with chest pain. 16 In fact, women are more likely to present with atypical symptoms such as fatigue, sleep disturbance, shortness of breath, back pain, upper abdominal or epigastric pain, and nausea[journals.lww.com]
Vomiting
  • 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]
  • 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]
  • Sweating Tachycardia Vomiting and sinus bradycardia– this may occur as a result of excessive vagal stimulation, which is most common in inferior MI Nausea and vomiting may also be aggravated by opiates given for pain relief Sudden death – this usually[almostadoctor.co.uk]
  • […] 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
  • Depending on the location of the pain several forms of myocardial infarction are distinguished: The typical form - chest pain Atypical form - abdominal pain Combined form – abdominal and chest pain Painless form - there is no pain (more common for patients[bookinghealth.com]
  • 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]
Epigastric Pain
  • Unawareness of atypical symptoms Only about half of women with an MI present with chest pain. 16 In fact, women are more likely to present with atypical symptoms such as fatigue, sleep disturbance, shortness of breath, back pain, upper abdominal or epigastric[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]
Jaw 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]
  • 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]
  • 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]
Heart Failure
  • Informal Informal words should be reserved for casual, colloquial communication. noun heart attack Synonyms for myocardial infarction noun heart attack noun heart failure Synonyms noun heart failure noun heart attack Synonyms noun heart attack noun disease[thesaurus.com]
  • Each year over 1.5 million people in Europe and US are diagnosed with heart failure related to a prior AMI.[encarebiotech.com]
  • Activase is indicated for use in acute myocardial infarction (AMI) for the reduction of mortality and reduction of the incidence of heart failure.[activase.com]
  • failure - where the body cannot pump blood round the body well enough Cardiogenic shock - heart failure that prevents organs functioning Heart rupture - where parts of the heart split apart All of these cases can be treated but, in some cases, the complications[diabetes.co.uk]
  • This alters both the contractility and the conductance of the myocardium and may subsequently lead to the development of an arrhythmia or heart failure.[tocris.com]
Chest Pain
  • Calcium channel blocker therapy was initiated in all of the patients with no recurrence of anginal chest pain on follow-up. One patient complained of chest pain distinct from anginal pain. CONCLUSIONS.[pediatrics.aappublications.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]
  • 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 or fainting Unexplained[lakelandhealth.org]
  • […] women who didn't have chest pain delayed seeking treatment longer than those who had chest pain.[journals.lww.com]
Tachycardia
  • 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]
  • Cardiac dysrhythmias were found in 4 patients, 3 with nonsustained ventricular tachycardia. Drug abuse, lipid profile, and hypercoagulability studies were negative in all.[pediatrics.aappublications.org]
  • […] following old myocardial infarction Supraventricular tachycardia post old mi Clinical Information Documented history of previous myocardial infarction (mi), typically with objective evidence via positive biomarkers of myocardial necrosis.[icd10data.com]
  • Sweating Tachycardia Vomiting and sinus bradycardia– this may occur as a result of excessive vagal stimulation, which is most common in inferior MI Nausea and vomiting may also be aggravated by opiates given for pain relief Sudden death – this usually[almostadoctor.co.uk]
  • Typical signs are tachycardia, a barely palpable pulse, low blood pressure, mildly elevated temperature, cardiac arrhythmia, and elevation of the S-T segment and Q wave on the electrocardiogram.[medical-dictionary.thefreedictionary.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.[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
  • 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]
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]
  • […] 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]
  • […] 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]
Confusion
  • […] 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.[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
  • 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 [20] : 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
  • Occlusion proximal to S1 Signs of basal septal involvement: ST elevation in aVR ST elevation in V1 2.5 mm Complete RBBB ST depression in V5 Occlusion proximal to D1 Signs of high lateral involvement: ST elevation / Q-wave formation in aVL ST depression[lifeinthefastlane.com]
  • […] heart at the opposite angle to those showing ST elevation.[almostadoctor.co.uk]
  • 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[medlineplus.gov]
  • Myocardial infarction Synonyms ST-Elevation Myocardial Infarction (STEMI) Non-ST-Elevation Myocardial Infarction (NSTEMI) Related conditions Acute Coronary Syndrome Chest Pain Stable Angina 1.[clinicaladvisor.com]
  • Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J . 2008 Dec. 156 (6):1026-34.[emedicine.medscape.com]
Complete Left Bundle Branch Block
  • ., 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[clevelandclinicmeded.com]
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

Symptoms

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