Myocardial infarction

Overview – Myocardial infarction, also called a heart attack occurs when the flow of blood to the heart is blocked. The most common cause of blockage of blood flow is due to plaque formation in the coronary arteries. Coronary arteries supply blood to the heart. Plaque is the build-up of cholesterol, fat, and other substances. The plaque eventually breaks away and forms a clot. The interrupted blood supply can cause damage to the part of the heart muscle because it is devoid of oxygen and nutrients.

Another cause of a heart attack is a spasm of the coronary artery that shuts down blood flow to part of the heart muscle.

The risk factors for myocardial infarction are older age, tobacco use, high cholesterol or high triglyceride levels, high blood pressure, obesity, diabetes mellitus, family history of heart attack, metabolic syndrome, stress, illicit drug use, smoking, autoimmune conditions such as rheumatoid arthritis, lupus.

 

Symptoms

  • Heart attack symptoms may vary in people.
  • Chest pain is generally described as tightness, or squeezing, or crushing, or heavyweight on chest (elephant sitting on the chest). Pain may be generally provoked by activity, such as exercise. The pain often radiates to other parts of the body including the upper abdomen, shoulders, arms, wrist, fingers, neck and throat, lower jaw and teeth (but not upper jaw).
  • Shortness of breath, nausea, vomiting, indigestion, cold sweat, palpitations, dizziness.

 

Complications

  • Heart failure – The ability to pump enough blood out of your heart can be reduced because of the damage to the heart tissue causing heart failure.
  • Arrhythmia and sudden cardiac arrest.

 

Diagnosis

  • Electrocardiogram and blood tests are done in patients presenting with symptoms of myocardial infarction.
  • Additional tests that may be done are chest x-ray, echocardiogram, angiogram, exercise stress test, cardiac CT or MRI.

 

Lifestyle management

  • Follow a healthy diet and exercise program as recommended by your doctor. Your doctor will recommend a heart-healthy diet that includes lean proteins, fruits, vegetables, and whole grains. Your diet should be low in saturated fat, trans fat, salt. Maintain a healthy weight.
  • Do not smoke.
  • Talk to your doctor about how to control conditions that can lead to heart attacks, such as high blood pressure, high cholesterol, and diabetes.
  • Manage stress well. Find healthy ways to minimize or deal with stressful events in your life.
  • Schedule regular medical checkups with your doctor.
  • Drink alcohol in moderation. That means up to one drink a day for women and men older than age 65, and up to two drinks a day for men age 65 and younger.
  • Talk to your doctor about cardiac rehabilitation. Rehabilitation programs focus on medications, lifestyle changes, emotional issues and a gradual return to your normal activities.

 

Medical management

  • Myocardial infarction is a medical emergency. Restoring blood flow quickly prevents heart damage.
  • Medications given to treat heart attack may include
  • Aspirin – Aspirin is given immediately because it reduces blood clotting, and helps maintain blood flow through a narrowed artery.
  • Thrombolytics (clot busters) help dissolve a blood clot. The earlier a patient with myocardial infarction receives thrombolytics the lesser is the damage to the heart.
  • Antiplatelet medications may be given to prevent new clots and keep existing clots from getting larger.
  • Other blood-thinning medications such as heparin may be given.
  • Nitroglycerin can help improve blood flow.
  • Beta-blockers, ACE inhibitors may be given to reduce the stress on the heart.
  • Statins are given to reduce blood cholesterol levels.

 

  • The surgery procedures in addition to medications are coronary angioplasty and stenting or coronary artery bypass surgery.

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