Heart attack, Acute myocardial infarction

Brief description on acute myocardial infarction

1. “HEART ATTACK AN OVERVIEW” Dr. Jain T. Kallarakkal MD FCCP FRCP DM St Mary’s Hospital, Thodupuzha

2. Is a muscle the size of a clenched fist Is located behind the breastbone Pumps about 100,000 times a day Pumps about 7,600 litres of blood per day The Heart

3. Occurs when the coronary arteries that supply the heart muscle become blocked. Partially blocked it causes angina. When fully blocked it causes a myocardial infarction or a heart attack! What Is Heart Attack?

4. Chest pain (angina) Heaviness, tightness, pain, burning, pressure or squeezing behind the breastbone or in the arms, neck, or jaws Perhaps no pain Warning Signs

5. Other warning signs of a heart attack Shortness of breath Sweating Nausea Light-headedness

6. Lack of oxygen due to ischemia (lack of blood supply) Narrowing of coronary arteries Heart responds with angina Finally, heart attack (myocardial infarction) Possible permanent damage Consequencess

7. Help during a cardiac arrest Give breaths and pump the heart Done by ordinary people Saves lives Cardiopulmonary resuscitation

8. Unchangeable Risk Factors Changeable Risk Factors Risk Factors

9. Age- the older you get, the greater the chance. Sex- males have a greater rate even after women pass menopause. Family history- if family members have had CHD, there is a greater chance. Unchangeable Risk Factors

10. Hypertension Serum cholesterol Obesity Diabetes Mellitus Physical Inactivity Cigarette Smoking Alcohol Intake Changeable Risk Factors

11. Hypertension “Blood pressure measures how hard blood pushes against the blood vessel walls.”

12. Top number = pressure when heart contracts (systolic) Bottom number = pressure when heart relaxes (diastolic) Example: healthy BP = 120 80 Blood pressure has TWO numbers

13. Classifications of hypertension

14. Increase risk of stroke Increase risk of heart disease Damage kidneys and eyes Cause impotence Disrupt circulation

15. Waxy fat substance in the blood  Our body needs cholesterol to function Liver makes all the cholesterol it needs to survive  Other sources of cholesterol come from food  Cholesterol is found in animal products such as meat, eggs and whole milk dairy products If the level of cholesterol gets to high, it can stick to artery walls and cause serious health problems Cholesterol

16. Cholesterol Level

17. HDL is known as the good cholesterol. It helps carry some of the bad cholesterol out of the body. It does not have the tendency to clog arteries. Levels should be >35. High levels of HDL >60 can actually negate one other risk factor. Good Cholesterol

18. LDL is known as bad cholesterol. It has a tendency to increase risk of CHD. LDL’s are a major component of the atherosclerotic plaque that clogs arteries. Levels should be <130 Bad Cholesterol

19. Obesity

20. Associated with diabetes mellitus hypertension cholesterol abnormality Body mass index Weight (kg) Height (m2) 20-25 : Ideal > 28 : Overweight > 30 : Obesity Obesity

21. People who are obese have 2 to 6 times the risk of developing hypertension. Location of the body fat is significant. Obesity

22. Diabetes Mellitus

23. 2-4 fold risk for CHD Asymptomatic CHD ~ 30-40% Painless AMI, arrythmias , CCF, longer hospital stay CHD- A major (60%) cause of mortality Diabetes

24. Increasing physical activity has been shown to decrease blood pressure. Moderate to intense physical activity for 30-45 minutes on most days of the week is recommended. Physical Inactivity

25. Causes an increase in blood pressure Lowers the levels of HDL Within 1 year of quitting, CAD risk decreases, within 2 years it reaches the level of a nonsmoker. Smoking

26. Contributes to development of atherosclerosis Lowers levels of HDL causes deterioration of elasticity of vessels Responsible for 20% of all deaths from heart disease Female smokers have a higher risk than male smokers Smoking

27. In small amounts it acts as a vasodilator. In large amounts it acts as a vasoconstrictor & adds to the caloric intake The good & Bad affects of Alcohol are divided with a very fine line! Alcohol Intake

28. High Carbohydrate intake Very little physical exertion Very little interest in sports Higher incidence of diabetes and obesity Indian Scenario

29. Typical History Electrocardiography Serum Cardiac Markers Echocardiography Stress Testing Myocardial Perfusion Imaging Coronary Angiography Diagnosis

30. Call for help Do not attribute it to “Gas” Reach a hospital as soon as possible Insist on an ECG Attempt Cardiopulmonary Resuscitation What you must do?

31. Treatment Drugs Angioplasty & Stent Coronary Artery Bypass Surgery

32. Aspirin is an antiplatelet agent Aspirin should be given in a dose of 75-325 mg/day to all patients with ACS unless there is a contraindication Clopidogrel is a potent antiplatelet agent Give 300 mg loading dose followed by 75 mg/day

33. Primary Angioplasty

34. CABG

35. Prevention - Diet Eat a variety of fruits and vegetables every day. ( 5 servings - they are naturally low in fat and high in vitamins and minerals) Eat a variety of grain products Choose nonfat or low-fat products. Use lean meats- choose chicken, fish, turkey and lean cuts of beef and pork. Switch to fat-free milk- gradually reduce the fat content of the milk you drink.

36. Choose fats with 2 gms or less of saturated fats per serving such as liquid and tub margarines, canola oil and olive oil. Balance the # of calories you eat with the number of calories you use each day. Maintain a level of physical activity that keeps you fit and matches the # of calories you eat. Diet

37. Limit your intake of foods high in calories and low in nutrition, including foods like soft drinks and candy. Limit foods high in saturated fat, trans fat and cholesterol. Eat less than 6 gms of salt a day. Have no more than one alcoholic drink a day. Diet

38. Adults aged 18-64 should accumulate at least 150 minutes of moderate-to-vigorous intensity aerobic physical activity per week in bouts of 10 minutes or more Be active most days of the week Consult a healthcare professional before starting an activity program Exercise

39. Avoid Smoking Blood Pressure Control, BP < 140/90 Physical Activity Lipid Control. Cholesterol < 200 Mg/Dl LDL < 130 Mg/Dl HDL > 35 Mg/Dl Diabetic Control Weight Reduction Aspirin in High Risk Groups Diet . Cholesterol Free Diet with plenty of fruits vegetables and fibres

40. Cardiovascular disease is the number one killer. It is highly preventable and controllable with diet and exercise. Conclusions