Myocardial infarction

cardiovascular disease Myocardial infarction

1. MYOCARDIAL INFARCTION

2. MYOCARDIAL INFARCTION: MI is defined as a diseased condition which is caused by reduced blood flow in a coronary artery due to atherosclerosis & occlusion of an artery by an embolus or thrombus. MI or heart attack is the irreversible damage of myocardial tissue caused by prolonged ischaemia & hypoxia.

3. TYPES OF INFARCTS 1. According to anatomic region of left ventricle invoved : Anterior Posterior Lateral Septal Circumferential Combinations--- Anterolateral , Posterolateral , Anteroseptal 2 . According to degree of thickness of ventricular wall involved: Transmural (full thickness) Laminar (subendocardial ) 3 According to age of infarcts: Newly formed (acute, recent, fresh) Advanced infarcts (old, healed, organised )

4. EPIDEMIOLOGY It is evident that  MI  is the leading cause of morbidity and mortality  worldwide . It is responsible for over 15% of mortality each year, Incidence is higher in elderly people, about 5% occurs at people under age 40. Males have higher risk. Women during reproductive period have low risk. 

5. RISK FACTORS: The presence of any risk factor is associated with doubling the risk of an MI . NON-MODIFIABLE: AGE SEX FAMILY HISTORY MODIFIABLE: Tobacco smoking Hypertension Drug abuse Obesity Stress Alcohol Diabetes Hyperlipoproteinaemia Hyperhomocysteinemia Chronic kidney disease

6. ETIOPATHOGENESIS: Mechanism of myocardial ischaemia . Role of platelets. Acute plaque rupture. Non-atherosclerotic causes. Transmural versus subendocardial infarcts.

7. CLINICAL FEATURES: Chest pain associated with tightness or squeezing Pain in the arms and/or upper back Upper abdominal discomfort Jaw pain, toothache, and/or headache Dyspnea Diaphoresis Malaise Women are more likely to experience an atypical MI   Some patients may not experience any symptoms are known as a silent heart attack

8. DIAGNOSIS: Patient History: Perform an electrocardiogram :( ECG ) ==CHANGES: 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.

9.  Serum Cardiac Biomarkers  Myoglobin Creatine phosphokinase (CK-MB) Troponin I The combination of CPK MB and troponin testing have higher sensitivity and is used for the purpose of "ruling out" myocardial infarction . ECHOCARDIOGRAM: evaluate cardiac function ( ventricular),ejection fraction

10. Complications include: Arrhythmia Cardiogenic shock Congestive heart failure Thromboembolism Rupture Cardiac aneurism Pericarditis

11. MANAGEMENT: 1.NON-PHARMACOLOGICAL : Counselling and education of patients Life style measures Smoking cessation Avoid Alcohol intake Diet and nutrition Salt restriction

12. 2.PHARMACOLOGICAL: 2.PHARMACOLOGICAL : Thrombolytic agents Anticoagulants Antiplatelet agents Antihypertensive agents Lipid lowering drugs Vasodialators Others i ) Analgesics ii) Antiulcer drugs iii) Antidepressants

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