Myocardial Infarction

MYOCARDIAL INFARCTION is the sudden stoppage of blood supply to heart muscles due to blockages in the blood vessels supplying the heart muscles. This leads to death of heart muscles and collapse of heart functions.

 

Myocardial infarction is one of the lifetime chronic diseases responsible for death and disabilities across the world.

 

The name itself insists on the involvement of Myocardium, a middle cardiac muscle surrounded by Pericardium (connective tissue) and with inner lining Endocardium (endothelial cells).

 

Many people are unaware of what is a heart attack and how it occurs.HEART ATTACK is the common term used for MYOCARDIAL INFARCTION. The heart attack awareness is very essential for every people to safe guard themselves and promote heart health.

 

Causes of myocardial infarction or heart attack :

The heart muscle is supplied by coronary artery. This further divides into:

 

Right coronary artery

 

Left coronary artery – divides into a) Left anterior descending artery and b) Left circumflex artery.

 

The plaque buildup in these arteries causes the formation of blood clot on the ruptured area of plaque. Larger enough blood clot will block the blood flow to the heart muscles, thus causing heart attack.

 

The least common cause is the spasm (tightening) of the coronary arteries.

 

These blockages and spasm causes the necrosis of the myocardium.

 

Risk factor for heart attack :

 

various risk factors involved in cause of heart attack or myocardial infarction are listed below.

 

    • Aging – Almost 4 out of 5 deaths due to heart attack are of ages more than age 55 in male and age 65 in female.

 

    • Gender – usually male are more affected than female up to certain age that is to menopause in females. Then the affecting ratio almost equals.

 

    • High cholesterol deposition – the body has both LDL and HDL. Too much of LDL than HDL is the reason for plaque formation in the blood vessels.

 

    • High blood pressure – The blood pressure will differ according to the age and the physical activities.

 

    • Diabetes (type 1 or type 2) – this elevated blood sugar level step up the process or condition called atherosclerosis.

 

    • Racial – African American, Native Americans, and Asian and pacific islanders have high risk of heart attack occurrences.

 

  • Obesity – the over weight of body is measured by body mass index (BMI). The formula for BMI is

BMI = (WEIGHT IN KILOGRAMS/HEIGHT IN METER SQUARE).

BMI above 25 is called as overweight and over 30 are called as obese.

 

    • Smoking – nicotine, tar and carbon monoxide are the chemicals in cigarette smoking leading to the plaque formation in the blood vessels.

 

    • Inactive life – in advanced life style the physical activity is considerably reduced and no active function of muscles in the luxury life.

 

    • Hereditary – heart attack in few families run from generation to generations.

 

    • diet high in saturated fat

 

    • Alcoholism – when consumed in moderate quantity it is of no problem. When it exceeds the moderate level then chances of heart attack are high.

 

    • Chronic stress – job stress, socioeconomic status, and behavior habit all will have an impact on the risk factor to heart attack.

 

    • C – reactive protein : the increased c – reactive protein shows the inflammation in the body and in blood vessels (atherosclerosis)

 

    • Birth control pills – these pills taken by certain female are at early risk of the heart attack.

 

  • Difficulties in delivery time – contribute to early risk of heart attack in females.

 

Signs and symptoms:

 

various signs and symptoms that show the occurrence of heart attack are follows.

 

    • Chest pain or discomfort – especially in the center of the chest region lasting for few minutes.

 

    • Shortening of breath – even at rest or sudden occurrence.

 

    • Jaw pain and Upper body pain or discomfort (extending to one or both arms). Pain may be milder or very intense.

 

    • Feeling of indigestion

 

    • Nausea – a feeling of unsettled stomach.

 

    • Palpitation – continued awareness of the irregular heart beat.

 

    • Unexplained Vomiting

 

    • lightheadedness

 

    • Fatigue (tired) – loss of stamina.

 

    • Sudden sweat breakout with cold and excessive sweating.

 

    • Sleeping problems – unable to move to sleeping mood.

 

    • Low energy – body is fully drained of the energy needed.

 

    • malaise feeling

 

  • Sudden restlessness in some anxious situations.

 

These symptoms are not same for everyone. Some people get heart attack without symptoms or very mild symptoms called as silent heart attack. In silent heart attack no pain is felt. Diabetic patients are more prone to this type of heart attack.

 

Various diagnosis of heart attack :

 

1)Electrocardiogram (ECG):

 

This shows the area and extent of damage of heart muscles. The heart rate and heart rhythms are monitored.

 

2) Blood measures:

 

The biochemical markers in the cells are released in the time of injury. By measuring the level of marker released from heart cells, the size of heart attack and start of heart attack is determined.

 

3) Echo cardiogram (ECHO):

 

Echo cardiogram shows the pumping and non pumping regions of heart. ECHO will determine any structural damages in the heart mainly the valves and septums.

 

4) Cardiac catheterization:

 

Cardiac catheterization is the process of injecting a liquid dye into the arteries. The dye fills the arteries and shows the area of blockages. By this method doctors determine the surgical procedures needed to be done.

 

5) Exercise tolerance test:

 

This test sees the response of heart and blood vessels on exertion during exercise. The exertion response will be slight or severe according to the heart conditions.

 

6) Cardiac computerized tomography (CT SCAN):

 

CT scan is done by lying on the bed surrounded by X-rays, which shows the heart and chest regions image and size. This scan shows the extent of heart damages.

 

7) Magnetic resonance imaging (MRI):

 

As same as CT scan except for X-rays here magnetic field are used to show the images of heart.

 

Treatment protocols :

 

heart attack drugs :

 

Before suspicion of heart attack :

 

    • Oxygen should be balanced for its insufficiency or shortage.

 

    • Nitroglycerin and morphine-improving blood flow through coronary arteries relaxation and dilatation reducing workload of heart and relieving the pain

 

    • Some other Treatment to relieve chest pain.

 

  • Aspirin to stop further blood clot by preventing further platelet adhesion formation.

 

After strong suspecting of heart attack :

    • Anti-platelet medications (ASPIRIN and CLOPIDOGREL)-controlling blood clot construction.

 

    • Anti-coagulation medications-this act like the blood thinner and control the blood clot growth.

 

    • BETA BLOCKER dilates the blood vessels to lessen the BP and heart rate. This reduces the risk of another attack.

 

    • ACE inhibitors-reduces or prevent the abnormal structural changes in the chambers of heart and lowers the risk of successive heart attack.

 

    • Oxygen supplementations.

 

  • Anti arrhythmic drugs – for normal rhythmic action of heart beat.

 

Surgical procedures:

 

Angioplasty :

 

Angioplasty is the method of re-opening of the blood vessels obstructed by plaque formation. The steps involved are:

 

    1. A thin catheter with balloon at the end is inserted into the artery affected. Once catheter reaches the obstructed area, balloon is inflated and makes the blocked artery to dilate. This technique is called as PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA)

 

    1. Clearing plaque formations.

 

    1. Injecting drugs to clear fibrin   in blood clot

 

  1. A small tubular structure is placed during PTCA to keep blood vessels open.

 

coronary heart bypass surgery

 

Surgery is also called as the

coronary artery bypass surgery(CABG).

In this process of surgery the blood vessel from other part of the body is taken and used as a separate pathway of blood or bypass to the heart.

 

Mostly taken bypass grafts are 1) INTERNAL MAMMARY arteries, 2) RADIAL artery and 3) SAPHANEOUS veins.

 

In the surgery the chest region is opened to access the heart. The graft is connected one end to below the blockage of the coronary artery and other end to the aorta (Major artery supplying the whole body and heart).

 

The bypass surgery is continued to other coronary arteries affected. Some time it can go up to three or four.

 

During the surgery circulation is maintained by the heart-lung machine. But still it is not prevalent.

 

Off pump or beating heart beat bypass surgery is done by stabilizing the blocked area alone in a highly controlled manner.

 

After the surgery, patient is shifted to ICU for monitoring for about 2 to 3 days. The monitoring of heart rate, blood pressure, oxygen consumption, and other parameters are done.

 

Cardiac rehabilitation :

 

Rehabilitation is the process of bringing back the person to a near normal life.

 

After the cardiac surgery, rehabilitation should be undergone to recover quickly. The rehabilitation contains exercise programs,

 

physiotherapy management,

 

life style changes,

 

stress free life,

 

healthy food habit suitable for heart.

 

It relieves the cardiac symptoms and risk factors.

 

It requires lot of involvement from the patient and the rehab teams.

 

Regular monitor or checkups will keep the improvement faster.

 

Cardiac rehabilitation focuses both on the physical and mental health of the patients.

 

The main aim of cardiac rehabilitation is to prevent the occurrence of second or consequent attack.

 

Preventive measures for heart attack :

 

    • NUTRITIOUS FOOD TARGETING HEART

 

    • CUT THE FAST FOODS IN DIET

 

    • REGULAR EXERCISE

 

    • MORNING WALK

 

    • DIABETIC CONTROL

 

    • HIGH BLOOD PRESSURE CONTROL

 

    • STRESS FREE LIFE

 

    • HEALTHY LIFE STYLE

 

    • AVOID SMOKING

 

    • USE ALCOHOL IN MODERATE AMOUNT

 

    • WEIGHT REDUCTION

 

    • FREQUENT CHECKUP FOR WHOLE BODY

 

  • YOGA

 

Conclusion :

 

MYOCARDIAL INFARCTION (HEART ATTACK) is preventable and curable. But prevention is always better than cure.

 

The myocardial infarction detected at very early stages can be treated effectively. The late detection will lead to several management processes. Close monitoring is very important in heart attack.

 

Basic prevention for heart attack and low risk depends on the regular exercise regime and diet management.

 

All countries have started to focus on the awareness programs for heart attack aiming at low death rate due to heart attack. Various researches are in progress and new medicines are invented day by day for the control of heart attack. The rate of awareness about heart attack is almost reached a high to some extent in today`s world.

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