or acute myocardial infarction ( AMI ).
commonly known as a heart
attack, occurs when blood flow decreases or stops to a part
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of the heart, causing damage to the heart muscle.
Most common symptom is chest pain or discomfort which
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may travel to the shoulder, arm, back , neck or jaw. Often itoccurs in centre or left side of the chest and last for more
than a few minutes.
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other symptom may include shortness of breath, nausea,
feeling faint, feeling tired.
CHEST PAIN(MI).
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WHAT is heart attack ?Occurs when the coronary arteries that supply the
heart muscle become blocked.
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Partially blocked is called angina.
When fully blocked it causes a myocardial infarction or a
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heart attack.CAD.
Ischemic heart disease( IHD) or coronary artery
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disease(CAD) :Heart attack:
A heart attack occurs when
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the blood flow to a part of the heart is blocked by ablood clot. If this clot cuts off the blood flow
completely , the part of the heart muscle supplied by
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that artery begins to die.
MI.
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Myocardial infarction(MI) is a disease condition
which is caused by reduced blood flow in a coronary
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artery due to atherosclerosis and occlusion of anartery by an embolus or thrombus.
Most myocardial infarction occur due to coronary
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artery disease.
The complete blockage of a coronary artery caused by
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a rupture of an atherosclerotic plaque.Blockage of coronary artery.
COMPLICATION OF MI.
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About 30% of people have atypical symptoms.
Women more often have atypical symptoms than men.
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An MI may cause : -Heart failure, an irregular heart beat, cardiogenic
shock, or cardiac arrest.
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Symptom angina/mi.RISK FACTORS.
Unchangeable risk factor :--
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Age- the older you get, the greater thechance.
Sex----males have a greater rate aven after women pass
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menopause.
Family history---if family members have had CHD, there is
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a greater chance.Changeable risk factors.
Hypertension
Serum cholesterol
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ObesityDiabetes mellitus
Physical inactivity
Cigarette smoking
Alcohol intake
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CHOLESTEROL.Waxy fat substance in the blood.
Liver makes all the cholesterol it need to survive,
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other source of cholesterol come from food.GOOD CHOLESTEROL---
HDL---it does not tendency to clog
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arteries.Level should be > 35.
Cholesterol.
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LDL--bad cholesterol.
Tendency to increase risk of CHD.
Major component of the atherosclerotic plaque that
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clogs arteries.Levels should be < 130.
DIABETES.
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2-4 fold risk for CHD.Asymptomatic CHD~ 30-40 %.
Painless AMI,arrythmias, CCF.
CHD- A major ( 60% ) cause of mortality.
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PHYSICAL INACTIVITY--Increasing physical activity has been shown to decrease
blood pressure.
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Moderate to increase physical activity for 30-45 minutes on
most days of the week is recomended.
SMOKING.
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SMOKING-
Contribute to development of atherosclerosis.
Lowers levels of HDL.
Female smokers have a higher risk than male smokers.
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ALCOHOL not too good either!
Alcohol kills brain cells
Damage liver
Increases BP
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Increases risk of heart attack.PATHOPHYSIOLOGY.
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Coronary artery cannot supply enough blood to the heart inresponse to the demand due to CAD.
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Within 10 seconds myocardial cells experience ischemia.|
Ischemic cells cannot get enough oxygen or glucose.
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Cells convert to anaerobic metabolism, and produces Lactic as
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waste---Pain develops from lactic acid accumulation.
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Patient feels anginal symptoms until receiving demand
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increeases O2 requirements of myocardial cells.
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RISK OF HIGH CHOLESTEROL.
Criteria of MI.
Troponin or CK-MB increased with one of these:
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Chest pain
Positive ischemic change in ECG( ST segment elevation and
T wave changes )
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Pathological Q wave presence in ECG Newly.
MI DIAGNOSIS.
WHO CRITERIA.
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History of ischemic type of chest discomfort.
Evolutionary ECG changes.
Rise and fall in serum cardiac marker.
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LAB.DIAG :Best marker: Troponins.
Next test : CK-MB.
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PredictiveCRP > 3mg/L( highest risk).
CLINICAL DIAGNOSIS OF MI.
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Silent MI-in diabetes mellitus, elderly, cardiac transplantation
recipients.
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Typical features-profuse sweating, dyspnea, chest pain,
rapid, weak pulse etc.
TESTES USEFUL FOR DIAGNOSIS OF MI.
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1.Electrocardiograms(ECG).
2.Blood tests.
3.Coronary angiography.(CAG).
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An ECG which is a recording of the heart's electricalactivity, may confirm an elevation MI(STEMI), if ST
elevation is present.
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Commonly used blood test include troponin and less
often creatne kinase MB.
STEMI.
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CARDIACBIOMARKERS.Cardiac biomarkers are used to detect cardiac
diseases.
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Acute coronary syndrome resulting from myocardial
ischemia.
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Congestive heart failure.CARDIAC MARKERS TESTED IN
ACUTE CHEST PAIN
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UNSTABLE ANGINA
SUSPICIOUS ECG CHANGES
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HISTORY SUGGESTIVE OF MYOCARDIALINFARCTION.
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CARDIAC MARKERS.A. CARDIAC MARKERS FOR ACUTE CORONARY SYNDROME
1.CREATINE KINASE (CK-MB )
2.CARDIAC TROPONINS ( cTnT )
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3.HIGH SENSITYVITY TROPONIN4.BNP and NTproBNP
B. RISK MARKER FOR CARDIAC DISEASE (PREDICTION)
1.PLASMA hsCRP
2.TOTAL CHOLESTEROL LEVEL IN SERUM
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3.LDL- CHOLESTEROL and Apo-B100 level4.HDL level and ApoA1 level
5.Lp(a) level
6.Serum homocysteine level
ELECTROCARDIOGRAM.
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ACUTE ANTERIOR MI.
MI-Management.
MEDICAL management MI.
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