Myocardial Infarction Causes,Symptoms, Risk Factor And Treatment

What Is Myocardial Infarction?

 

A  myocardial infarction ( heart attack  ) occurs when the flow of blood to a part of the heart muscle is blocked: if the blood flow is not restored in a short time, the affected section of the heart is damaged by lack of oxygen and begins to die.



Myocardial Infarction

Heart attacks are the leading cause of death in Western countries, but today there are therapeutic approaches that can save lives and prevent disabilities arising from it: treatment is most effective if it is started within an hour of symptom onset.

 

Myocardial infarction pathophysiology

 

Heart attacks occur mainly due to a pathology called atherosclerosis: different lipid material (fat) accumulates over the years along the inner walls of the coronary arteries (the arteries that supply blood and oxygen to the heart) up to form a true and its atherosclerotic plaque.

Over time, part of the plaque can break, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough it can partially or completely block the flow of oxygen-rich blood to that part of the heart muscle fed by the artery.

 




During a heart attack, if the coronary obstruction is not rapidly treated, the heart muscle begins to yield and be replaced by scar tissue. This damage to the heart may not be obvious or, on the contrary, it may cause serious and long-lasting problems

 

Myocardial infarction causes

 

The medical term used to indicate heart attacks is myocardial infarction. “Mio” refers to muscle, “cardio” refers to the heart, “heart attack” refers to the death of tissue due to lack of oxygen.

 

Like any muscle, the heart needs a constant supply of blood and oxygen. Without blood, the heart cells immediately suffer severe damage and this causes pain and a feeling of pressure.

Is myocardial infarction fatal?

If the blood flow has not restored the cardiac cells can die and a scar can be formed in their place (from the medical point of view “scar tissue”), replacing the functioning cardiac tissue. Lack of blood flow to the heart can also result in an irregular heart rhythm, which can be fatal.

 

  • A heart attack occurs when one or more of the arteries that carry oxygen-rich blood to the heart becomes blocked: these arteries are called coronary arteries and surround the heart like a crown.
  • Over time one of the coronary arteries may shrink due to an accumulation of cholesterol, this accumulation (generally known as plaque) that forms in the arteries throughout the body is called atherosclerosis.
  • At the base of a heart attack there is usually one of these plaques that breaks forming a blood clot where there has been a rupture: if the clot is large enough the flow of blood passing through the artery can be blocked.
  • A less common cause of heart attack is the spasm of a coronary artery that stops the flow of blood to a part of the heart muscle: drugs like cocaine can cause very life-threatening spasms.
  • A heart attack represents the end of a process that generally evolves for many hours. As the minutes’ pass, the heart tissue has deprived of blood deteriorates and dies.

 

If blood flow can restore over time, heart damage can prevent or otherwise limited.

 

Types of myocardial infarction

 

From a general point of view the infarct can be classified as follows:

 

Type I: Blockage of perfusion following the rupture of a coronary plaque

Second Type: Lack of oxygen caused by another condition, such as a coronary spasm, severe respiratory failure or severe arterial hypertension,

Third Type: Sudden and unexpected cardiac death, with cardiac arrest.

 

Finally, there are type 4 and 5 heart attacks, links to surgical conditions.




Myocardial Infarction Symptoms

 

The most common symptom of heart attack represented by pain or discomfort in the chest: most of the heart attacks, in fact, cause a sharp pain in the center of the chest that lasts for a few minutes or disappears and then reappears. The discomfort may consist of a sense of pressure, pangs in the heart, pain and/or a sense of swelling.

 

Angina symptoms can be similar to the symptoms of a heart attack: angina is the chest pain that occurs in people with coronary artery disease, usually when they are active.

The anginal pain usually lasts only a few minutes and disappears with rest: if angina does not disappear or occurs differently than usual (for example it occurs more frequently or occurs at rest) it could be a sign of the beginning of a heart attack and the patient must be visited immediately by a doctor.



Some heart attacks are sudden and intense and no one doubts what is happening, but on the contrary, in some cases, the symptoms can also start slowly, with mild and annoying pain. Often the affected people are not sure what is happening and wait too long before asking for help.

 

The following are some early signs that may indicate the appearance of a heart attack:

 

  • Pressure, pain or pangs in the center of the chest that lasts more than a few minutes,
  • The pain extends beyond the chest to the shoulder, arm, back, and also to the teeth and the jaw,
  • Increased episodes of chest pain,
  • Prolonged pain in the upper part of the abdomen,
  • Shortness of breath,
  • Sweating,
  • Looming feeling of fatigue,
  • Fainting,
  • Nausea and vomit.

 

Signs and symptoms of infarction in women may be different and less obvious than those that occur in men, in addition to what we have just listed we also mention:

 

  • Abdominal pain or heartburn,
  • Wet skin,
  • Stunning or dizziness.

 

In general, the greater the signs and symptoms that felt, the higher the probability that you are in the presence of a heart attack.

 

Some people, on the other hand, do not experience any symptoms.

 

A heart attack can occur at any time while you work or play while you are at rest or in motion. Some heart attacks suddenly strike, but many people who have already had previous experience of this kind can warn of danger signals with hours, days or even weeks in advance.

A predictor of a heart attack can be recurrent chest pain (angina), which is exacerbated under stress and is relieved at rest. Angina is caused by a temporary insufficient blood supply to the heart, also known as “cardiac ischemia”.

 

Learn to recognize the signs of heart attack, but remember this: even if you are not sure it is a heart attack, say it anyway and tell your doctor about your symptoms.

 

Myocardial Infarction Risk Factors

 

Some factors, called coronary risk factors, increase the risk of myocardial attack. These factors contribute to the unwanted formation of deposits (atherosclerosis) which constricts arteries throughout the body, including arteries to your heart. Coronary risk factors include:

 

1. Smoke.

The smoke, including long-term exposure to passive, damaging the inner walls of the arteries (including those that go to the heart), causing the formation of deposits of cholesterol and other substances that may hinder the flow of blood. Smoking also increases the risk of deadly blood clots forming a heart attack.

 

2. High blood pressure.

Blood pressure is determined by the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries. Over time, high blood pressure can damage arteries that carry blood to the heart, accelerating atherosclerosis. The risk of high blood pressure increases with age, but the main culprits, in fact, are obesity and a diet too rich in salt. Hypertension can also be a hereditary problem.

 

3. High blood cholesterol and high triglyceride levels.

Cholesterol is a substantial part of the deposits that can narrow the arteries throughout the body, including those that reach the heart. A high level of the wrong type of cholesterol in the blood increases the risk of a heart attack. Low-density lipoprotein (LDL) cholesterol, which is bad cholesterol, more likely leads to narrow arteries and comes from a diet high in saturated fat and cholesterol.


Similarly, a high level of triglycerides, a type of fat whose presence in the blood depends mainly on the type of diet, is not desirable. It is good to remember that a high level of high-density lipoprotein cholesterol, the so-called good cholesterol that helps the body rid itself from excess cholesterol, is instead desirable and reduces the risk of attack to the myocardium.

 

4. The lack of physical activity .

An inactive lifestyle contributes to high blood cholesterol and obesity levels. In contrast, people who exercise regularly have better cardiovascular health, which reduces the overall risk of a heart attack. Exercise is also useful for reducing high blood pressure.

 

5. Obesity.

Obese people have a high percentage of body fat (body mass index equal to or greater than 30). L ‘ obesity increases the risk of heart disease because it has associated with high blood cholesterol levels, high blood pressure, and diabetes.

 

6. Diabetes.

Diabetes is the body’s inability to properly produce or respond properly to insulin. Insulin, a hormone secreted by the pancreas, allows the body to use glucose, which is a type of food sugar. Diabetes can occur already in childhood but appears more often in middle age and between overweight people. Diabetes greatly increases the risk of a heart attack.

 

7. Stress.

You can react to stress in ways that can increase the risk of myocardial infarction. If you are under stress, you can eat too much or smoke more from nervous tension. Too much stress, as well as too much anger, can also increase blood pressure.

 

8. Alcohol.

If consumed in moderation, alcohol contributes to increasing HDL levels, good cholesterol, and may have a slightly protective effect against heart attacks, but the scientific community is now in agreement that these benefits do not justify the risks involved.

Men should not consume more than two drinks a day and women no more than one. Excessive intake can raise blood pressure and triglyceride levels, increasing the risk of a heart attack.

 

9. Family history of a heart attack.

If your brothers, parents or grandparents have had heart attacks in the past, you too could be at risk. Your family may have a genetic condition that increases unwanted cholesterol levels in the blood. Hypertension can also be inherited from one’s family.

 

10.Homocysteine, C-reactive protein, and fibrinogen.

People who show increased blood levels of homocysteine, C-reactive protein and fibrinogen seem to be exposed to an increased risk of heart disease. Some research suggests that homocysteine ​​levels can be reduced through folic acid supplements and through a healthy diet.

Fibrinogen and C-reactive protein levels can be reduced by modifying other risk factors for heart disease, such as stopping smoking, lowering cholesterol levels and performing regular physical activity.

 

11. Anti-inflammatories

A meta-analysis published in the British Medical Journal  in April 2017 returns to emphasize the increased risk of heart attack associated with the use of anti-inflammatories; the results speak of an increase of up to 50% and more in the risk with all the most common molecules (also present in over-the-counter drugs, such as ibuprofen, diclofenac, and naproxen).

More than the duration of the treatment (the risk increases after about a week of treatment and then remains more or less constant) it seems to be a high dosage to determine the appearance of the risk.

 

12. Migraine:

Subjects with migraine seem to have a higher absolute risk of cardiovascular events than the general population.

Many of these risk factors can be modified or eliminated to reduce the likelihood of having a first or second heart attack, however, it is not possible to change other risk factors, such as sexual or hereditary: for example, men are generally more at risk. of women.


The risk increases for women after menopause, usually after 55 years. If your father has had heart disease before age 55 and your mother before age 65, the risk of developing heart disease is greater.

 

Complications of myocardial infarction

 

The complications that result from a heart attack are often linked to the damage suffered by the heart during the heart attack:

 

1.Cardiac rhythm abnormalities (arrhythmias).

If the heart muscle is damaged by a heart attack, short electrical circuits can develop causing abnormal heart rhythms, some of which can be serious, even fatal.

 

2. Heart failure.

The amount of tissue damaged in the heart can be so extensive that the still functioning part of the muscle cannot properly pump blood to the heart.

This decreases blood flow to tissues and organs throughout the body and can cause shortness of breath, fatigue, and swelling in the ankles and feet. Heart failure can be a temporary problem that resolves itself after the heart resumes its normal activity in a few days.

 

3. Heartbreak.

Some areas of the heart muscle weakened by the infarct can rupture, leaving a hole in the heart tissue. This break is often rapidly fatal.

 

4. Valve problems.

Heart valves damaged during a heart attack can develop serious, life-threatening problems.

 

 

Myocardial Infarction Diagnosis

 

The diagnosis of infarction is made based on symptoms, personal and family medical history and diagnostic test results.

 

ECG ( Electrocardiogram ):

This test detects and records the electrical activity of the heart. Certain changes in the appearance of electric waves on an ECG are important signals of myocardial infarction. An electrocardiogram is also able to show if there are arrhythmias (abnormal heartbeats), which can be caused by a heart attack.

 

Blood test:

During a heart attack, the heart muscle cells explode, leaving some proteins in the blood. Blood tests can measure the amount of these proteins in the blood. Levels of these above-average blood proteins are evidence of a heart attack.

The common blood tests used are the troponin test (but note that an increase in this marker is not sufficient to make the diagnosis of infarction), the CK or CK-MB tests, and the serum-myoglobin tests. Blood tests have often repeated to check for changes that occur over time.

 

Coronary angiography:

Coronary angiography is a special x-ray examination of the heart and blood vessels. It is often done during a heart attack to detect obstructions in the coronary arteries. The doctor passes a catheter (a thin flexible tube) through an artery in the arm or groin (thigh) and passes it through the heart. This procedure, called cardiac catheterization, is part of coronary angiography.




A dye that can be visualized by X-ray is injected into the blood through the tip of the catheter. This dye allows the doctor to analyze blood flow through the heart and blood vessels. If an obstruction is detected another procedure, called angioplasty, could be used to restore blood flow through the artery.

Sometimes, during angioplasty, a stent (a small tube) in the artery to keep it dilated.

 

Myocardial Infarction Treatment

 

Drugs For Treatment Of Myocardial Infarction

 

The more minutes pass, after a heart attack, the more oxygen-free tissue remains, it deteriorates and dies. The best way to prevent progressive damage is to quickly restore blood flow.

 

The drugs used to treat a heart attack include:

 

1. Aspirin.

L ‘ aspirin can be administered by emergency medical personnel as soon as you reach the hospital or shortly thereafter anyway. Aspirin inhibits blood clotting, thus helping to maintain blood flow through the blocked artery. It is recommended that you take aspirin yourself waiting for help to come only if your doctor has already recommended doing so and if you have heart failure symptoms.

 

2.Thrombolytics.

These drugs help dissolve the blood clot that blocks the flow of blood to the heart. The sooner the thrombolytic drug is taken as a result of a heart attack, the greater the chance of survival and the reduction of damage to the heart.

 

3. Other antiplatelet agents.

Emergency medical practitioners can give other drugs that are in some ways similar to aspirin as they help prevent blood clots from forming again. These include Clopidogrel (Plavix®) and others called platelet receptor IIb / IIIa inhibitors.

 

4. Other drugs to thin the blood.

Most likely the patient suffering from a heart attack will be given other drugs, such as heparin , to make the blood less ‘sticky’ and less prone to forming dangerous blood clots. Heparin administered intravenously or by injection under the skin and is usually used during the first few days after a heart attack.

 

5. Painkillers.

If the chest pain or pain associated with it is very strong it is possible to take a painkiller, such as morphine, to relieve the discomfort.

 

6. Nitroglycerin.

This drug, used to treat chest pain (angina), temporarily dilates arterial blood vessels, improving blood flow to and from the heart.

 

7. Beta-blockers.

These drugs help to relax the heart muscle, slow down the heartbeat and decrease blood pressure, making the work of the heart easier. Beta-blockers can limit the amount of damage to the heart muscle and prevent future heart attacks.

 

8. Drugs that reduce cholesterol.

Examples are statins, niacin, fibrates, and bile acid sequestrants. These drugs help keep blood cholesterol levels low and can be useful if given immediately after a heart attack to improve survival.

 

Surgical management of myocardial infarction

 

In addition to drugs, the patient can undergo one of the following procedures to treat heart attack:

 

1. Angioplasty and coronary stents.

Emergency angioplasty dilates the obstructed coronary arteries, letting the blood flow reach the heart more freely. The doctors insert a long, thin tube (catheter) that passes through an artery, usually into the legs, until it reaches the obstructed heart artery.

This catheter is equipped with a special balloon tip. Once positioned, the balloon tip is quickly inflated so as to dilate the blocked coronary artery. At the same time, a metal stent can be inserted into the artery to keep it open for a long time and thus restore blood flow to the heart.

Depending on the case, the doctor may choose to insert a stent covered with a slow-release drug that can help keep the artery dilated.

Coronary angioplasty is done at the same time as a coronary catheterization (angiogram), a procedure that doctors perform before identifying blocked coronary arteries. When angioplasty is performed to treat a heart attack, the sooner the better.

If instead, it performed days or weeks after the person suffering from a heart attack has stabilized with an artery completely blocked, no benefit can be derived from it.

 

2. Coronary bypass surgery.

In rare cases, doctors can perform an emergency bypass operation at the time of the infarction. The bypass involves the reconditioned veins or arteries located beyond the blocked or restricted coronary arteries (bypassing the compressed section of the artery), restoring the flow of blood to the heart.

Alternatively, the doctor may suggest that you undergo this procedure after your heart has had time to recover from the heart attack.

Once the blood flow to the heart restored and the patient’s condition stabilizes following the heart attack, he can be hospitalized for observation. As physical exertion and emotional shock stress the heart, make sure you are at rest. Visitors generally limited to family members and close friends.

 

Rehabilitation

 

The goal of emergency treatment of a heart attack is to restore blood flow and save heart tissue. The purpose of the subsequent treatment is to allow the heart to heal and prevent another heart attack.

 

Some hospitals offer cardiac rehabilitation programs, which can begin when you are in hospital and, depending on the severity of the heart attack, can continue for weeks or months after returning home. Cardiac rehabilitation programs generally focus on three main areas: drugs, lifestyle changes, and emotional states.

 

 

Prevention of myocardial infarction

 

It is never too late to take preventive measures to prevent a heart attack, even if you have already had a previous heart attack experience.

 

Drug therapy has become an increasingly important part to reduce the risk of a second heart attack and to help the damaged heart function better. Different factors in lifestyle play a fundamental role in the prevention and recovery of a heart attack.

 

Doctors generally prescribe drug therapy to people who have had a heart attack or who are at high risk of having one.

 

Lifestyle

 

Lifestyle can greatly affect heart health. Taking the following measures can help not only prevent but also recover from a heart attack:

 

No smoking.

If you smoke the most important thing you can do to improve heart health is to quit. It is very difficult to stop smoking on your own, but you could ask your doctor to prescribe a treatment plan to help you get rid of this harmful habit.

 

Check cholesterol.

Check your cholesterol levels regularly, through a blood test. If bad cholesterol levels are too high. The doctor can prescribe dietary changes and medications. That help reduces cholesterol and protect one’s cardiovascular health.

 

Undergo regular medical checks.

Some of the main risk factors for heart attacks, high blood cholesterol, high blood pressure, and diabetes. Do not generate any symptoms in the early stages. Your doctor can run tests to check that you are free from these problems.

If, on the other hand, the doctor finds one of these problems. You and your doctor can better manage the situation in order to prevent complications. That can arise and that can cause a heart attack.



Check blood pressure.

Blood pressure should be checked regularly, frequently if you have high blood pressure or if you experience previous coronary heart disease.

 

Do regular physical activity.

Years ago doctors forbade physical exercise following a heart attack for fear that it could cause another. In fact, regular physical activity helps improve heart muscle function following a heart attack. Exercise is now an important component of a cardiac rehabilitation program.

It helps prevent a heart attack, helping you to achieve and maintain a healthy weight and to control diabetes, cholesterol, and high blood pressure. The exercise does not have to be too hard. For example, walking 30 minutes a day and five days a week can improve health.

 

Maintain adequate weight.

Obesity puts the heart under stress and can help determine high cholesterol, high blood pressure, and diabetes. Losing weight can reduce the risk of heart disease.

 

Follow a healthy diet for the heart.

Too much-saturated fat and cholesterol in the diet can narrow the arteries directed to the heart. If you have affected by a heart attack. Try to limit the amount of fat and cholesterol and sodium in your diet. A high sodium diet can increase blood pressure.

Follow the advice of your doctor and dietician about the healthiest diet for your heart. Prepare healthy meals for the heart.

For example, fish is part of a healthy diet. It contains omega 3 fatty acids, which help improve blood cholesterol levels and prevent blood clots from forming. Also, eat plenty of fruit and vegetables. Fruits and vegetables contain antioxidants,

 

Manage stress.

To reduce the risk of a heart attack, try to reduce daily stress. Review your workaholic work habits and find a healthy way to minimize or otherwise cope with stressful events in your life.



Consume alcohol in moderation.

Drinking more than one or two alcoholic beverages a day increases blood pressure. So cut down on alcohol consumption if necessary. From a cardiac health point of view, one to two glasses a day are ideal for men. While women can consume an alcoholic beverage a day.

 

Note: The information contained in this article must in no way replace the doctor-patient relationship. On the contrary, it recommended seeking the advice of your doctor. Before putting into practice any advice or indication indicated.

 

Sources 

 


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Myocardial Infarction Causes,Symptoms, Risk Factor And Treatment
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Myocardial Infarction Causes,Symptoms, Risk Factor And Treatment
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A  myocardial infarction ( heart attack  ) occurs when the flow of blood to a part of the heart muscle is blocked: if the blood flow is not restored in a short time, the affected section of the heart is damaged by lack of oxygen and begins to die.
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Life-Fitness
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