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Myocardial infarction

Myocardial infarction

Interruption of blood supply to a part of the heart

Myocardial infarction (heart attack) occurs due to complete or partial blockage of an artery that feeds the heart. Interruption of blood flow to the heart can lead to serious damage or death of the heart muscle.

Typically, symptoms of a myocardial infarction include shortness of breath, pressure, burning, or pain in the chest, which may radiate to the neck, left arm, back, or jaw, as well as nausea, and abdominal pain. The set and severity of symptoms may vary: someone experiences severe pain, someone has it mildly or completely absent. “Painless” (also called “silent”) myocardial infarction is more likely to be suffered by the elderly and people with diabetes. Women are more likely than men to report atypical symptoms during a heart attack, such as pain in the upper back or shoulders, dizziness, or unusual tiredness. Symptoms may come and go within hours.

The vast majority of cases of myocardial infarction develops in people with coronary heart disease (CHD). In coronary artery disease, the walls of the arteries supplying blood to the heart narrow, causing the heart to receive less oxygen. Most often, the narrowing of the arteries occurs as a result of the deposition of cholesterol in the walls of blood vessels.

Risk factors for myocardial infarction include high blood pressure and cholesterol levels, smoking, being overweight, diabetes, and lack of physical activity. A less common cause of a heart attack is spasm (constriction) of the coronary arteries (which feed the heart). It is not entirely clear what can cause this spasm, but possible causes include drug use, smoking, severe stress (for example, bereavement, this condition is also called Takotsubo syndrome, or "broken heart syndrome"). Spasm can occur in arteries that are not affected by atherosclerosis. Another rare cause of a heart attack is a dissection (rupture) of the wall of an artery.

An electrocardiogram (ECG), which can show signs of damage to the heart, and a blood test for markers of myocardial damage (troponin) are used to diagnose a heart attack. In addition, doctors may use other tests, such as angiography, an ultrasound of the heart, x-rays of the heart, CT, or MRtmen

Therapy:

First aid

Myocardial infarction requires doctors to start treatment immediately, so it is extremely important to call an ambulance at the first suspicion of myocardial infarction.

First aid for heart attack:

  • Call an ambulance.
  • Ask the person to sit down, say that the ambulance is on its way - perhaps this will calm him down a bit. The sitting position relieves stress on the heart. Help him take off his tight clothes.
  • Ask if the person is taking any medications to treat heart disease. If a person's doctor has recommended that a person take medication for a heart attack (eg, nitroglycerin, antiplatelet drugs), help them take it.
  • If the person is unconscious and not breathing, cardiopulmonary resuscitation shou
  • ld be started.

Reperfusion therapy

Treatment will depend on the type of myocardial infarction (NSTEMI or STEMI). In particular, with STEMI, it is necessary to carry out reperfusion therapy as soon as possible, that is, to restore blood flow in the artery. The goal of treatment is to save the heart as much as possible by removing the cause and restoring the patency of the blocked artery.

Percutaneous coronary intervention (PCI) is the preferred type of reperfusion therapy aimed at restoring blood flow in a blocked artery. It is important to perform PCI within 120 minutes of seeking medical attention. This procedure begins with an angiogram—a catheter filled with a contrast agent is inserted through a blood vessel in the groin or arm to find the location and extent of the blockage. The doctor monitors the location of the catheter using an x-ray machine.The catheter is equipped with a special balloon. When the catheter reaches the constriction, the balloon inflates, expanding the lumen of the artery. As a rule, after this, doctors immediately install a special stent in the artery to reduce the risk of re-narrowing of the artery in the future.

Coronary artery bypass grafting is performed when blood flow in a blocked artery cannot be restored with PCI (for example, the anatomical features of the patient's body do not allow) or the person has developed complications after a myocardial infarction, such as cardiogenic shock and heart valve disease. During this operation, the doctor takes a healthy artery or vein from the human body and transplants it in such a way that blood flows through it to the heart, bypassing the blocked place. Possible complications of this operation: bleeding, heart failure, stroke, infection, myocardial infarction, kidney failure, death.

Drug therapy

Drug therapy for myocardial infarction may include the following drugs:

  • Painkillers relieve pain and reduce the activity of the sympathetic nervous system, which in turn reduces the workload on the heart.
  • Beta-blockers help reduce stress on the heart muscle, slow the heart rate, and reduce blood pressure, resulting in less damage to the heart caused by ischemia.
  • Blockers of the RAAS (renin-angiotensin-aldosterone system) lower blood pressure and reduce the load on the heart.
  • Lipid-lowering therapy reduces the amount of cholesterol in the blood, which reduces the risk of another heart attack and stroke.
  • Antiplatelet agents prevent the formation of new blood clots and reduce the risk of recurrent myocardial infarction.
  • Anticoagulants affect blood clotting. They work best in the first few hours after a heart attack.

Rehabilitation

Rehabilitation reduces mortality from cardiovascular diseases, the number of hospitalizations, improves the quality of life. Rehabilitation after myocardial infarction should begin in the hospital and continue after returning home. It may include the following activities:

  • Lifestyle modification - includes advice on reducing the risk of cardiovascular events, control of risk factors.
  • Physical exercise - moderate aerobic exercise at least three times a week for at least 30 minutes a day. The load level is determined depending on the severity of the condition.
  • Working with stress, anxiety and depression - screening with questionnaires, psychological counseling and prescribing medications if necessary.

Physical therapy, which consists of training with a specialist, should not be confused with physiotherapy (eg, electrophoresis, magnetophoresis). The first really has an effectiveness in the rehabilitation of people after myocardial infarction, stroke, injuries. The second has not proven its effectiveness and safety after myocardial infarction.

Timeline

Further reading

Title
Author
Link
Type
Date

Myocardial Infarction: Nursing Management and Study Guide

MARIANNE BELLEZA, R.N.

Web page

FEBRUARY 20, 2021

Myocardial Infarction: Practice Essentials, Background, Definitions

A Maziar Zafari, MD, PhD, FACC, FAHA

Web page

May 07, 2019

Documentaries, videos and podcasts

Title
Date
Link

Case Study #18: Myocardial Infarction

February 2, 2022

Heart attack (myocardial infarction) pathophysiology | NCLEX-RN | Khan Academy

October 23, 2014

Myocardial Infarction - Lets break this down into simple terms (Nursing School Lesson)

October 22, 2020

Myocardial Infarction (Heart Attack) for Nursing & NCLEX

August 21, 2019

Myocardial Infarction (Heart Attack) Ischemia Pathophysiology, ECG, Nursing, Signs, Symptoms Part 1

September 29, 2016

News

Title
Author
Date
Publisher
Description
November 13, 2020
clinicaltrials.gov
CMR Findings in COVID-19 Patients Presenting With Myocardial Infarction - Full Text View.
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