Acute Myocardial infarction

Acute myocardial infraction is a sudden obstruction in the blood flow to the heart muscle. It is an emergency condition in which the plaque formed due to the deposition of fat, cholesterol, calcium or cellular waste products is ruptured leading to the formation of thrombus. This leads to the obstruction of coronary vessel resulting in acute reduction of blood supply.

Signs and Symptoms:

The symptoms of Acute myocardial infraction include:

  • Chest Pain

Uninterrupted and intense chest pain which often radiates to neck, shoulder, jaw and down to the left arm. The chest pain is usually experienced as pressure, squeezing, aching or burning sensation, and can also be presented as a feeling of indigestion or fullness of gas.

The important signs of the patient to be considered include the following:

  • Increase in the heart rate
  • Irregular pulse
  • Elevated blood pressure
  • Coughing and wheezing
  • Nausea and vomiting
  • Shortening of breath
  • Distended neck veins
  • Production of frothy sputum
  • Excessive sweating, light headedness and palpitations.
  • Loss of consciousness due to inadequate blood flow to the brain

 Causes:

Coronary artery blockage is the primary cause of acute myocardial infarction. It is due to the accumulation of cholesterol in the arteries. The increase in LDL levels (bad cholesterol) in the body leads to plaque formation in the arteries. Saturated and trans fats are other types of fats which also lead to the formation of plaque in the arteries and obstruct the blood flow. Certain dairy products including butter and cheese, meat, beef, and processed foods are the main sources of saturated and trans fats.

During a heart attack, the plaque gets ruptured and spills cholesterol into the bloodstream. This leads to the formation of blood clots, when are big enough can block the artery at the site of rupture and deprives the heart muscle from obtaining enough oxygen and nutrients. There can be a partial block of the artery or a complete block of the artery. A complete block refers to an ST level elevation Myocardial Infraction (STEMI) and a partial block refers to a non-ST elevation Myocardial Infraction (NSTEMI).

Risk Factors:

Some of underlying risk factors of the acute myocardial infraction are modifiable.

  • Sex
  • Age
  • Family History
  • Male Pattern Baldness
  • Smoking
  • Diabetes Mellitus
  • Hypertension
  • Obesity
  • Lack of exercise
  • Poor oral hygiene
  • Presence of peripheral vascular disease
  • Elevated levels of homocysteine

Other factors include

  • Trauma
  • Drug use (Cocaine)
  • Vasculitis
  • Coronary artery anomalies
  • Coronary artery emboli
  • Aortic dissection
  • Hyperthyroidism, anemia

Diagnosis:

Electrocardiogram

Electrocardiogram remains a crucial tool used to diagnose a patient with acute myocardial infraction. One of the significant finding is the presence of the raised ST segment.

Cardiac Imaging

The coronary cardiac imaging is used to check for the presence or to rule out the coronary artery disease. The test is considered for the individuals who are at risk of having an acute myocardial infraction.

Laboratory procedures:

The laboratory tests should include identification of marker known as cardiac troponins, complete blood picture, lipid profile, renal function and metabolic panel.

Treatment:

Any patient diagnosed with acute myocardial infraction advised to take aspirin 165 mg - 325 mg immediately regardless of their condition (STEMI or NSTEMI). In STEMI the patient should receive dual antiplatelet agents, including heparin infusion. This should immediately be followed by a reperfusion with percutaneous coronary intervention (PCI). If PCI is unavailable within 90 minutes of diagnosis of STEMI, an intravenous thrombolytic agent should be considered for reperfusion. NSTEMI in a stable asymptomatic patient can be managed with antiplatelet agents.

Prevention:

Any individual can improve heart health and prevent the occurrence of current heart condition by following the below-mentioned lifestyle changes:

  • Avoid smoking.
  • Go for regular health checkups.
  • Control blood pressure and cholesterol levels.
  • Get regular exercise and maintain a healthy weight.
  • Keep diabetes under control.
  • Manage stress.
  • Consume alcohol in moderation.

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Contact Dr. Raghu and his team at:
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Mail: raghu@drraghu.com