Myocardial infarction commonly known as Heart Attack,it occurs when oxygen supply to heart muscles becomes nil, due to occlusion of one of the branches of coronary artery.

CAUSES–

• Coronary Thrombosis

• Coronary Embolism

• Sub-intimal haemorrhage

• Critical lowering of blood pressure

• Syphilitic aortitis
  

RISK FACTORS

• AGE- Commonly After 50 Years.
• Sex- Mostly Men
• Hypertension
• Obesity
• Stress
• Smoking ,Alcohol,Unhealthy Diet.
• Diabetes
• Gout
• Burger’s Disease
• Polycythaemia
• Hyperthyroidism
• Brisk Haemorrhage as in – (A)- Peptic ulcer (B)- Surgical Operation

SYMPTOMS –

• Breathlessness ,Restlessness
• Cough,Sputum,Haemoptysis
• Shock
• Severe Sweating
• Pain- Mild to Severe mostly in the middle of Chest with Left Shoulder and Arm. Jaw and Neck
• Low Blood Pressure
• Nausea and Vomiting
• Pulse -Tachycardia
• Irregular Heart Beat
• Cardiac arrest

INVESTIGATION –

• ECG
• 2D ECHO
• CRP
• CBC
• Troponin I
• LFT
• KFT
• Serum Electrolytes
• Apoloprotein B (apo B)
• Lipid Profile
• Random Blood Sugar, HbA1C
• NT-proBNP
• Coronary Angiogram
• CTCA (CT Coronary Angiogram)
• Urine Examination

COMPLICATIONS-

• Sudden Death
• Heart Failure
• Pericarditis
• Ventricular Fibrillation
• Cardiac Aneurysm
• Complete Heart Block
• Thrombo Embolism Pulmonary
• Cardiac Arrhythmias
• Neurological Disorders- Coma, Hemiplegia, Syncope, Convulsions.
• Cyanosis
• Cardiac arrest

PROGNOSIS-

In About a quarter of all cases of Myocardial Infarction death occurs within the first few minutes without medical care. If there will be no complications within the first four weeks,the Prognosis is favourable.

Sudden death under 40 is not uncommon.Unfavourable features are old age,cardiogenic shock,Cardiac failure,heart block and ventricular arrhythmias.

PREVENTION OF HEART ATTACK-

According to the World Health Organization, as many as 80% of all heart attacks and strokes are preventable. The majority of deaths due to CVD are precipitated by risk factors such as high blood pressure, high cholesterol, obesity, or diabetes, which can, to a large extent, be prevented or controlled through the consumption of a healthy diet, regular exercise and avoiding tobacco. Keeping an eye on your blood pressure, cholesterol levels and blood sugar levels is also very important.

• Eat healthy
• Stay Active
• Lose or manage your weight
• Get healthy sleep
• Manage your blood pressure
• Manage your Blood sugar level
• Lower your cholesterol
• Don’t Smoke
• Avoid Alcohol
• Manage your stress

MANAGEMENT & TREATMENT-

First Aid

If you think someone is having a heart attack:

If the person is unconscious and unresponsive, does not have a pulse, and an automated external defibrillator (AED) is immediately available – follow the instructions on the AED device.

Have the person sit down, rest, and try to keep calm.

Loosen any tight clothing.

Ask if the person takes any chest pain medicine, such as nitroglycerin for a known heart condition, and help them take it.

If the pain does not go away promptly with rest or within 3 minutes of taking nitroglycerin, call for emergency medical help.

If the person is unconscious and unresponsive, and not breathing or does not have a pulse, call the local emergency number, then begin CPR.

If an infant or child is unconscious and unresponsive, and not breathing or does not have a pulse, perform 1 minute of CPR, then call the local emergency number. 

TREATMENT –

Types of medications

Heart attack treatment involves a variety of drugs. The following list provides an overview of the common types. You can also learn about medication in more detail.

Your health care team will recommend the best combination of medications for your situation.

• Anticoagulant: Sometimes called blood thinners, these medicines make it harder for clots to form and also keep existing blood clots from getting larger.
• Antiplatelet agent: Keeps blood clots from forming by preventing blood platelets from sticking together.
• Angiotensin-converting enzyme (ACE) inhibitor: Relaxes blood vessels and allows them to expand while decreasing resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the heart’s work easier or more efficient.
• Angiotensin II receptor blocker: These medicines inhibit angiotensin II from having effects on the heart and blood vessels. This keeps blood pressure from rising.
• Angiotensin receptor neprilysin inhibitor: Neprilysin is an enzyme that breaks down natural substances in the body that open narrowed arteries. By inhibiting neprilysin, those natural substances can have their normal effect. That improves artery opening and blood flow, reduces sodium (salt) retention and decreases strain on the heart.
• Beta blocker: Makes the heart beat slower and with less force, which lowers blood pressure.
• Combined alpha and beta blocker: Combined alpha and beta blockers may be used as an IV drip for people in hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the person is at risk for heart failure.
• Calcium channel blocker: Interrupts the movement of calcium into the cells of the heart and blood vessels. May decrease the heart’s pumping strength and relax the blood vessels.
• Cholesterol-lowering medications: Various medications can lower blood cholesterol levels, but statins are the best first course of action. When statins don’t work, or if a person has serious side effects from statin therapy, other drugs may be recommended.
• Vasodilator: Relaxes blood vessels and increases the supply of blood and oxygen to the heart while reducing its workload. Available as pills to be swallowed, chewable tablets and as a topical application (cream).

Common medical procedures following a heart attack

You’ll find many common medical procedures for heart attack listed here. For more detailed explanations of these treatments, see our page devoted to cardiac procedure.

• Angioplasty: Special tubing with an attached deflated balloon is threaded up to the coronary arteries. The balloon is inflated to widen blocked areas where blood flow to the heart muscle has been reduced or cut off.
• Laser angioplasty: Similar to angioplasty except the catheter has a laser tip that opens the blocked artery.
• Heart valve surgery: Repairs an abnormal or diseased heart valve or replaces it with a healthy one.
• Atherectomy: Similar to angioplasty except the catheter has a special tool on its tip to cut away plaque from the artery.
• Bypass surgery: Treats blocked heart arteries by creating new pathways around the clot so blood can flow to your heart muscle.
• Minimally invasive heart surgery: An alternative to standard bypass surgery using small incisions.
• Stent procedure: A stent is a wire mesh tube that is placed during angioplasty to hold open an artery and restore blood flow.
• Transmyocardial revascularization (TMR): A laser is used to drill a series of holes from the outside of the heart into the heart’s pumping chamber.

In addition to the above treatments, you might hear about implantable medical devices being used to treat certain conditions that increase risk of heart Attack.