Myocardial Infarction Overview
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Questions and Answers

What is the primary cause of myocardial infarction?

  • Short-term exposure to air pollution
  • Irreversible death of heart muscle due to lack of oxygen (correct)
  • High levels of blood cholesterol
  • Excessive alcohol intake

Which of the following lifestyle factors is most closely associated with myocardial infarction?

  • Healthy diet
  • Smoking (correct)
  • High level of exercise
  • Meditation

How does diabetes mellitus increase the risk of myocardial infarction?

  • By reducing blood flow to the heart
  • By lowering blood cholesterol levels
  • By facilitating the formation of atherosclerotic plaque (correct)
  • By increasing heart muscle strength

Which gender is reported to have a higher risk of myocardial infarction before menopause?

<p>Men (B)</p> Signup and view all the answers

What genetic factor increases the risk of myocardial infarction?

<p>Having a family history of ischemic heart disease (B)</p> Signup and view all the answers

What role do the genes CDKN2A and CDKN2B play in myocardial infarction?

<p>They are linked to the increased risk of MI (B)</p> Signup and view all the answers

Chronic high-stress levels are linked to myocardial infarction primarily due to which factor?

<p>Contributing to the development of atherosclerosis (C)</p> Signup and view all the answers

At what age does a first-degree male relative having a myocardial infarction significantly increase someone’s risk?

<p>Before age 55 (D)</p> Signup and view all the answers

What physiological change can high blood pressure cause in the heart muscle?

<p>It can cause the heart muscle to thicken. (C)</p> Signup and view all the answers

Which of the following is a common consequence of smoking on cardiovascular health?

<p>Plaque build-up in arteries. (D)</p> Signup and view all the answers

How does diabetes contribute to myocardial infarction risk?

<p>By promoting atherosclerotic plaque formation. (B)</p> Signup and view all the answers

Which dietary factor can directly lead to the build-up of cholesterol in the arteries?

<p>High intake of saturated and trans fats. (B)</p> Signup and view all the answers

What effect does heavy alcohol consumption have on fibrinolysis?

<p>It reduces fibrinolysis. (A)</p> Signup and view all the answers

Which lifestyle factor can increase the likelihood of a heart attack?

<p>Lack of exercise. (D)</p> Signup and view all the answers

Which demographic group has the highest AMI rates according to the American Heart Association?

<p>Black women aged 35 to 74. (B)</p> Signup and view all the answers

Cocaine use is considered a less common risk factor for which condition?

<p>Myocardial Infarction. (B)</p> Signup and view all the answers

What mechanism primarily leads to myocardial infarction in cocaine users?

<p>Coronary artery spasm during increased oxygen demand (B)</p> Signup and view all the answers

Which of the following factors is associated with an increased risk of myocardial infarction (MI)?

<p>Age above 60 years (D)</p> Signup and view all the answers

What is a common sign of myocardial infarction that can radiate to other areas of the body?

<p>Chest pain traveling into shoulders and arms (C)</p> Signup and view all the answers

In the classification of myocardial infarction, which condition reflects a complete blockage of a major coronary artery?

<p>STEMI (A)</p> Signup and view all the answers

How does emotional stress affect the risk of myocardial infarction?

<p>It raises cortisol levels and inflammation. (C)</p> Signup and view all the answers

What is a potential symptom of myocardial infarction that might be confused with digestive issues?

<p>Nausea and epigastric fullness (A)</p> Signup and view all the answers

What effect does extreme cold have on the cardiovascular system?

<p>It constricts blood vessels, increasing pressure. (D)</p> Signup and view all the answers

Which of these symptoms is NOT typically associated with myocardial infarction?

<p>Sharp abdominal pain (B)</p> Signup and view all the answers

Which method is NOT typically used in the diagnosis of Myocardial Infarction?

<p>Liver function tests (A)</p> Signup and view all the answers

What is a primary prevention strategy for reducing the risk of Myocardial Infarction?

<p>Regular exercise (B)</p> Signup and view all the answers

Which cardiac marker is specifically used to indicate heart muscle cell damage?

<p>Troponin (A)</p> Signup and view all the answers

What is the purpose of coronary angiography?

<p>To visualize the inside of blood vessels (D)</p> Signup and view all the answers

Which of the following is NOT considered during secondary prevention of Myocardial Infarction?

<p>Vaccination for influenza (C)</p> Signup and view all the answers

Which lifestyle modification is considered a primary preventive measure against Myocardial Infarction?

<p>Low-fat dietary changes (C)</p> Signup and view all the answers

Which condition is monitored as part of secondary prevention for Myocardial Infarction?

<p>Blood glucose levels (B)</p> Signup and view all the answers

What is the aim of performing aortic angiography in the context of Myocardial Infarction?

<p>Visualize narrowing or obstruction in heart vessels (D)</p> Signup and view all the answers

Which dietary pattern is specifically designed to lower blood pressure?

<p>DASH diet (C)</p> Signup and view all the answers

What is a primary focus of secondary prevention in myocardial infarction?

<p>Early detection and treatment (C)</p> Signup and view all the answers

What does the acronym ABCDES represent in lifestyle modifications for heart disease prevention?

<p>Alcohol, Blood Pressure, Cholesterol, Diabetes, Exercise, Smoking (C)</p> Signup and view all the answers

Which dietary fat is considered the primary source in the Mediterranean diet?

<p>Olive oil (D)</p> Signup and view all the answers

What impact does the DASH diet have on blood pressure according to studies?

<p>Lowers systolic pressure by about 8 mm Hg and diastolic by about 4 mm Hg (A)</p> Signup and view all the answers

What is the maximum safe amount of alcohol for women per day to reduce heart disease risk?

<p>1 drink (D)</p> Signup and view all the answers

What type of dietary changes is encouraged to help prevent myocardial infarction?

<p>Fruits, vegetables, and whole grains with low saturated fat (A)</p> Signup and view all the answers

Which factor is NOT part of cardiac rehabilitation management after a myocardial infarction?

<p>Cardiac arrest management (D)</p> Signup and view all the answers

What type of fats should be consumed to lower cardiovascular risk?

<p>Polyunsaturated fats (D)</p> Signup and view all the answers

What is the recommended amount of moderate intensity physical activity for individuals with prediabetes to reduce their risk of progressing to diabetes?

<p>150 minutes per week (C)</p> Signup and view all the answers

Which of the following is NOT a part of the Physical Activity Guidelines for Americans?

<p>Engaging in weightlifting twice a week (D)</p> Signup and view all the answers

How does smoking affect heart disease risk?

<p>It increases the risk by two to three times (C)</p> Signup and view all the answers

What does a Body Mass Index (BMI) of 30 or higher indicate?

<p>Overweight status (C)</p> Signup and view all the answers

According to the American Heart Association, how can insufficient sleep affect heart attack risk?

<p>It contributes to higher heart attack risk (B)</p> Signup and view all the answers

Which medication is considered an anticoagulant for heart attack treatment?

<p>Unfractionated heparin (A)</p> Signup and view all the answers

Which of these factors is NOT advised for preventing myocardial infarction?

<p>Using tobacco products moderately (D)</p> Signup and view all the answers

Flashcards

Myocardial Infarction (MI)

Irreversible death of heart muscle due to lack of oxygen.

Mechanism of MI

Usually involves a blocked coronary artery by a ruptured plaque.

Lifestyle risk factors for MI

Smoking, obesity, lack of exercise, and high stress.

Disease Risk Factors for MI

Diabetes, high blood pressure, high cholesterol, and some infections

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Genetic risk factors for MI

Family history of heart disease and specific genes.

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Risk factors for MI in Men

Men are more prone before menopause, compared to women.

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Risk factors of other ages

Old Age is a risk factor for heart attacks.

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Risk Factors for MI from pills

Some contraceptive pills increase the risk of a heart attack.

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Coronary Artery Disease

Narrowed or blocked coronary arteries, reducing blood flow to the heart muscle, potentially leading to a heart attack.

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High Blood Pressure

High blood pressure damages blood vessels, increasing risk of plaque build-up and narrowing of arteries, potentially causing a heart attack or MI (Myocardial Infarction).

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Smoking

Smoking damages blood vessel linings, causing inflammation and promoting plaque build-up, restricting blood flow to the heart.

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Diabetes

Diabetes increases plaque formation, blood clots, and risk of heart attack (MI).

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Lack of Exercise

Inactivity leads to fat build-up in arteries, potentially causing a heart attack.

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Poor Diet (High Saturated/Trans Fats)

High saturated and trans fats lead to cholesterol build-up, increasing risk of heart attack, by clogging the arteries.

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Poor Diet (High Salt)

High salt intake raises blood pressure, a major risk factor for heart attack.

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Alcohol (Heavy Consumption)

Heavy alcohol consumption hinders blood clot prevention (fibrinolysis), raises reactive oxygen species (ROS), and causes heart strain.

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Coronary Artery Spasm

Sudden narrowing of a coronary artery, restricting blood flow to the heart.

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ST-segment Elevation MI (STEMI)

A severe heart attack caused by a completely blocked coronary artery, resulting in extensive heart damage.

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NSTEMI

A less severe heart attack, caused by a partially blocked coronary artery.

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Chest Pain (MI symptom)

Common symptom of a heart attack, often felt as pressure, squeezing, or pain in the chest and radiating to the arms, back, neck, and jaw.

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Increased Heart Rate (Tachycardia)

A faster-than-normal heart rate, a symptom potentially associated with a heart attack.

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Coronary Artery Occlusion

Complete blockage of a coronary artery, preventing blood flow to the heart.

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Increased Blood Pressure

High blood pressure, a risk factor for heart attacks, often coupled with heart rate increase.

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Post-MI Rehab

A program that helps people recover after a heart attack (MI) by providing exercise, risk factor management, and emotional support.

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Cardiac Rehabilitation

A key part of post-MI recovery that involves structured exercise programs, education, and counseling to improve heart health.

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Exercise Training

A component of cardiac rehabilitation that includes supervised physical activity to improve cardiovascular fitness, strength, and endurance.

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Risk Factor Modification

Adjusting lifestyle habits like diet, smoking, and stress levels to reduce the risk of future heart problems.

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Psychosocial Support

Emotional support, counseling, and stress management techniques provided during cardiac rehab.

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Heart Failure

A condition where the heart cannot pump blood effectively, often a complication after a heart attack.

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Arrhythmias

Irregular or abnormal heart rhythms that can be caused by damage from a heart attack.

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Cardiac Arrest

A sudden, complete stoppage of the heart's electrical activity, a potential complication after MI.

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What is the purpose of a coronary angiogram?

A coronary angiogram allows doctors to visually examine the arteries supplying the heart, identifying any narrowing or blockages.

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What does a chest x-ray reveal in a suspected MI?

A chest X-ray in suspected MI is often used to identify complications such as pneumonia or heart failure, as well as determine the cause of the heart attack.

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What blood tests reveal MI?

Cardiac markers are blood tests that detect proteins released when heart muscle cells are damaged, indicating a possible MI.

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How does a coronary angiogram work?

A catheter is inserted into an artery, usually the femoral artery, and guided to the heart. A dye is injected, and X-rays are taken to visualize the blood flow.

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What's the difference between primary and secondary MI prevention?

Primary prevention aims to prevent MI in the first place by reducing risk factors, while secondary prevention focuses on stopping a second MI after the first one.

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What are the 3 levels of MI prevention?

The three levels of MI prevention are primary, secondary, and tertiary. Each level targets different phases of MI risk.

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What are examples of primary MI prevention?

Primary MI prevention includes healthy lifestyle changes like diet, exercise, stress management, and screenings to identify risk factors.

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What are examples of secondary MI prevention?

Secondary MI prevention focuses on preventing another heart attack after a first MI using medications such as beta-blockers and statins, and managing existing conditions like hypertension and diabetes.

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Replacing Saturated Fat

Swapping out unhealthy fats like butter and lard with healthier options like olive oil and canola oil to decrease heart disease risk.

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Diabetes and Heart Disease

Diabetes significantly increases the risk of developing heart disease.

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Preventing Diabetes

Lifestyle changes such as losing weight and exercising can help prevent diabetes from progressing.

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Moderate Aerobic Exercise

The recommended amount of moderate aerobic activity is at least 150 minutes per week or 75 minutes of vigorous activity.

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Smoking's Impact

Smokers have a significantly higher risk of heart disease and death compared to non-smokers.

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Healthy Weight for Heart

Maintaining a healthy weight reduces the risk of heart attack by lowering cholesterol and blood pressure.

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Sleep and Heart Health

Getting enough sleep can help prevent heart attacks and heart disease.

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Nitrates for Heart Attacks

Nitroglycerin, a nitrate medication, helps relax blood vessels and improve blood flow during a heart attack.

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Study Notes

Myocardial Infarction (MI)

  • Also called a heart attack
  • Irreversible death (necrosis) of heart muscle
  • Due to prolonged lack of oxygen (ischemia)
  • Blood flow to a part of the heart stops
  • Causes damage to heart muscle

Mechanism of MI

  • Often involves complete blockage of a coronary artery
  • Caused by a rupture of an atherosclerotic plaque
  • Also known as heart attack, cardiovascular stroke, or infarction of the heart

Etiology (Causes)

  • Lifestyle factors:
    • Smoking (36%)
    • Obesity (20%)
    • Lack of exercise (7-12%)
    • Stress (approximately 3%)
    • Tobacco smoke exposure
    • Alcohol intake
  • Diseases:
    • Diabetes mellitus (increases atherosclerotic plaque formation)
    • High blood pressure
    • High cholesterol levels
    • Endometriosis in women under 40 and Obesity
    • Chronic/acute infections

Genetics

  • Family history of ischemic heart disease or MI increases risk
  • Genome-wide studies have identified genetic variants associated with a higher MI risk
  • Genes like CDKN2A and 2B on chromosome 9 are implicated, though not always in coding regions

Risk Factors

  • Non-modifiable:
    • Age
    • Gender
    • Genetic factors
    • Race/ethnicity
  • Modifiable:
    • High blood pressure
    • Smoking
    • Cardiovascular disease
    • Diabetes mellitus
    • Physical inactivity
    • Obesity
    • High cholesterol

Classification of MI

  • Type 1: Spontaneous MI related to coronary events (plaque erosion/rupture, dissection).
  • Type 2: MI secondary to ischemia due to increased oxygen demand or decreased supply.
  • Type 3: Sudden unexpected cardiac death often with symptoms suggestive of myocardial ischemia.
  • Type 4: MI associated with percutaneous coronary intervention (PCI) or stent thrombosis.
  • Type 5: MI associated with cardiac surgery

Subtypes of MI

  • STEMI (ST-segment elevation myocardial infarction): Major coronary artery completely blocked by a ruptured plaque, resulting in extensive heart damage.
  • NSTEMI (Non-ST-segment elevation myocardial infarction): Coronary artery partially blocked or a branch off a major artery is blocked, usually resulting in less heart damage.

Pathophysiology

  • Atherosclerosis (gradual): Artery narrowing
  • Arterial spasm (sudden): Artery constriction
  • Atherosclerosis + Plaque (sudden not usually reversible): Artery blockage
  • Ischemia (reduced oxygen demand): Tissue damage
  • Hypoxia
  • Thrombolysis
  • Angina (chest pain)
  • Unstable angina (chest pain that increases in frequency and severity)
  • Permanent thrombus (blood clot)
  • Necrosis (cell death)

Diagnosis

  • History of presenting illness
  • Physical examination
  • Electrocardiogram (ECG) findings
  • Cardiac markers (blood tests for heart muscle cell damage)
  • Coronary angiogram (visualisation of narrowing or blockage in the heart vessels)
  • Chest X-ray and routine blood tests (for complications or precipitating causes)

Cardiac Markers

  • Myoglobin (early marker of myocardial damage): released from skeletal muscle and heart muscle into the blood stream.
  • Creatine kinase (CK-MB): released from skeletal and heart muscle cells into blood stream.
  • Cardiac Troponins (cTnI, cTnT): proteins specific to heart muscle; most specific indicator of MI.
  • Lactate dehydrogenase (LDH): enzyme found in many tissues released into bloodstream

Coronary Angiography

  • Medical imaging technique to visualize blood vessels
  • Catheter inserted into an artery (usually femoral artery)
  • Radio-opaque dye injected
  • X-rays (fluoroscopy) to detect blockages/narrowing
  • Therapeutic measure in some cases

Prevention

  • Primary: Health education, lifestyle modifications, risk factor awareness, risk factor identification and management
  • Secondary: Early detection and treatment of hypertension, hyperlipidemia, diabetes, atrial fibrillation, antiplatelet therapy, beta blockers, ACE inhibitors, and statins.
  • Tertiary: Post-MI rehabilitation, cardiac rehabilitation programs, exercise training, risk factor modification, psychosocial support, long-term management (medication adherence, follow-up)

Dietary Modifications

  • DASH (Dietary Approaches to Stop Hypertension)
  • Mediterranean diet: High in fruits, vegetables, nuts, seeds, whole grains; low in saturated fat and cholesterol
  • Omega-3 fatty acids (salmon, trout, tuna)

Lifestyle Modifications

  • ABCDESS: Alcohol reduction, blood pressure management, cholesterol control, diabetes management, exercise, smoking cessation, healthy weight maintenance

Sleep

  • Getting enough sleep is crucial
  • Insufficient sleep and poor quality sleep can increase MI risk
  • Avoid insufficient (<7 hours) or excessive sleep (≥10 hours)

Stress Management

  • Regular exercise
  • Relaxation techniques (e.g., meditation, deep breathing, yoga)
  • Maintaining positive attitude
  • Spending time with supportive people
  • Engaging in stimulating hobbies

Acute Phase (0-24 hours) Management

  • Pain management (e.g. morphine) with oxygen therapy
  • Maintaining SpO2 above 90%
  • Nitrates (e.g. Nitroglycerin)
  • Antiplatelet therapy (e.g. Aspirin, P2Y12 inhibitors)
  • Anticoagulation(e.g. heparin)
  • Beta blockers
  • ACE inhibitors/ARBs

Long Term Management

  • Antiplatelet therapy
  • Beta-blockers
  • ACE inhibitors/ARBs (angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers)

Complications Management

  • Heart Failure: Diuretics, digoxin, beta blockers
  • Ventricular arrhythmias: Anti-arrhythmic medications, ICD (Implantable Cardioverter Defibrillator)
  • Cardiac Arrest: CPR, defibrillation
  • Mechanical complications: Surgery, if needed (e.g., VSR, tamponade)
  • Stroke: Thrombolysis, anticoagulation

Follow-up

  • Outpatient clinic visits (1-2 weeks)
  • Echocardiogram (2-4 weeks)
  • Stress test (4-6 weeks)
  • Regular monitoring of blood pressure, lipids, blood glucose, and renal function

Surgical Procedures

  • Coronary Artery Bypass Grafting (CABG)
  • Percutaneous Coronary Intervention (PCI) - Angioplasty-Stenting

Complications of MI

  • Impaired contractility
  • Tissue necrosis
  • Electrical instability
  • Pericardial inflammation
  • Ventricular thrombus
  • Hypotension
  • Coronary perfusion
  • Ischemia
  • Papillary muscle infarction
  • Ventricular wall rupture
  • Mitral regurgitation
  • Arrhythmias
  • Congestive heart failure
  • Cardiac tamponade
  • Stroke (embolism)
  • Cardiogenic shock

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Description

This quiz covers the essentials of myocardial infarction, commonly known as a heart attack. Explore the mechanisms, causes, and genetic factors related to MI to enhance your understanding of this critical cardiovascular condition.

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