Myocardial Infarction Presentation PDF

MYOCARDIAL INFARCTION  Myocardial Infarction DEFINATIΟΝ: Myocardial Infarction (MI) also called (heart attack) Is the irreversible death (necrosis) of heart muscles due to prolonged lack of oxygen supply (ischemia) when blood flow (enriched with oxygen) stops to a pa...

MYOCARDIAL INFARCTION  Myocardial Infarction DEFINATIΟΝ: Myocardial Infarction (MI) also called (heart attack) Is the irreversible death (necrosis) of heart muscles due to prolonged lack of oxygen supply (ischemia) when blood flow (enriched with oxygen) stops to a part of heart causing damage to heart muscles. MECHANISM OF MYOCARDIAL INFARCTION The mechanism of a MI often involves the complete blockage of a coronary artery caused by a rupture of atherosclerotic plaque. Also called Heart Attack, Cardio Vascular Stroke, Infarction of heart, Cardiac Infarction.  ETIOLOGY LIFESTYLE 1. Smoking (36%) 2. Obesity( 20%) 3. Lack of exercise (7-12%) 4. Stress-related cause and chronic high stress levels (about3%) 5. Tobacco smoking and short-term exposure to air pollution 6. Other factors e.g. lack of physical activity 7. Acute and prolonged intake of high quantities of alcoholic drinks  DISEASE: 1. Diabetes mellitus-According to the American Heart Association (AHA)Diabetes can increase the formation of atherosclerotic plaque, which can lead to thrombosis and MI. 2. High blood pressure 3. High level of blood cholesterol 4. Endometriosis in women under the age of 40 and Obesity 5. A number of acute and chronic infections  GENETICS 1. Family history –Family history of ischemic heart disease or MI, particularly if one has a male first-degree relative (father, brother) who had a myocardial infarction before age 55 years, or a female first-degree relative (mother, sister) less than age 65 increases a person’s risk of MI. 2. Genes-Genome-wide association studies have found 27 genetic variants that are associated with an increased risk of myocardial infarction. The strongest association of MI has been found with chromosome 9 on the short arm p at locus 21, which contains genes CDKN2A and 2B, although the single nucleotide polymorphisms that are implicated are within a non- coding region. The majority of these variants are in regions that have not been previously implicated in coronary artery disease OTHERS 1. Men are more at risk than women (before menopause) 2. Contraceptive pills 3. Family history of ischemic heart disease 4. Old age increases risk of heart attack. RISK FACTORS  RISK FACTORS Coronary Artery Disease :- It occurs when the coronary arteries that supply blood to the heart muscle become narrowed or blocked, which can lead to a heart attack High Blood Pressure :-High blood pressure can damage blood vessel walls, making them less elastic and more likely to tear. This can lead to plaque build-up, or atherosclerosis, which can narrow arteries and block blood flow to the heart. High blood pressure can cause the heart muscle to thicken, which can contribute to MI. Smoking:-Chemicals in tobacco smoke, such as nicotine and carbon monoxide, damage the inner lining of blood vessels. This damage leads to inflammation and promotes the build-up of plaque inside the arteries.Plaque build-up narrows the arteries, restricting blood flow to the heart. Diabetes :-diabetes increase atherosclerotic plaque formation and thrombosis, thereby contributing to myocardial infarction. Lack of exercise :-Physical inactivity can cause fatty material to build up in your arteries, which can lead to a heart attack if the arteries that supply blood to your heart become damaged and clogged. Race and ethnicity:-According to the American Heart Association (AHA) AMI rates vary by race and ethnicity, with white men having the highest rates across all age groups. Black women have the highest AMI rates among women aged 35 to 74 years. Poor diet:- High in saturated and trans fats:-These fats can cause cholesterol to build up in the arteries, which can lead to a heart attack. High in salt:-Too much salt in the diet can raise blood pressure, which is a risk factor for heart intake:- Alcohol disease. Reducing fibrinolysis:-Heavy alcohol consumption can significantly reduce fibrinolysis, which is important for determining AMI. Increasing reactive oxygen species:-Alcohol consumption increases the level of reactive oxygen species (ROS) in myocytes, which can lead to cardiac dysfunction. Causing vasodilation:-Alcohol causes blood vessels to expand, which reduces blood pressure. To compensate, the heart pumps harder and faster, which increases the heart rate. LESS COMMON RISK FACTORS OF MYOCARDIAL INFARCTION Cocaine. Mechanism for the development of myocardial infarction in the cocaine user is coronary artery spasm at a time when oxygen demand is increased due to an increase in heart rate and blood pressure that are accompanied by platelet activation, and together culminate in coronary artery occlusion, Emotional stress –When you’re stressed, your body releases cortisol, which can: Increase blood sugar and blood pressure ,Lower HDL, or “good” cholesterol ,Increase inflammation in your body. Unhealthy behaviours such as overeating ,smoking ,consuming excess alcohol, abstaining from regular exercise. Extreme colds –According to the American Heart Association (AHA)When you’re cold, your body constricts blood vessels to keep your core warm and vital organs working. This narrowing increases pressure in the rest of your circulation, making it harder for your heart to pump blood. Age The American Heart Association (AHA) the global prevalence of MI is 3.8% for people under 60 years old and 9.5% for people over 60 years old. Family history and Genetic Factors High blood pressure during pregnancy Gender (men are more at risk than women).  SIGNS AND SYMPTOMS Most common sign and symptom is chest pain which travels into shoulders, arms, back, neck and jaws. Often it occurs in the centre or left side of the chest and lasts for more than a few minutes (30-60 minutes).The pain is often described as a pressure, squeezing, aching, burning, or sharp sensation Patient Blood Pressure (BP) Is initially elevated because of peripheral arterial vasoconstriction. Patient Heart rate (HR) Is often increased (Tachycardia). In some patient the symptom is epigastric with a feeling of indigestion, fullness and gas.  SIGNS AND SYMPTOMS Respiratory rate also increased due to pulmonary congestion or anxiety. Other signs and symptoms are fatigue, tiredness, malaise, coughing, wheezing, production of frothy sputum, shortness of breath, nausea, cold sweats, dizziness, headache.  CLASSIFICATION OF MYOCARDIAL INFARCTION  SUB TYPES STEMI ST-segment elevation myocardial infarction is a "classic" heart attack that occurs when a major coronary artery is completely blocked by a ruptured plaque. This results in extensive heart damage. NSTEMI Non-ST-segment elevation myocardial infarction is a heart attack that occurs when a coronary artery is partially blocked or when a branch off of a major coronary artery is blocked. This usually results in less damage to the heart muscle. PATHOPHYSIOLOGY  DIAGNOSIS OF MYOCARDIAL INFARCTION A diagnosis of Myocardial Infarction can be done by : 1. Integrating the history of the presenting illness. 2. Physical examination 3. Electrocardiogram findings 4. Cardiac markers (blood tests for heart muscles cell damage ) 5. A coronary angiogram allows visualization of narrowing or obstruction on the heart vessels. A chest radiograph and routine blood tests may indicate complications or precipitating causes and are often performed upon arrival to an emergency department. ELECTROCARDIOGRAM CARDIAC MARKERS  CORONARY ANGIOGRAPHY Angiography is a medical imaging technique used to visualize the inside of blood vessels and diagnose vascular disease. A catheter is inserted into an artery ( usually the femoral artery) and pushed to the vessels supplying the heart. A radio –opaque dye is administered through the catheter and a sequence of x- rays (fluoroscopy) Is performed. Obstructed or narrowed arteries can be identified, and angiography applied as therapeutic measure.  PREVENTION FROM MYOCARDIAL INFARCTION Here are the levels of prevention for Myocardial Infarction (MI) Primary Prevention 1. Health education: lifestyle modifications, risk factor awareness 2. Risk factor identification and management: - Hypertension - Hyperlipidemia - Diabetes - Smoking - Obesity 3. Dietary modifications: low-fat, high-fiber, omega-3 rich 4. Physical activity: regular exercise, ≥150 minutes/week 5. Stress management: relaxation techniques, mindfulness 6. Immunizations: flu, pneumococcal 7. Screening tests: Blood pressure- Lipid profile ,Fasting glucose,Electrocardiogram Secondary Prevention 1. Acute MI management: Emergency medical services (EMS)Reperfusion therapy (thrombolysis, PCI)Medical therapy(beta-blockers, ACE inhibitors) 2. Early detection and treatment of:- Hypertension, Hyperlipidemia, Diabetes, Atrial fibrillation. 3. Antiplatelet therapy (aspirin, clopidogrel) 4. Beta-blockers for hypertension and heart failure 5. ACE inhibitors/ARBs for hypertension and heart failure 6. Statins for hyperlipidemia 7. Regular monitoring - Blood pressure- Lipid profile- Fasting glucose, ECG. - 7. Lifestyle modifications:- Smoking cessation Weight management- Physical activity Tertiary Prevention - 1. Post-MI rehabilitation: Cardiac rehabilitation programs,Exercise training, Risk factor modification, Psychosocial support - 2. Complication management: Heart failure- Arrhythmias Cardiac arrest - 3. Long-term management: Medication adherence Regular follow-up Note: Primary prevention aims to prevent MI from occurring Secondary prevention focuses on early detection and treatment. Tertiary prevention manages post MI rehabilitation and prevents complication.  DIETARY MODIFICATIONS THAT CAN HELP PREVENT MYOCARDIAL INFARCTION Following a healthy dietary pattern such as the Dietary Approaches to Stop Hypertension (DASH) diet can help to lower blood pressure, The DASH diet is specifically designed to lower blood pressure, It emphasizes fruits vegetables whole grains low-fat dairy products, legumes,nuts seeds and lean meats, These foods are typically high in fibre and low in saturated fat cholesterol and sodium, The Mediterranean diet has been found to lower cholesterol and reduce CVD risk, This diet is rich in fruits, vegetables, nuts seeds and whole grains with limited consumption of red meat and sweets, Olive oil is the main source of dietary fat. Eating foods rich in omega-3 fatty acids such as salmon trout, tuna herning and mackerel also helps to reduce heart disease risk,  LIFESTYLE MODIFICATIONS THAT CAN HELP PREVENT MYOCARDIAL INFARCTION A healthy Lifestyle involves a range of healthy behavior, One way to think about heart disease risk and corresponding Lifestyles changes is the acronym ABCDES:- Alcohol Blood Pressure Cholesterol Diabetes Exercise Smoking  ALCOHOL Excessive alcohol consumption is associated with increased risk for death ,heart disease and liver disease. According to the CDC, the safe amount of alcohol to drink to reduce the risk of heart disease is: Women: No more than 1 drink per day Men: No more than 2 drinks per day BLOOD PRESSURE Studies suggest that the DASH diet can lower systolic blood pressure (the top number) by about 8 mm Hg and diastolic blood pressure (the bottom number) by about 4 mm Hg and reduce mortality. CHOLESTROL Research suggests that reducing saturated fat in the diet and replacing saturated fat with polyunsaturated fat may lower cardiovascular risk, This means replacing butter coconut oil palm oil, shortening or lard with alive safflower canola corn sesame soybean and sunflower oils  DIABETES Diabetes is a major risk factor for heart disease, Fortunately lifestyle changes can help. For example if you have prediabetes losing at least 7% of body weight and engaging in 150 minutes or more per week of moderate intensity physical activity has been shown to reduce the risk of progressing to diabetes, EXERCISES The Physical Activity Guidelines for Americans from the US Department of Health and Human Services recommend that all adults ages 18 to 64 engage in at least 150 minutes of moderate aerobic exercise per week or 75 minutes of vigorous aerobic activity per week. or an equivalent mix of the two. Activities such as brisk walking running swimming biking and other aerobic exercises are all good options,  SMOKING Smokers have a higher heart disease risk than never- smokers, and two to three times the risk of death. The more you smoke, the higher your risk of death. Quit-smoking medications like varenicline (Chantix) and bupropion (Wellbutrin), and nicotine replacement therapies, are generally safe and can effectively help people quit smoking..  OTHER FACTORS THAT CAN HELP PREVENT MYOCARDIAL INFARCTION WEIGHT Maintaining a healthy weight can help reduce the risk of myocardial infarction (heart attack). Body mass index (BMI) According to CDC, BMI of 30 or higher is considered overweight. A higher BMI is linked with higher cholesterol, higher blood pressure, and an increased risk of heart disease and stroke.  SLEEP Getting enough sleep can help prevent myocardial infarction (MI) or heart attack: Sleep duration: The AHA recommends avoiding insufficient sleep ( 90% 3. Nitrates: Nitroglycerin (sublingual or IV) 4. Antiplatelet therapy: Aspirin (162 325 mg)P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) 5. Anticoagulation: Unfractionated heparin (UFH) Low molecular weight heparin(LMWH) 6. Beta blockers: Metoprolol, atenolol (unless contraindicated) 7. ACE inhibitors/ARBs: For hypertension, heart failure, or diabetes Early In-Hospital Care (24-48 hours) 1. Continue oxygen therapy 2. Monitor cardiac rhythm 3. Optimize beta blocker dose 4. Start statin therapy 5. Consider aldosterone antagonist (spironolactone) 6. Cardiac rehabilitation referrals Long-Term Management Antiplatelet therapy (indefinite) Beta blockers (indefinite) ACE inhibitors/ARBs (indefinite) Complications Management 1. Heart failure: Diuretics, digoxin, beta blockers 2. Ventricular arrhythmias: Antiarrhythmic, ICD 3. Cardiac arrest: CPR, defibrillation 4. Mechanical complications: Surgery (e.g.. VSR, tamponade)00 5. Stroke: Thrombolysis, anticoagulation Follow -up Outpatient clinic visit (1-2 weeks) Echocardiogram (2-4 weeks) Stress test (4-6 weeks) Regular monitoring of:- Blood pressure- Lipids- Blood glucose+- Renal function Surgical Procedures: 1. Coronary Artery Bypass Grafting (CABG): On-pump or off- pump ,Single or multiple grafts 2. Percutaneous Coronary Intervention (PCI):- Angioplasty-Stenting (bare-metal or drug-eluting) Thank you