Myocardial Infarction

A. Definition
A heart attack (also known as a myocardial infarction) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen,causing injury to the heart muscle. Injury to the heart muscle causes chest pain and chest pressure sensation. If blood flow is not restored to the heart muscle within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is eventually replaced by scar tissue.

B. Types of Osteoporosis
Doctors use 3 different criteria to classify heart attacks. I. The part of the heart that was damaged. II. The changes seen on an electrocardiogram. III. The anatomic (or morphologic) extent of necrosis. I. According to the first criterion, there are two types of heart attacks  Anterior infarct-is the most dangerous type of heart attack and is caused by a blockage in the branch of the left coronary artery. It affects the lower chamber on the left side of the heart (left ventricle which pumps blood to all parts of the body) and damages the front part of the heart.  Posterior or inferior infarct- is a less serious form of heart attack and is caused by a blockage in the right coronary artery or one of its branches. It affects the back or the base of the heart.

II. According to the second criterion, there are two types of heart attacks  ST segment elevation myocardial infarction (STEMI)- this type of heart attack is caused by a prolonged period of blocked blood supply, and affects a large portion of the myocardium. It causes significant changes on the

electrocardiogram and in the level of blood chemical markers.  Non-ST segment elevation myocardial infarction (NSTEMI)- this type of heart attack is caused by a partial or temporary blockage in the blood supply and the extent of the damages is minimal. NSTEMI does not causes changes on the electrocardiogram, however the blood markers will indicate the occurrence of a heart attack by illustrating the tissue damage which has occurred. III. According to the third criterion, there are two types of heart attacks  Transmural myocardial infarction. This type of heart attack results in the death of the three layers of tissue (epicardium, myocardium, and endocardium) of the myocardial wall.  Nontransmural myocardial infarction. This type of heart attack results in the death of a limited area of myocardial wall tissue.

C. Signs and Symptoms

Signs and symptoms from the textbook Signs and symptoms manifested by the patient Fractures with little or no trauma  Due to weakness and increase fragility of the bone as a result of continuous bone loss and decreasing bone mass density. Loss of height (as much as 6 inches) over time Low back pain due to fractures of the Rationale

spinal bones Neck pain  Due to the fracture in right and left humeral neck Stooped posture or kyphosis, also called a "dowager's hump Decreased exercise tolerance  Due to weakness and increase fragility of the bone as a result of continuous bone loss and decreasing bone mass density. Protruding abdomen Possibly elevated parathyroid hormone serum calcium and phosphate     Calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker RBC count Due to the decreased capability of the bone marrow to produce RBCs. (+) pressure ulcer at the left heel Left foot is smaller than Right foot Due to decreased bone mass density. Due to prolonged immobility.

D. Risk factors
 Age Heart attacks are more frequent in men older than 45 and women older than 55.  Gender

The incidence of coronary artery disease and heart attack is higher in men than in women in all age groups  Family history of coronary artery disease A family history of coronary artery diseases increases the individual's risk for atherosclerosis and heart attack.  High levels of cholesterol.  High blood pressure or hypertension.  Tobacco use  Physical inactivity  Obesity  Diabetes  Alcohol use

E. Causes
 Hypoxia  Electrocution  Heart disease  Hemorrhage  Severe injury  Respiratory failure  Coronary thrombosis  Anaphylactic shock  Shock  Electrolyte imbalance  Arrhythmias  Coronary heart disease  Diabetes  Hypercholesterolemia

F. Complications  Arrhythmias and heart block- due to injured or ischemic conduction system tissue  Hypotension and Congestive heart failure- due to ischemic or injured muscle tissue, resulting in abnormal filling {"diastolic dysfunction"} or abnormal emptying {"systolic dysfunction"}).  Acute mitral regurgitation-results in an abrupt decrease in forward cardiac output, leading to congestive heart failure and often to cardiogenic shock.  Ventricular septal rupture-can occur usually several days following the acute infarction, due to softening of the necrotic portion of the septum  Left ventricular aneurysm formation- this weakening of the apical wall results in an outpouching or "dyskinesis" of the apex of the heart during systole.  Right ventricular infarction-Right ventricular infarction occurs almost

exclusively in the setting of right coronary artery occlusion. Hallmarks include elevation of the jugular venous pressure in the absence of pulmonary congestion  Pericarditis-Post infarction pericarditis usually begins several days after the infarct, due to an inflammatory exudate in the pericardium.  Cardiogenic shock- results when there is a marked reduction in forward cardiac output leading to hypotension, decreased organ perfusion, and at the same time elevated left ventricular filling pressures leading to congestive heart failure.

G. Treatment Medications:
Anticoagulants Decrease the blood's ability to coagulate preventing new blood clots from forming or preventing blot clots from becoming too large in size (which can lead to complications). Antiplatelet agents Antiplatelet agents prevent new blood clots from forming and helps maintain the blood flow through a narrow artery. Thrombolytics or clot-busters Dissolve the blood clot that is obstructing a narrow artery.

Beta blockers Limit the heart workload by decreasing the heart rate, relaxing the heart muscle, decreasing the blood pressure, reducing the heartbeat, and decreasing the overall myocardial demand for oxygen. Vasodilators Vasodilators relax the blood vessels allowing an increased oxygen-rich blood to flow within them and reduce the heart workload. It is also used to treat chest pain. Angiotensin converting enzyme inhibitors. Angiotensin converting enzyme inhibitors help the heart to heal and improve the heart functioning.

Invasive Cardiac Procedures

Coronary angioplasty or percutaneous transluminal coronary angioplasty, balloon angioplasty, or coronary artery balloon dilatation A catheter-based procedure used to increase the blood flow through an obstruct artery. Laser angioplasty Medical procedure used to open those coronary arteries blocked by plaque. Coronary artery bypass surgery Medical procedure used in some cases of heart attack to restore the blood flow to the affected portion of heart muscle. Minimally invasive heart surgery or limited access coronary. An alternative to the standard bypass surgery. This procedure is used when only one or two arteries need to be bypassed, and is performed through several small incisions (ports) in the chest and a small incision made directly over the coronary artery that needs to be bypassed.

F. Prevention
 Quit smoking Cigarette smoking damages the cell lining within the blood vessels and heart increasing the risk of atherosclerosis and blood clots.

 Keep cholesterol low Lower intake of saturated fat, trans fat, and cholesterol, to exercise daily, and as a last remedy, take prescription medication.  Natural Supplements Over the counter natural supplements, Fiber, Niacin, Plant Sterols, Garlic, and Co-enzyme Q10, have been proven to lower cholesterol levels.  Keep the blood pressure under control  Exercises regularly Research has shown that exercising at least 30 minutes every day can significantly decrease the risk of heart attack by lowering blood pressure and cholesterol, keeping your weight under control, and strengthening the heart muscle.  Maintain a healthy weight  Choose a healthy diet Eat vegetables, fruits, whole-grain and high-fiber food, fish, and lean protein and fat-free or low-fat diary products. Avoid aliments such as butter, high fat milk, ice creams (especially if you battle weight problems), fat meat, egg yellow, and nuts.