MI, heart attack, or coronary event|
- The heart uses a series of pipe-like structures (arteries) to pump fresh oxygen-rich blood and nutrients (vitamins, minerals, Proteins, and fat) to
the rest of the body. Oxygen is important for the survival of the body's living cells, because, without it, they will die. The heart is made up of myocardium (heart muscle). The arteries that supply blood to the heart itself are called the coronary arteries. When the coronary arteries are blocked or damaged, the flow of blood to the myocardial muscles is interrupted. They become hypoxic (without oxygen) and infraction (death) occurs. MI is the leading cause of death in America.
- Atherothrombotic cardiovascular
disease -- the major cause of most Myocardial Infarctions
- Vascular system refers to the system of arteries and veins that carry blood throughout the body, while cardio or cardiac refers to the heart. Cardiovascular refers to the arteries that supply blood to the heart.
- The normal artery is a tube (pipe) like structure that has many layers. The lining that covers the inside of the tube (endothelium) can be damaged by factors such as tobacco smoking, infection, High Blood Pressure, physical or chemical factors (deficiency of vitamin B6).
- Damaged endothelium is exposed to rapid blood flow and its contents, including fat-carrying protein (LDL) and cholesterol.
- LDL rubs against the endothelial lining, getting under it, and forming fatty streaks (yellowish fatty lines) or plaque.
- Plaques can also occur in arteries throughout the body, causing them to thicken and harden over years. This is called atherosclerosis.
- Platelets, which stop bleeding by
forming scabs (clots) and monocytes, clean up fatty streaks,
while arriving to repair the damaged endothelium.
- Platelets cause the muscles in the wall of the artery (smooth muscles) to multiply and grow.
- Over time, the process of endothelial damage (attempted repair by platelets and monocytes) and the growth of smooth muscle, leads to enlarging plaque that finally extends into the lumen or the center of the artery, and is called atheroma (shaped like a hill).
- The atheroma continues to grow, and its top layer becomes thin and subject to rupture.
- Platelets and red blood cells attach to the open area and a clot (thrombus) is formed.
- If the thrombus is large enough, it can block the entire lumen, as well as the flow of blood.
- When blood flow is interrupted, the heart muscles that normally receive blood from that particular artery undergo an infarction (MI).
- When the muscle cells are damaged (infarct), they release the chemicals (enzymes) inside of them into the blood.
- If the blockage lasts more than 4-6 hours, irreversible myocardial damage occurs.
- The area of infarction (dead muscle) is unable to participate in the electrical activities of the heart, which may cause dangerous electrical problems (arrythmias).
- The infarction could be small (silent or not noticed by the patient) and the heart may repair the damage by growing new paths for blood to get to the infarcted muscles.
- Infarction, when large enough, will cause major problems for the heart, and may lead to severe symptoms, even death.
- In rare cases, other disorders and diseases can cause MI, such as:
- Coronary emboli -- lesions of heart valves, or a thrombus in the left chambers of the heart
- Thrombotic coronary artery disease -- conditions that cause the blood to thicken and form blood clots.
- Coronary vasospasm -- as it is seen in cocaine or Amphetamine Abuse
- Coronary vasculitis -- as it is seen when the body's defenses attack the coronary arteries (SLE)
- Trauma -- damage to coronary arteries can occur when stabbed or if exposed to radiation.
- Carbon Monoxide Poisoning increases the heart muscle's demand for oxygen
As the patient enters the emergency
room, these events take place almost simultaneously:
- A history of symptoms and medical problems is necessary
- Physical examination
- Increased heart rate, blood pressure, and breathing
- There may be pale skin with a bluish discoloration of the lips.
- The eyes are examined with an ophthalmascope (a special flash light), and may show diabetic hypertensive (changes due to High Blood Pressure), and atherosclerotic changes (thick copper color arteries).
- One may hear wheezing or fluids on examination of the lungs with a stethoscope (hearing device).
- Using a stethoscope, one may hear extra or abnormal heart sounds (murmurs and gallops).
- Electrogardiograph (EKG)
--measures the electrical energy of the heart and the
paths it travels (painless test)
- The test is done by attaching electrodes or wires to the chest, legs, and arms.
- The recording of electrical energy that shows up as a tracing on paper
- In a normal heart, the tracings have a characteristic shape, size, direction, width and length, whereas with MI, these patterns are abnormal and can tell the doctor the location and severity of the infarct (front, back, below, sides, etc.).
- The doctor can also tell if there is an interruption (block) of normal electrical pathways, or if the heart rate is abnormal.
- A chest X-Ray may show fluids in the lungs.
- An Echocardiogram uses sound waves (painless) to see if the heart has suffered any structural damages after an MI.
- A pulse oxymeter is attached to the index finger and tells the doctor how much oxygen is in the patient's blood (painless).
- Blood is taken from the veins (usually in the arms) and sent to a lab for analysis of the enzymes and other chemicals that have leaked out from the damaged heart muscles, i.e., Troponin I (appears 6-8 hours after MI), Creatnine Kinase or CK (4-8 hours after MI), CKMB, LDH, and ESR.
- The number of white blood cells may also increase after a MI.
- Family history of atherosclerosis
- Age -- 50% of all cases occur in the elderly
- Sedentary life style -- the "couch potato" who does not exercise
- The occurrence is higher in males than in females until age 70. After 70, the risk is equal.
- Diabetes Mellitus -- high blood glucose (sugar)
- Hypertension --High Blood Pressure
- Obesity -- being overweight, especially around the waste or "rim" area.
- High levels of bad cholesterol (LDL)
- Low levels of good cholesterol (HDL), which protects against developing atherosclerosis
- High levels of homocystine -- an amino acid in the blood of 20-25% of Americans
- Possibly high levels of triglycerides (fat carrying chemicals in the blood)
- Possible infections Include Chlamydia, Helicobacter bacteria, or cytomegalovirus
- The drugs -- usually cocaine and
As the patient enters the emergency
room, all of the following are done by the emergency room
staff, under the guidance of a cardiologist (heart
- An IV or intravenous catheter (a thin plastic sheath around a thin needle) is placed in the arm (simple but slightly uncomfortable) through which fluids and liquid medication can be given.
- Oxygen (2-4 liters per minute) is given via a mask or two plastic tubes to treat hypoxia (this is painless and relieves shortness of breath).
- Nitroglycerin tablets under the tongue help to relax the atherosclerotic artery so that blood can pass with greater ease, and reduce chest pain.
- Nitroglycerin may be given up to 3 times every 5 minutes.
- Morphine, a powerful painkiller, can help reduce pain and Anxiety.
- Drugs such as Lidocaine, Pronestyl, Digitalis, and Verapamil may be given if complications like arrythmia (fast, slow, or an irregular heart rate) develop.
- Aspirin -- 325 mg taken by mouth in combination with other blood thinners will reduce the degree of blockage and death.
- Alteplase IV (tissue plasminogen activator or TPA), if given early within 4-6 hours after MI, may dissolve (make liquid) the clot and save the muscles. Not everyone qualifies for this treatment because of the significant risk of severe bleeding.
- Heparin IV can also thin the blood, and it is often given with TPA.
- Beta-blockers such as Lopressors are effective in reducing the damage of certain MIs and their recurrence.
- If the heart has stopped or the beating is extremely irregular, quick CPR (chest compression) should be started while medications are given intravenously to help the heart start or beat normally. If these measures fail, DC counter Shock will deliver large jolt of electrical energy to jump-start the heart and generate a normal rhythm.
- DC counter Shock is done by placing two large paddles moistened with gel on the chest and Shocking the heart.
- Once the patient is stabilized, he/she is transferred to the ICU (intensive care unit) for further monitoring and procedures.
- If the patient is not responding to medical treatment and there is evidence that the infarct is expanding (EKG changes, pain), a PTCA may be done.
- A cardiologist in an operating room setting performs the PTCA.
- During PTCA, a small cut is made in the skin and a wire with a flat balloon is pushed through the underlying blood vessels and guided into the heart and the blocked artery. The balloon is then inflated and, by pushing the atheroma against the wall as it opens, a tunnel for blood to flow through is created.
- During PTCA, a cardiologist will use a stent (a small springlike tube placed inside the artery) to keep the artery open after the procedure.
- Rarely, patients who have significant heart disease and may not qualify for PTCA, may need to have open-heart (or CABG) surgery in order to remove and replace the diseased and blocked arteries.
- After the MI, the patient is monitored by serial EKGs, blood tests, and followed up by a cardiologist.
- Fluids are taken and the amount urinated is closely measured.
- The first day after MI, a liquid or soft diet, low in fat and salt, is started.
- Very hot and cold beverages containing caffeine should be avoided.
- The diet is then gradually improved to solids.
- Stool softeners are often given to prevent Constipation.
- Sleeping pills may be given if needed.
- After 2-3 days of monitoring in the ICU, the patient is transferred a step downward, and observed further.
- A dietary specialist (nutritionist) may advise the patient about correcting his diet.
- The nutritionist will recommend that the patient:
- Exercise, when approved by the doctor (i.e., walking, yoga, meditation, or tai chi)
- Reducing stress -- make life simple and organize priorities.
- Eat more fruit and vegetables
- Eat more fiber, especially oat bran, pectins, and flax seed
- Use vegetable oils (cold pressed) and reduce saturated fats, cholesterol, and animal products (dairy, beef, pork).
- Reduce sugars and starchy foods
- Eat fish, salmon, and other oily fish 2-3 times per week.
- Avoid all fried foods. Try baking, boiling, or even BBQ.
- Studies have shown that multivitamins and multiminerals, vitamin C, flaxseed oil, vitamin E, EPA, mesoglycan, carnitine, Folic Acid, and pantethine may help as supplements (ask your doctor first).
- When stable, the patient is discharged home with a follow-up appointment to see the doctor.
If you experience any symptoms of MI, call 911 immediately. Do not delay, because more than 60% of deaths occur within one hour of the onset of symptoms.
-- a lack of oxygen to the myocardium produces pain, but causes no infarct.
- Esophageal Spasm -- tube that carries food from the mouth to the stomach can have spasms (cramps) and cause chest pains.
- Aortic Dissection -- the major artery located in the center of the chest and abdomen can rupture and cause chest pains.
- Pulmonary Embolism --
a blood clot can travel to the lungs and cause chest pains and shortness of breath.
- Pericarditis --
an infection of the sac surrounding the heart can cause pain and EKG changes similar to MI.
- When diseased, the gallbladder and pancreas can produce symptoms similar to MI.
If you want your friend to read or know about this article, Click here