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Treatment of myocardial infarction medscape

A myocardial infarction or heart attack MI signifies the death of heart muscle cells due to lack of oxygen supply. This occurs when a coronary artery which supplies oxygenated blood to the heart is significantly blocked, commonly by plaques or cholesterol deposits. The coronary circulation consists of the right and left main coronary arteries. The left coronary artery further divides into the left circumflex artery and the left anterior descending artery LAD.

The LAD supplies the anterior front part of the left ventricle the lower chamber of the heart. Depending on the extent of blockage to the LAD and its branches, the septum wall between the left and right ventricles and the lateral side of the ventricle may also be affected.

Therefore an anterior myocardial infarction is the death of heart muscles of the front, and possibly the side and septum, of the left ventricle. Depending on the extent of involvement, cardiac function may be compromised in terms of its ability to pump and deliver adequate blood supply to the rest of the body. If severe, cardiogenic shock resulting in death can occur.

The factors that lead to anterior MI are similar to those causing damage in other parts of the heart which are supplied by other branches of the coronary arteries. Risk factors which may predispose one to develop a heart attack include:. A heart attack involving the left ventricle can compromise the pumping action of the heart and the blood supply to the rest of the body.

This can lead to symptoms like:. Upon medical examination the patient may be found to have low blood pressure due to failure of blood circulation with irregular heartbeats. An electrocardiogram ECG will reveal the electrical changes in particular areas of the heart. The evaluation of lead changes in V1-V5 will show abnormalities in the waves, particularly the appearance of Q-waves and R wave progression in anterior wall infarcts. Specific biomarkers in the blood may also reveal the occurrence of an infarct.

Serum level of troponin is the best biomarker because it has a high level of specificity and sensitivity. Other biomarkers include creatine kinase—MB and myoglobin. Myoglobin levels rise earlier than the two biomarkers, but it has poor specificity and may also increase in other conditions.Medically reviewed by Drugs. Last updated on Aug 31, A heart attack occurs when one of the heart's coronary arteries is blocked suddenly or has extremely slow blood flow.

A heart attack also is called a myocardial infarction. The usual cause of sudden blockage in a coronary artery is the formation of a blood clot thrombus. The blood clot typically forms inside a coronary artery that already has been narrowed by atherosclerosis, a condition in which fatty deposits plaques build up along the inside walls of blood vessels.

treatment of myocardial infarction medscape

Slow blood flow in a coronary artery can happen when the heart is beating very fast or the person has low blood pressure. If the demand for oxygen is greater than the supply, a heart attack can happen without formation of a blood clot. People with atherosclerosis are also more likely to have this reason for a heart attack.

Acute Myocardial Infarction (AMI): Symptoms and Treatment Guidelines

Each coronary artery supplies blood to a specific part of the heart's muscular wall, so a blocked artery causes pain and malfunction in the area it supplies. Depending on the location and amount of heart muscle involved, this malfunction can seriously interfere with the heart's ability to pump blood.

Also, some of the coronary arteries supply areas of the heart that regulate heartbeat, so a blockage sometimes causes potentially fatal abnormal heartbeats, called cardiac arrhythmias. The pattern of symptoms that develops with each heart attack and the chances of survival are linked to the location and extent of the coronary artery blockage.

Most heart attacks result from atherosclerosis. The risk factors for heart attack and atherosclerosis are basically the same:. In early middle age, men have a greater risk of heart attack than women. However, a woman's risk increases once she begins menopause.

This could be the result of a menopause-related decrease in levels of estrogen, a female sex hormone that may offer some protection against atherosclerosis. Although most heart attacks are caused by atherosclerosis, there are rarer cases in which heart attacks result from other medical conditions. These include congenital abnormalities of the coronary arteries, hypercoagulability an abnormally increased tendency to form blood clotsa collagen vascular disease, such as rheumatoid arthritis or systemic lupus erythematosus SLE, or lupuscocaine abuse, a spasm of the coronary artery, or an embolus small traveling blood clotwhich floats into a coronary artery and lodges there.

The most common symptom of a heart attack is chest pain, usually described as crushing, squeezing, pressing, heavy, or occasionally, stabbing or burning.

Chest pain tends to be focused either in the center of the chest or just below the center of the rib cage, and it can spread to the arms, abdomen, neck, lower jaw or neck. Other symptoms can include sudden weakness, sweating, nausea, vomiting, breathlessness, or lightheadedness.Acute Myocardial Infarction AMI also known as a heart attack is caused by the complete or partial occlusion of a coronary artery and requires prompt hospitalization and extensive care management.

It is part of a spectrum of conditions that result from myocardial ischemia known as an acute coronary syndrome. Get more details on acute coronary syndrome here. Severe pre-existing coronary artery disease coronary atheromaPrinzmetal angina or drug-induced vasoconstriction, Reduced O2 content e. In Hypoxia or anemia.

Vasodilator drugs causing coronary steal, Heart valve disease particularly aortic stenosis. Sustained tachycardia, arrhythmias also reduce diastolic timeHypertension, Sympathetic stimulation e. Ventricular Hypertrophy. ST-segment elevation myocardial infarction aka transmural MI is myocardial necrosis with electrocardiogram changes indicating ST-segment elevation not quickly reversed by nitroglycerin.

This is characterized by elevated troponin I or troponin T and Creatinine kinase. In practice, the ST elevation alone is sufficient to treat because the troponins take time to rise. Non—ST-segment elevation myocardial infarction also known as subendocardial MI is myocardial necrosis that is evidenced by elevation of cardiac markers in the blood specifically troponin I or troponin T and CK.

There is no acute ST-segment elevation. Electrocardiogram changes such as an ST-segment depression or T-wave inversion may be present. Unstable angina is characterized by prolonged, severe angina, usually at rest, possibly with ECG changes. Type 1: This is the commonest type. It occurs due to a primary coronary event such as atherosclerotic plaque rupture, fissuring, coronary dissection or erosion.

It is also referred to as a spontaneous myocardial infarction. Type 2: This occurs due to an imbalance in myocardial oxygen supply and demands. This can be a case of ischemia because of an increased oxygen demand like in hypertension or due to decreased oxygen supply like in an embolism, coronary artery spasm, hypotension reduced blood pressurearrhythmia, anemia or tachycardia increased heart rate.Enhance your health with free online physiotherapy exercise lessons and videos about various disease and health condition.

Myocardial infarction treatment attempts to save as much myocardium as possible and to prevent further complications. Acute myocardial infarction AMIcommonly known as a heart attackis the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion blockage of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids fatty acids and white blood cells in the wall of an artery.

The resulting ischemia restriction in blood supply and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death of heart muscle tissue.

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The most frequent cause of myocardial infarction MI is rupture of an atherosclerotic plaque within a coronary artery with subsequent arterial spasm and thrombus formation.

In this stage patient is in severe pain, he is at risk of sudden death. In these cases patient and family must understand what is happening. In case of lethal arrhythmia, constant monitoring of the heart rhythm allows instant recognition of ventricular fibrillation and its electric conversion using direct current shock. Paddles are placed in front and back of the chest and a current is passed through the chest usually about joules. This electric conversion should be followed by drugs.

Treatment is difficult.

The Anterior Myocardial Infarction

Diuretics can reduce the breathlessness by lowering the filling pressure of the heart. Forward flow can be improved by drugs which make the heart beat more strongly or drugs reducing peripheral resistance. Occasionally counter pulsation is used when a long balloon is placed in the aorta.

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It is inflated during diastole, increasing arterial pressure and coronary perfusion. It is deflated during systole, reducing systolic pressure and hence reducing the work of the heart.

Anterior Myocardial Infarction: Causes, Symptoms, Diagnosis and Treatment

Clotting in a peripheral vein is common among patients. When it occurs in thigh or pelvic veins pulmonary embolism may occur. The risk is higher in heart failure, with extensive infarction, or in patients with varicose veins. The risk should be reduced by early mobilisation and leg exercises.

treatment of myocardial infarction medscape

Clotting over the endocardium damaged by the infarction may lead to systemic embolism. Anticoagulation may reduce this risk. Bed rest reduces physical fitness and impairs the reflexes that prevent and undue fall of blood pressure when we assume the upright position. General weakness and dizziness leads to severity of heart attack. Regular exercise and altering the posture of patient help to overcome these problems and improve patient morale. Most patients able to sit up in chair and take a few steps within 24 hrs of heart attack.

As the days in hospital pass, exercise increases but the patient must avoid undue tachycardia. Before discharge patient must climb stairs in hospital. Inflammation of the lining of the heart occurs after infarction.

This is painful and is reduced by the drugs. Patient leaving hospital should be diagnosed, prescribed by drugs and level of exercise and activities permitted at home and the expected date of returning to work should be given.

Beta blockers- atenolol Digitalis, diuretics, and vaso-dilator drugs to reduce heart failure.Upon waking up, the patient narrated that he fell unconscious because of the unexplainable pain in the chest that he felt. ER doctors diagnosed him with myocardial infarction. Myocardial Infarction by Osmosis. Some of the patients have prodromal symptoms or a previous diagnosis of CAD, but about half report no previous symptoms.

The goals of medical management are to minimize myocardial damage, preserve myocardial function, and prevent complications. The nursing management involved in MI is critical and systematic, and efficiency is needed to implement the care for a patient with MI. Based on the clinical manifestations, history, and diagnostic assessment data, major nursing diagnoses may include.

Nursing interventions should be anchored on the goals in the nursing care plan. After the implementation of the interventions within the time specified, the nurse should check if:.

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To ensure that every action documented is an action done, documentation must be secured. The following should be documented:. All questions are given in a single page and correct answers, rationales or explanations if any are immediately shown after you have selected an answer. No time limit for this exam. Chest pain B. Dyspnea C.

treatment of myocardial infarction medscape

Edema D. An intravenous analgesic frequently administered to relieve chest pain associated with MI is:. Meperidine hydrochloride B. Hydromorphone hydrochloride C. Morphine sulfate D. Codeine sulfate. An absent P wave B. An abnormal Q wave C.

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T-wave inversion D. ST segment elevation. Which of the following statements about myocardial infarction pain is incorrect? It is relieved by rest and inactivity.Outcomes for those suffering from an MI can vary greatly. Factors such as education level, patient-physician relationship, quality of care and family support all effect patient compliance in post-MI treatment.

The challenge then, becomes addressing and treating the common cause of MI, which is Coronary artery disease itself. Among the guidelines are recommendations for multidisciplinary approach and rehabilitation services. Many post- MI patients today do not receive such services, even if they receive the most advanced care and medication to address the CAD.

Patient education to address underlying causes, such as diet and lifestyle factors, does occur often, but can vary greatly, depending on the patient-physician relationship. Medications to treat MI patients can include beta blockers, ASA and thromblytics, as well as statins, to reduce elevated lipid levels. It is imperative that patients know why they must take specific medications, not just that they take them.

Though post-MI treatment typically begins in the hospital, follow up and continuing education is extremely important. In one study of three managed care systems, informational and educational brochures were created and mailed to patients, to encourage continued use of beta blocker medication. While the study strongly suggests the need for continuing education and reminders, to achieve enforcement, a hybrid approach to postal services and personal correspondence may have an even greater effect.

Again, follow up appears as a key factor in compliance. One of the other factors identified by Phend, which is quality of nursing care, can play a vital role. Physicians are often the first care providers to information to patients. However, contact with other health care workers occurs most often, after initial treatment for an MI.

Myocardial Infarction

Nurses can and often do provide additional education, answer questions, arrange for additional services and schedule appointments in clinics, prior to patient discharge. The position of a nurse in accordance with post-MI treatment can be one of the educators and supporting means; when there is none. Even if the patient is not in permanent contact with the nurse, referral to supportive services and educational groups can be an integral part of care, prior to patient discharge.

Nurses often fill roles such as case manager and community care provider. At the moment risk reduction is generally recognized as the safest course of action in treating post-MI patients.

Aside from factors such as family support, transportation and access to treatment, fragmentation of care is also an obstacle to care. Patients often leave the hospital and receive post-MI care in clinics or community centers. Physicians are responsible for risk management for patients after an MI, yet they have so little time to spend with each patient, in the clinic setting.

Patients often have multiple risk factors, such as smoking, atherosclerosis and CAD. The nurse can bridge the gap and address all the risk factors together, providing a much more intense follow up program post-MI.

Nurses often call or speak to patients directly on the phone. This is an important opportunity to ensure patient compliance, answer questions about lifestyle changes or medications and other aspects of post-MI care. Once damage to the heart from an MI has occurred; heart failure is often reduced with appropriate medication at appropriate levels. Post-MI programs that address appropriate patient education should therefore, also monitor and adjust medication to appropriate or optimum levels.

This model of care is very applicable to the post-MI clinic setting, where it can help to ensure patients receive better care within the critical three month post-MI period.

Lipid lowering medications are often a vital part of post-MI care.

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Nurses who fill the role of case manager, can ensure that lipid lowering medication is included in post-MI care, when necessary. Other forms of treatment, such as diagnostic ECG, echocardiogram and angiography are often part of post-MI treatment. Nurses who manage post-MI care can ensure patients are scheduled, understand the need for such diagnostic tests and better prepare patients for them as well. Beyond post-MI care in the clinic setting, are barriers in accessing post-MI care, such as transportation, lack of health coverage and lack of family support.

The more a patient understands the importance of care, the more likely the patient is to comply with treatment. However, many patients lack understanding of the situation and the importance of post-MI care. The managed care study shows how important patient education can be, even without intervention by a nurse or case manager. The role of the nurse as case manager then becomes one of educator and community support.A myocardial infarction MIcommonly known as a heart attackoccurs when blood flow decreases or stops to a part of the heartcausing damage to the heart muscle.

Most MIs occur due to coronary artery disease. Treatment of an MI is time-critical. Worldwide, about Myocardial infarction MI refers to tissue death infarction of the heart muscle myocardium caused by ischaemia, that is lack of oxygen delivery to myocardial tissue. It is a type of acute coronary syndromewhich describes a sudden or short-term change in symptoms related to blood flow to the heart. The phrase "heart attack" is often used non-specifically to refer to myocardial infarction.

An MI is different from—but can cause— cardiac arrestwhere the heart is not contracting at all or so poorly that all vital organs cease to function, thus might lead to death. However, an MI may lead to heart failure. Chest pain that may or may not radiate to other parts of the body is the most typical and significant symptom of myocardial infarction. It might be accompanied by other symptoms such as sweating.

Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper abdomen. It could be felt as an unexplained anxiety, or even pain might be absent at all.

Typically, chest pain because of ischemia, be it unstable angina or myocardial infarction, lessens with the use of nitroglycerinbut nitroglycerin may also relieve chest pain arising from non-cardiac causes. Chest pain may be accompanied by sweatingnausea or vomiting, and fainting[24] [30] and these symptoms may also occur without any pain at all. In people with diabetes, differences in pain thresholdautonomic neuropathyand psychological factors have been cited as possible explanations for the lack of symptoms.

The most prominent risk factors for myocardial infarction are older age, actively smokinghigh blood pressurediabetes mellitusand total cholesterol and high-density lipoprotein levels.

Many risk factors for myocardial infarction are potentially modifiable, with the most important being tobacco smoking including secondhand smoke. There is varying evidence about the importance of saturated fat in the development of myocardial infarctions. Eating polyunsaturated fat instead of saturated fats has been shown in studies to be associated with a decreased risk of myocardial infarction, [46] while other studies find little evidence that reducing dietary saturated fat or increasing polyunsaturated fat intake affects heart attack risk.

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. Genome-wide association studies have found 27 genetic variants that are associated with an increased risk of myocardial infarction.

The risk of having a myocardial infarction increases with older age, low physical activity, and low socioeconomic status. Women who use combined oral contraceptive pills have a modestly increased risk of myocardial infarction, especially in the presence of other risk factors.

Endometriosis in women under the age of 40 is an identified risk factor. Air pollution is also an important modifiable risk. Short-term exposure to air pollution such as carbon monoxidenitrogen dioxideand sulfur dioxide but not ozone have been associated with MI and other acute cardiovascular events.

A number of acute and chronic infections including Chlamydophila pneumoniaeinfluenzaHelicobacter pyloriand Porphyromonas gingivalis among others have been linked to atherosclerosis and myocardial infarction. Calcium deposits in the coronary arteries can be detected with CT scans. Calcium seen in coronary arteries can provide predictive information beyond that of classical risk factors. In people without evident coronary artery diseasepossible causes for the myocardial infarction are coronary spasm or coronary artery dissection.

The most common cause of a myocardial infarction is the rupture of an atherosclerotic plaque on an artery supplying heart muscle. Blockage of an artery can lead to tissue death in tissue being supplied by that artery. The gradual buildup of cholesterol and fibrous tissue in plaques in the wall of the coronary arteries or other arteries, typically over decades, is termed atherosclerosis. Over time, they become laden with cholesterol products, particularly LDLand become foam cells.

A cholesterol core forms as foam cells die. In response to growth factors secreted by macrophages, smooth muscle and other cells move into the plaque and act to stabilize it. A stable plaque may have a thick fibrous cap with calcification.

If there is ongoing inflammation, the cap may be thin or ulcerate.


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