myocardial infarction

myocardial infarction

1. chest pain

   • heart problems
   • lung problems
   • gastrointestinal problems
   • anxiety/panic attack

2. angina

   • chest pain or discomfort
   • symptom of heart disease
   • caused by reduced oxygen in the blood in the heart
   • types
     • typical/stable
       • on exertion
       • <20 min
       • 70% atherosclerosis
       • reversible
       • ST segment depression
       • relieved by rest/nitrates
     • prinzmetal/variant
       • unrelated to exertion
       • due to coronary vasospasm
       • reversible injury
       • ST segment elevation
       • relieved by nitrates/calcium-channel blockers
     • unstable/crescendo
       • occurs at rest
       • due to acute plaque changes
       • reversible injury
       • ST segment depression
       • relieved by nitrates
       • high risk of progression to MI
   • emergency treatment
     • morphine
     • oxygen
     • nitrates
     • aspirin

3. types of MI

   • subendocardial injury
     • ST depression
   • transmural injury
     • ST elevation

4. signs and sypmtoms

   • chest discomfort
   • trouble breathing
   • feeling faint
   • sick or discomfort in stomach

5. gross and microscopic findings of MI

   • 0-24 hrs
     • no gross changes
     • coagulation necrosis present within 12-24 hrs
     • nenutrofils begin to enter
   • 1-3 days
     • pallor of infarcted tissue
     • myocyte nuclei and striations disappear
     • neutrophils are abundant and lyse the dead myocardial cells
   • 3-7 days
     • red granulation tissue
     • macrophages begin to remove necrotic debris
   • 7-10 days
     • necrotic area is brightly yellow
     • granulation tissue and collagen are well developed
   • during 2 months
     • white patchy noncontractile scar

6. investigations

   • ECG
   • lipid profile
   • chest x-ray
     • pulmonary edema
     • left ventricular hypertrophy
   • blood test
     • biomarkers
   • echocardiogram
     • uses ultrasound
   • coronary angiography
     • uses special dyes and x-rays

7. complications

   • arrhythmia
   • cardiogenic shock
   • thromosis
   • acute pericarditis
   • rupture
   • cardiac tamponade
   • dressler syndrome
   • ventricular aneurysm

8. risk factors of MI

   • age
   • smpking
   • high BP
   • high cholesterol/ TG/ LDL
   • diabetes
   • family history
   • lack of physical activity
   • obesity
   • stress
   • illegal drug use
   • preeclampsia
   • autoimmune condition

9. treatment of MI

   • aspirin/heparin
   • oxygen
   • nitrates
   • ACE inhibitors
   • fibrinolysis/angioplasty
   • surgical
     • coronary angioplasty
   • psychological/ lifestyle changes
     • support groups

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