cardiovascular disease Myocardial infarction

1. MYOCARDIAL INFARCTION

2. MYOCARDIAL INFARCTION:
 MI is defined as a diseased condition which is
caused by reduced blood flow in a coronary artery
due to atherosclerosis & occlusion of an artery by an
embolus or thrombus.
 MI or heart attack is the irreversible damage of
myocardial tissue caused by prolonged ischaemia &
hypoxia.

3. TYPES OF INFARCTS
1. According to anatomic region of left ventricle invoved:
Anterior Posterior Lateral Septal Circumferential
Combinations--- Anterolateral, Posterolateral, Anteroseptal
2. According to degree of thickness of ventricular wall involved:
Transmural (full thickness)
Laminar (subendocardial)
3 According to age of infarcts:
Newly formed (acute, recent, fresh)
Advanced infarcts (old, healed, organised)

4. EPIDEMIOLOGY
 It is evident that MI is the leading cause of morbidity and mortality worldwide. It is
responsible for over 15% of mortality each year,
 Incidence is higher in elderly people, about 5% occurs at people under age 40.
 Males have higher risk.
 Women during reproductive period have low risk.

5. RISK FACTORS:
 The presence of any risk factor is associated with doubling the risk of an MI.
 NON-MODIFIABLE: AGE SEX FAMILY HISTORY
 MODIFIABLE:
 Tobacco smoking
 Hypertension
 Drug abuse
 Obesity
 Stress
 Alcohol
 Diabetes
 Hyperlipoproteinaemia
 Hyperhomocysteinemia
 Chronic kidney disease

6. ETIOPATHOGENESIS:
 Mechanism of myocardial ischaemia.
 Role of platelets.
 Acute plaque rupture.
 Non-atherosclerotic causes.
 Transmural versus subendocardial infarcts.

8. CLINICAL FEATURES:
 Chest pain associated with tightness or squeezing
 Pain in the arms and/or upper back
 Upper abdominal discomfort
 Jaw pain, toothache, and/or headache
 Dyspnea
 Diaphoresis
 Malaise
 Women are more likely to experience an atypical MI
 Some patients may not experience any symptoms are known as a silent heart attack

9. DIAGNOSIS:
 Patient History:
 Perform an electrocardiogram:( ECG )
==CHANGES:
 ST segment elevation, followed by T wave inversion and Q waves, are associated with transmural
infarction.
 ST segment depression and T wave inversion are associated with subendocardial infarction.

10. Serum Cardiac Biomarkers
 Myoglobin
 Creatine phosphokinase
 (CK-MB)
 Troponin I
 The combination of CPK MB and troponin testing have higher sensitivity and is
used for the purpose of "ruling out" myocardial infarction.
 ECHOCARDIOGRAM: evaluate cardiac function (ventricular),ejection fraction

11. Complications include:
 Arrhythmia
 Cardiogenic shock
 Congestive heart failure
 Thromboembolism
 Rupture
 Cardiac aneurism
 Pericarditis

12. MANAGEMENT:
 1.NON-PHARMACOLOGICAL:
 Counselling and education of patients
 Life style measures
 Smoking cessation
 Avoid Alcohol intake
 Diet and nutrition
 Salt restriction

13. 2.PHARMACOLOGICAL:
 2.PHARMACOLOGICAL:
 Thrombolytic agents
 Anticoagulants
 Antiplatelet agents
 Antihypertensive agents
 Lipid lowering drugs
 Vasodialators
 Others i) Analgesics ii) Antiulcer drugs iii) Antidepressants

18. THANK YOU 