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MYOCARDIAL INFARCTION "heart attack

Myocardial infarction, also known as "heart attack," is the death of cardiac muscle due to prolonged severe ischemia. It is by far the most important form of ischemic heart disease. About 1.5 million individuals in the United States suffer a myocardial infarction annually. Incidence and Risk Factors: Myocardial infarction can occur at virtually any age, but its frequency rises progressively with increasing age and when predispositions to atherosclerosis are present. Nearly 10% of myocardial infarcts occur in people under age 40, and 45% occur in people under age 65. Blacks and whites are equally affected. Throughout life, men are at significantly greater risk than women. Indeed, except for those having some predisposing atherogenic condition, women are protected against myocardial infarction and other heart diseases during the reproductive years (because an increase of estrogen). However, the decrease of estrogen following menopause is associated with rapid development of coronary artery disease, and ischemic heart disease is the most common cause of death in elderly women. Postmenopausal hormonal replacement therapy is not currently felt to protect against atherosclerosis and ischemic heart disease. Signs and symptoms: Chest pain, pain radiates most often to the left arm and lower jaw. Dyspnea (shortness of breath). Diaphoresis (an excessive form of sweating). Nausea. Vomiting. Palpitations. Fatigue. Approximately one fourth of all myocardial infarction patients have silent symptoms (most common in diabetic patients).

Risk factors: Risk factors for atherosclerosis are generally risk factors for myocardial infarction. Diabetes (with or without insulin resistance) the single most important risk factor for ischemic heart disease. Tobacco smoking. Hypercholesterolemia (more accurately hyperlipoproteinemia, especially high low density lipoprotein and low high density lipoprotein). Low HDL. High Triglycerides. High blood pressure. Family history of ischemic heart disease. Obesity (defined by a body mass index of more than 30 kg/m). Age -Men acquire an independent risk factor at age 45, Women acquire an independent risk factor at age 55(after menopause); in addition individuals acquire another independent risk factor if they have a first-degree male relative (brother, father), who suffered a coronary vascular event at or before age 55.

Diagnosis:

Another independent risk factor is acquired if one has a first-degree female relative (mother, sister) who suffered a coronary vascular event at age 65 or younger. Hyperhomocysteinemia (high homocysteine, a toxic blood amino acid that is elevated when intakes of vitamins B2, B6, B12 and folic acid are insufficient) Stress - Occupations with high stress index are known to have susceptibility for atherosclerosis. Alcohol - Studies show that prolonged exposure to high quantities of alcohol can increase the risk of heart attack. Males are more at risk than females.

Electrocardiogram (ECG). Blood test (cardiac enzymes creatine kinase specifically the MB fraction and troponin. Chest radiograph. Treatment: Prevention: Quit smoking. (If you don't smoke, don't start!) Eat a healthy diet, cut back on foods high in saturated fat and sodium (salt) to lower cholesterol and blood pressure. Control your blood sugar if you have diabetes. Exercise. It may sound hard if you haven't exercised for a while, but try to work up to 30 to 60 minutes of aerobic exercise (that raises your heart rate) 4 to 6 times a week. Lose weight if you're overweight. Control your blood pressure if you have hypertension.

Antiplatelet drug such as aspirin. Beta blocker therapy such as metoprolol or carvedilol. ACE inhibitor such as captopril. Statin therapy. Aldosterone antagonist agent such as eplerenone or spironolactone.

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