MYOCARDIAL INFARCTION

Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly

known as a heart attack, is 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 (especially macrophages) 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
(infarction) of heart muscle tissue (myocardium).
TYPES OF MI

•A transmural MI is characterized by ischemic necrosis of the full thickness of

the affected muscle segment(s), extending from the endocardium through
the myocardium to the epicardium.

•A nontransmural MI is defined as an area of ischemic necrosis that does not

extend through the full thickness of myocardial wall segment(s). In a
nontransmural MI, the area of ischemic necrosis is limited to the
endocardium or to the endocardium and myocardium.
•It is the endocardial and subendocardial zones of the myocardial wall
segment that are the least perfused regions of the heart and the most
vulnerable to conditions of ischemia
1. Q wave infarction, which is diagnosed by the presence of pathological Q
waves and is also called transmural infarction. However, transmural
infarction is not always present; hence, the term Q-wave infarction may be
preferable for ECG description

2. Non-Q wave infarction, which is diagnosed in the presence of ST

depression and T wave abnormalities.
symptoms of acute myocardial infarction

•sudden chest pain (typically radiating to the left arm or left side of the neck)
• shortness of breath
• nausea& vomiting
•Palpitations
• sweating
• anxiety (often described as a sense of impending doom)
• Women may experience fewer typical symptoms than men, most
commonly shortness of breath, weakness, a feeling of indigestion, and
fatigue.
•Approximately one quarter of all myocardial infarctions are "silent", without
chest pain or other symptoms.
diagnostic tests
electrocardiogram (ECG)
Echocardiography
blood tests The most often used markers are the creatine kinase-MB (CK-
MB) fraction and the troponin levels.
treatment
Immediate treatment is to give oxygen, aspirin, and sublingual nitroglycerin.

Most cases of STEMI (ST elevation MI) are treated with thrombolysis or
percutaneous coronary intervention (PCI). NSTEMI (non-ST elevation MI)
should be managed with medication, although PCI is often performed during
hospital admission. In people who have multiple blockages and who are
relatively stable, or in a few emergency cases, bypass surgery may be an
option.

*Nitroglycerin – 3 tabs 5 mins apart