HEART ATTACK

Dea Prista Agatha, MD

Definition
Otherwise know as Myocardial Infarction
An MI occurs when there is a diminished blood supply to
the heart which leads to myocardial cell damage and
ischemia.
Contractile function stops in the necrotic areas of the
heart.
Ischemia usually occurs due to blockage of the coronary
vessels.
This blockage is often the result of thrombus that is
superimposed
on
an
ulcerated
or
unstable
atherosclerotic plaque formation in the coronary artery

Coronary Artery Anatomy

Risk Factors
The presence of any risk factor is associated with
doubling the risk of an MI.
Non Modifiable
Age
Gender
Family history

Modifiable
Smoking
Diabetes
Hypertension
Hyperlipidemia
Obesity
Physical Inactivity

Pathophysiology
Atherosclerosis with superimposed coronary thrombosis
Slowly growing high-grade stenoses can progress to complete
occlusion but do not usually precipitate acute MI d/t collateral
circulation
During development of plaques, abrupt transition can occur,
resulting in
Platelet activation
Thrombin generation
Thrombus formation
Blood flow occlusion leads to imbalance between supply and
demand and could lead to myocardial necrosis
Less severe stenosis with lipid-laden plaques and fragile caps
more likely to rupture and causing thrombsis and MI

Pathophysiology
Stable Angina
Progressive
narrowing of
coronary lumen
Stable fibrous cap

Unstable
Angina
Progressive
narrowing
Acute worsening
of coronary
lumen due to
thrombus
formation
NSTEMI
Acute worsening
of coronary lumen
due to thrombus
formation
Sub-occlusive/
transient coronary
thrombus with
myocardial necrosis

STEMI
Minimal prior
narrowing of
coronary lumen
Acute rupture of
thin fibrous cap
Occlusive
thrombus
formation
Acute injury
pattern
Myocardial
necrosis

Signs and Symptoms

Chest pain
Nausea and vomiting
Sympathetic
nervous
system
stimulation: cold sweat, temperature
increase
Cardiovascular changes
Initially the BP and pulse may be
elevated.
Later, BP will drop due to
decreased cardiac output.
Urine output will decrease
Lung sounds will change to
crackles
Jugular
veins
may become
distended and have obvious
pulsations.

Long Term Care

Modern treatments, along with healthy lifestyle choices, can assist
in recovering from a heart attack and greatly reduce the risk of
further heart problems and relieve or control symptoms such as
angina.
The most important things you can do to reduce your risk and aid
heart attack recovery are:
Aspirin, Beta Blockers and Clopidogrel will be indefinite.
Lipid lowering medication along with diet modifications.
Smoking cessation
Lifestyle modifications (physically active, achieve and maintain a
healthy body weight )
Control blood pressure
If the person affected has diabetes, they should also aim to keep
their blood glucose levels within the normal non-diabetic range.

THANK YOU