MYOCARDIAL INFRACTION

Presented By-Anoop SinghDepartment of Pharmacy,Dr. B. R. Ambedkar University, Agra

INTRODUCTION Myocardial infarction (MI) refers to the process by which areas of myocardial cells in the heart are permanently destroyed.

It occurs when myocardial tissues are abruptly and severely deprived of oxygen.

DEFINITION Myocardial infarction is a diseased condition which is caused by reduced blood flow in a coronary artery due to atherosclerosis and occlusion of an artery by an embolus or thrombus.

NON-MODIFIABLE RISK FACTORS

FACTOR AGE

SEX

FAMILYHISTORY

AGE: More than 40 years.

FAMILY HISTORY: Myocardial infarction can be inherited from parents to children.

GENDER: Myocardial infarction is 3 times more in men than women.

MODIFIABLE RISK FACTORS

FACTOR

HIGHBLOOD LIPIDSLEVEL

HYPER-TENSION

SMOKING

PHYSICALINACTIVITY

OBESITY

DIABETESMELLITUS

STRESS

HIGH BLOOD CHOLESTROL LEVEL

LOW DENSITYLIPOPROTEIN

(LDL)DANGEROUS

HIGH DENSITYLIPOPROTEIN

(HDL)

LIPIDS(LIPOPROTIENS)

HDL is not dangerous because it contains more proteins & very less lipids.Secondly it carry lipids away from arteries to the liver for metabolism. So it prevents lipids accumulation within arteries.LDL is dangerous because it contains more lipids & has capacity to deposit fat within arteries.So, LDL level more than 160mg/dl will place a person at a risk of myocardial infarction.

HYPERTENSION

If a person’s blood pressure is more than 140/90 mmHg continuously for 4-5 years

Sustained stress on arterial walls injury to endothelial lining atherosclerosis narrowed & thickened arterial walls risk of M.I.Also salt consumption 5gms/ day cause M.I.

SMOKING

Smoking nicotine catecholamine (epinephrine & nor epinephrine) release increases heart rate & blood pressure increases cardiac workload.

+CO decreases O2 available to myocardium

Injury to myocardium

PHYSICAL INACTIVITY

Improper lipid metabolism

LDL level increases

Starts accumulating in blood vessels

Risk of M.I.

OBESITY

More lipids are produced

LDL level increases

Atherosclerosis

Risk of M.I.

DIABETES MELLITUS

Glucose molecules may stick to lumen of artery

Blockage of artery

Risk of having M.I.

STRESS

SNS stimulation

Release of catecholamine

Increases heart rate & intensify the force of myocardial contraction

Increases O2 demand

Cell death

Risk of M.I.

PATHOPHYSIOLOGY

Causative factor: Obesity

Atherosclerosis

Narrowing of lumen

ed heart insufficient blood flow to myocardiumContractility ed O2 demand of myocardial cells

Inadequate creates an O2 deficitBlood supply myocardial cell death

inflammationOliguria CK-MB & Troponine released Fever

Anaerobic glycolysis

Accumulation of lactic acid

Irritation of myocardial nerve fibers

Transmission of pain massage to myocardium

Chest pain & radiation towards shoulder & arm

Stimulation of vomiting SNS Stimulation center increasedNausea & Vomiting catecholamine

Diaphoresis Increased(perfuse sweating) Heart Rate

Cold & Clammy skin “Cold Sweat”

CLINICAL MANIFESTATIONS Cardiovascular-

Chest pain/Discomfort Palpitations Elevated BP ECG may show tachycardia, bradycardia and

dysarrythmia

CONTD….. Respiratory-

Shortness of breath Dyspnea/Tachypnea Crackles Pulmonary edema-may be present

Gastrointestinal- Nausea Vomiting

CONTD….. Genitourinary-

Decreased urinary output Skin-

Cool, clammy skin Diaphoresis Pallor, Cyanosis Coolness of extremities

CONTD….. Neurogenic-

Anxiety, restleness Light- headedness Headache Visual Disturbances Altered speech Altered motor functions Altered level of consciousness

CONTD….. Psychosocial-

Fear feeling

Pt. may deny that anything is wrong

PAINCharacteristics: Severe, immobilizing chest pain.Usually prescribed as heaviness, pressure, tightness, burning.Radiation: It may radiate to neck, jaw, arm or back.Duration: Lasts for 20 minutes or more.

NAUSEA & VOMITING

Stimulation of vomiting center by severe pain causes nausea & vomiting.

FEVER 100.4 to 102.2°FIt is due to inflammatory process caused by Myocardial cell death.

DIAGNOSTIC TESTS

ASSESSMENT/DIAGNOSTIC FINDINGS

It is generally based on presenting symptoms, ECG and laboratory test results. Patient history-it includes

• Description of presenting symptoms

• History of previous illness, family health history

CONTD….. Electrocardiogram- ECG provides information that assists in diagnosing acute MI. The classic ECG changes are-

T wave inversion ST segment elevation Abnormal Q wave

ECHOCARDIOGRAM PURPOSE: it is useful to assess the ability

of heart muscles to contract & relax. It is done to evaluate ventricular function by

checking ejection rate.

MEGNATIC RESONANCE IMAGING (MRI) PURPOSE: To detect site & extent of myocardial

cells.

ANGIOGRAPHY

To detect percentage of blockage & type of MI.

CHEST X-RAY To detect cardiomegaly.

MEDICAL MANAGEMENT

DRUG THERAPY FIBRINOLYTIC

THERAPY

MEDICAL MANAGEMENT

How Can Myocardial Infarction Be Prevented? One way to lower your risk is to eat a heart-healthy diet. This

diet should largely consist of: whole grains vegetables fruits lean protein

You should also reduce the amount of the following in your diet:

sugar saturated fat trans fat cholesterol

THANKSTHANK

YOU