Heart attack (Myocardial Infarction)

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It is a destruction of heart tissue from the sudden reduced blood flow to the heart. It usually results from coronary artery disease. Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and chest pressure sensation. If blood flow is not restored to the heart muscle within 20 to 40 minutes, irreversible damage and/or death (infarction) of the heart muscle tissue (myocardium) will begin to occur. Muscle continues to die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is eventually replaced by scar tissue.

Symptoms

Classical symptoms of acute myocardial infarction includes:

-Sudden chest pain (described as tightness, pressure, or squeezing), typically pain radiating to the left arm or left side of the neck, back or even jaws
-Shortness of breath
-Palpitations
-Nausea, abdominal pain, or both often are present in infarcts involving the inferior or posterior wall.
-Nausea with or without vomiting
-Anxiety (often described as a sense of impending doom)
-Lightheadedness with or without faint
-Cough
-Diaphoresis (heavy sweating)
-Elderly patients and those with diabetes may have particularly subtle presentations and may complain of fatigue, syncope, or weakness. The elderly may also present with only altered mental status. Those with preexisting altered mental status or dementia may have no recollection of recent symptoms and may have no complaints whatsoever.
-Women may experience fewer typical symptoms than men, most commonly shortness of breath, weakness, a feeling of indigestion, and fatigue
-No symptoms (Approximately one quarter of all heart attacks are silent, without chest pain or new symptoms. Silent heart attacks are especially common among patients with diabetes. A high index of suspicion should be maintained for MI especially when evaluating women, patients with diabetes, older patients, patients with dementia, and those with a history of heart failure.)
A heart attack is a medical emergency, and people experiencing chest pain are advised to alert their emergency medical services, because prompt treatment can be crucial to survival.


Causes and risk factors of heart attack.

Heart attacks are the leading cause of death for both men and women all over the world. Important risk factors are previous cardiovascular disease (such as angina, a previous heart attack or stroke), older age (especially men over 40 and women over 50), tobacco smoking, high blood levels of certain lipids (triglycerides, low-density lipoprotein or "bad cholesterol") and low levels of high density lipoprotein (HDL, "good cholesterol"), diabetes, high blood pressure, obesity, chronic kidney disease, heart failure, excessive alcohol consumption, the abuse of certain drugs, and chronic high stress levels.

Atherosclerosis

Atherosclerosis is a gradual process by which plaques of cholesterol are deposited in the walls of arteries. Cholesterol plaques cause hardening and narrowing of the arterial walls. In consequence, arteries that are narrowed cannot deliver enough blood to maintain normal function of the parts of the body they supply. (For example, atherosclerosis of the arteries in the legs causes reduced blood flow to the legs, that leads to pain in the legs while walking or exercising, leg ulcers, or a delay in the healing of wounds to the legs). Atherosclerosis of the arteries that furnish blood to the brain can lead to vascular dementia (mental deterioration due to gradual death of brain tissue over many years) or even a stroke (sudden death of brain tissue). Coronary atherosclerosis refers to the atherosclerosis that causes hardening and narrowing of the coronary arteries.

Angina pectoris

Angina pectoris is chest pain or pressure that occurs when the blood and oxygen supply to the heart muscle cannot keep up with the needs of the muscle. When coronary arteries are narrowed by more than 50 to 70 percent, the arteries may not be able to increase the supply of blood to the heart muscle during exercise or other periods of high demand for oxygen. An insufficient supply of oxygen to the heart muscle causes angina. Angina that occurs with exercise or exertion is called exertional angina.

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 ischaemic heart disease (IHD)
-Tobacco smoking
-Hypercholesterolemia (especially high low density lipoprotein and low high density lipoprotein)
-Poorly controlled high blood pressure
-Family history
-Obesity (defined by a body mass index of more than 30 kg/m², or alternatively by waist circumference or waist-hip ratio).
-Old age
-High homocysteine level (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)
-Male gender
-Blood Type A personality
-Sedentary lifestyle
Many of these risk factors are modifiable, so many heart attacks can be prevented by maintaining a healthier lifestyle. Physical activity, for example, is associated with a lower risk profile.

Age

Myocardial Infarction most frequently occurs in persons older than 45 years.
Certain people younger than 45 years are at risk, particularly cocaine users, persons with type 1 diabetes, patients with hypercholesterolemia, and those with a positive family history. A positive family history for earl coronary diseases includes any first-degree male relative aged 45 years or younger or any first-degree female relative aged 55 years or younger who experienced a myocardial infarction.

What are the risk factors for heart attack in women?

Coronary artery disease and heart attacks are believed to occur primarily in men. Although it is true that the prevalence of CAD among women is lower before menopause, CAD is the leading cause of death and disability in women after menopause. In addition, women who use combined oral contraceptive pills have a reasonably increased risk of heart attack, especially in the presence of other risk factors, such as smoking.

First aid

As myocardial infarction is a common medical emergency, the signs are often part of first aid courses. When symptoms of heart attack occur, people usually wait approximately three hours, instead of doing what is recommended - calling for help immediately. Acting immediately by calling the emergency services can prevent sustained damage to the heart. Patient may rest in a position which minimizes breathing difficulties. A half-sitting position with knees bent is optional. Access to more oxygen can be given by opening the window and widening the collar for easier breathing.
Aspirin can be given quickly (if the patient is not allergic to aspirin). Aspirin reduces formation of further blood clots that clog arteries. Chewing is the preferred method of administration, so that the Aspirin can be absorbed quickly.
If possible the rescuer should obtain basic information from the victim, in case the patient is unable to answer questions once emergency medical technicians arrive. Other general first aid principles include monitoring pulse, breathing, level of consciousness and, if possible, the blood pressure of the patient.


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