Myocardial infarction (MI; Latin: infarctus myocardii) or acute myocardial infarction (AMI),

commonly known as a heart attack, occurs when blood stops flowing properly to a part of the
heart, and the heart muscle is injured because it is not receiving enough oxygen. Usually, this is
because one of the coronary arteries that supplies blood to the heart develops a blockage due to an
unstable buildup of white blood cells, cholesterol and fat. The event is called "acute" if it is sudden
and serious. Myocardial infarction differs from cardiac arrest, although cardiac arrest can be a
consequence of MI.
A person having an acute MI usually has sudden chest pain that is felt behind the sternum and
sometimes travels to the left arm or the left side of the neck. Additionally, the person may have
shortness of breath, sweating, nausea, vomiting, abnormal heartbeats, and anxiety. Women
experience fewer of these symptoms than men, but usually have shortness of breath, weakness, a
feeling of indigestion, and fatigue.[1] In many cases, in some estimates as high as 64%, the person
does not have chest pain or has vague symptoms.[2] These are called "silent" myocardial
infarctions. Important risks are previous cardiovascular disease, old age, tobacco smoking,
abnormal blood levels of certain lipids, diabetes, high blood pressure, lack of physical activity,
obesity, chronic kidney disease, excessive alcohol consumption, and the use of cocaine and
amphetamines.[3][4] The main ways to determine if a person has had a myocardial infarction are
electrocardiograms (ECGs) that trace the electrical signals in the heart and testing the blood for
substances associated with damage to the heart muscle. ECG testing is used to differentiate
between two types of myocardial infarction based on the appearance of the tracing. An ST section
of the tracing higher than the baseline is called an ST elevation MI (STEMI) which usually
requires more aggressive treatment. If this is not the case, the diagnosis is confirmed with a blood
test (usually troponin). Immediate treatments for a suspected MI often include aspirin, which
prevents further blood from clotting; nitroglycerin, sometimes given to treat chest pain; and
oxygen.[5] STEMI is treated by restoring circulation to the heart, called reperfusion therapy, and
typical methods are angioplasty, where the arteries are pushed open, and thrombolysis, where the
blockage is removed using medications.[6] Non-ST elevation myocardial infarction (NSTEMI)
may be managed with medication, although angioplasty may be required if the person is
considered to be at high risk.[7] People who have multiple blockages of their coronary arteries,
particularly if they also have diabetes, may also be treated with bypass surgery (CABG).[8][9]
Ischemic heart disease, which includes MI, angina, and heart failure when it happens after MI,
was the leading cause of death for both men and women worldwide in 2011.[10][11]
CONTENTS
Signs and symptoms 1
Causes 2
Lifestyle 2.1
Disease 2.2
Genetic 2.3
Other 2.4
Pathophysiology 3
Pathological types 3.1
Diagnosis 4
Classification 4.1
Electrocardiogram 4.2
Cardiac biomarkers 4.3
Imaging 4.4
Prevention 5
Lifestyle 5.1
Medication 5.2
Management 6
STEMI 6.1
NSTEMI 6.2
Cardiac rehabilitation 6.3
Secondary prevention 6.4
Prognosis 7
Complications 7.1
Epidemiology 8
Society and culture 9
Economics 9.1
Legal implications 9.2
Research 10
References 11
External links 12
SIGNS AND SYMPTOMS
The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and
rarely instantaneous.[12] Chest pain is the most common symptom of acute MI and is often
described as a sensation of tightness, pressure, or squeezing. Chest pain due to ischemia (a lack of
blood and hence oxygen supply) of the heart muscle is termed angina pectoris. Pain radiates most
often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper
abdomen,[8][13] where it may mimic heartburn. Levine's sign, in which patients localize the chest
pain by clenching their fists over their sternums, has classically been thought to be predictive of
cardiac chest pain, although a prospective observational study showed it had a poor positive
predictive value.[14]
Shortness of breath (dyspnea) occurs when the damage to the heart limits the output of the left
ventricle, causing left ventricular failure and consequent pulmonary edema. Other symptoms
include diaphoresis (an excessive form of sweating),[15] weakness, light-headedness, nausea,
vomiting, and palpitations. These symptoms are likely induced by a massive surge of
catecholamines from the sympathetic nervous system[16] which occurs in response to pain and the
hemodynamic abnormalities that result from cardiac dysfunction. Loss of consciousness (due to
inadequate blood flow to the brain and cardiogenic shock) and sudden death (frequently due to the
development of ventricular fibrillation) can occur in MIs.[8]
Female, elderly, and diabetic patients report atypical symptoms more frequently than their male
and younger counterparts.[17][18] Women also report more numerous symptoms compared with
men (2.6 on average vs. 1.8 symptoms in men).[17] The most common symptoms of MI in women
include dyspnea, weakness, and fatigue. Fatigue, sleep disturbances, and dyspnea have been
reported as frequently occurring symptoms that may manifest as long as one month before the
actual clinically manifested ischemic event. In women, chest pain may be less predictive of
coronary ischemia than in men.[19] Women may also experience back or jaw pain during an
episode.[20]
At least one-fourth of all MIs are silent, without chest pain or other symptoms.[2][21] These cases
can be discovered later on electrocardiograms, using blood enzyme tests or at autopsy without a
prior history of related complaints. Estimates of the prevalence of silent MIs vary between 22 and
64%.[2] A silent course is more common in the donor heart is not fully innervated by the nervous
system of the recipient.[23] In people with diabetes, differences in pain threshold, autonomic
neuropathy, and psychological factors have been cited as possible explanations for the lack of
symptoms.[22]
Any group of symptoms compatible with a sudden interruption of the blood flow to the heart are
called an acute coronary syndrome.[24]
The differential diagnosis includes other catastrophic causes of chest pain, such as pulmonary
embolism, aortic dissection, pericardial effusion causing cardiac tamponade, tension
pneumothorax, and esophageal rupture. Other noncatastrophic differentials include
gastroesophageal reflux and Tietze's syndrome.[25]
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MYOCARDIAL INFARCTION

Article Id: WHEBN0020556798

Reproduction Date:
Title: Myocardial infarction
Author: World Heritage Encyclopedia
Language: English
Subject: List of births, marriages, and deaths in Coronation Street, Coronary artery disease,
Cardiac arrest, Cardiology, Coronary circulation
Collection: Aging-Associated Diseases, Articles Containing Video Clips, Causes of Death,
Ischemic Heart Diseases, Medical Emergencies, Rtt
Publisher: World Heritage Encyclopedia
Publication
Date:
PrevNext
MYOCARDIAL INFARCTION
Myocardial infarction
Classification and external resources

Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct)
after occlusion (1) of a branch of the left coronary artery (LCA). In the diagram, RCA is the right
coronary artery.
ICD-10 I21-I22
ICD-9 410
DiseasesDB 8664
MedlinePlus 000195
eMedicine med/1567 emerg/327 ped/2520
MeSH D009203
Myocardial infarction (MI; Latin: infarctus myocardii) or acute myocardial infarction (AMI),
commonly known as a heart attack, occurs when blood stops flowing properly to a part of the
heart, and the heart muscle is injured because it is not receiving enough oxygen. Usually, this is
because one of the coronary arteries that supplies blood to the heart develops a blockage due to an
unstable buildup of white blood cells, cholesterol and fat. The event is called "acute" if it is sudden
and serious. Myocardial infarction differs from cardiac arrest, although cardiac arrest can be a
consequence of MI.
A person having an acute MI usually has sudden chest pain that is felt behind the sternum and
sometimes travels to the left arm or the left side of the neck. Additionally, the person may have
shortness of breath, sweating, nausea, vomiting, abnormal heartbeats, and anxiety. Women
experience fewer of these symptoms than men, but usually have shortness of breath, weakness, a
feeling of indigestion, and fatigue.[1] In many cases, in some estimates as high as 64%, the person
does not have chest pain or has vague symptoms.[2] These are called "silent" myocardial
infarctions. Important risks are previous cardiovascular disease, old age, tobacco smoking,
abnormal blood levels of certain lipids, diabetes, high blood pressure, lack of physical activity,
obesity, chronic kidney disease, excessive alcohol consumption, and the use of cocaine and
amphetamines.[3][4] The main ways to determine if a person has had a myocardial infarction are
electrocardiograms (ECGs) that trace the electrical signals in the heart and testing the blood for
substances associated with damage to the heart muscle. ECG testing is used to differentiate
between two types of myocardial infarction based on the appearance of the tracing. An ST section
of the tracing higher than the baseline is called an ST elevation MI (STEMI) which usually
requires more aggressive treatment. If this is not the case, the diagnosis is confirmed with a blood
test (usually troponin). Immediate treatments for a suspected MI often include aspirin, which
prevents further blood from clotting; nitroglycerin, sometimes given to treat chest pain; and
oxygen.[5] STEMI is treated by restoring circulation to the heart, called reperfusion therapy, and
typical methods are angioplasty, where the arteries are pushed open, and thrombolysis, where the
blockage is removed using medications.[6] Non-ST elevation myocardial infarction (NSTEMI)
may be managed with medication, although angioplasty may be required if the person is
considered to be at high risk.[7] People who have multiple blockages of their coronary arteries,
particularly if they also have diabetes, may also be treated with bypass surgery (CABG).[8][9]
Ischemic heart disease, which includes MI, angina, and heart failure when it happens after MI,
was the leading cause of death for both men and women worldwide in 2011.[10][11]
CONTENTS
Signs and symptoms 1
Causes 2
Lifestyle 2.1
Disease 2.2
Genetic 2.3
Other 2.4
Pathophysiology 3
Pathological types 3.1
Diagnosis 4
Classification 4.1
Electrocardiogram 4.2
Cardiac biomarkers 4.3
Imaging 4.4
Prevention 5
Lifestyle 5.1
Medication 5.2
Management 6
STEMI 6.1
NSTEMI 6.2
Cardiac rehabilitation 6.3
Secondary prevention 6.4
Prognosis 7
Complications 7.1
Epidemiology 8
Society and culture 9
Economics 9.1
Legal implications 9.2
Research 10
References 11
External links 12
SIGNS AND SYMPTOMS
The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and
rarely instantaneous.[12] Chest pain is the most common symptom of acute MI and is often
described as a sensation of tightness, pressure, or squeezing. Chest pain due to ischemia (a lack of
blood and hence oxygen supply) of the heart muscle is termed angina pectoris. Pain radiates most
often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper
abdomen,[8][13] where it may mimic heartburn. Levine's sign, in which patients localize the chest
pain by clenching their fists over their sternums, has classically been thought to be predictive of
cardiac chest pain, although a prospective observational study showed it had a poor positive
predictive value.[14]
Shortness of breath (dyspnea) occurs when the damage to the heart limits the output of the left
ventricle, causing left ventricular failure and consequent pulmonary edema. Other symptoms
include diaphoresis (an excessive form of sweating),[15] weakness, light-headedness, nausea,
vomiting, and palpitations. These symptoms are likely induced by a massive surge of
catecholamines from the sympathetic nervous system[16] which occurs in response to pain and the
hemodynamic abnormalities that result from cardiac dysfunction. Loss of consciousness (due to
inadequate blood flow to the brain and cardiogenic shock) and sudden death (frequently due to the
development of ventricular fibrillation) can occur in MIs.[8]
Female, elderly, and diabetic patients report atypical symptoms more frequently than their male
and younger counterparts.[17][18] Women also report more numerous symptoms compared with
men (2.6 on average vs. 1.8 symptoms in men).[17] The most common symptoms of MI in women
include dyspnea, weakness, and fatigue. Fatigue, sleep disturbances, and dyspnea have been
reported as frequently occurring symptoms that may manifest as long as one month before the
actual clinically manifested ischemic event. In women, chest pain may be less predictive of
coronary ischemia than in men.[19] Women may also experience back or jaw pain during an
episode.[20]
At least one-fourth of all MIs are silent, without chest pain or other symptoms.[2][21] These cases
can be discovered later on electrocardiograms, using blood enzyme tests or at autopsy without a
prior history of related complaints. Estimates of the prevalence of silent MIs vary between 22 and
64%.[2] A silent course is more common in the donor heart is not fully innervated by the nervous
system of the recipient.[23] In people with diabetes, differences in pain threshold, autonomic
neuropathy, and psychological factors have been cited as possible explanations for the lack of
symptoms.[22]
Any group of symptoms compatible with a sudden interruption of the blood flow to the heart are
called an acute coronary syndrome.[24]
The differential diagnosis includes other catastrophic causes of chest pain, such as pulmonary
embolism, aortic dissection, pericardial effusion causing cardiac tamponade, tension
pneumothorax, and esophageal rupture. Other noncatastrophic differentials include
gastroesophageal reflux and Tietze's syndrome.[25]

CAUSES
Many of the risk factors for myocardial infarction are modifiable and thus many cases may be
preventable.
LIFESTYLE

Smoking appears to be the cause of about 36% and obesity the cause of 20% of coronary artery
disease.[26] Lack of exercise has been linked to 7–12% of cases.[26][27] Less common causes
include stress-related causes such as job stress, which accounts for about 3% of cases,[26] and
chronic high stress levels.[28]
Tobacco smoking, including secondhand smoke[29] Short-term exposure to air pollution,
including carbon monoxide, nitrogen dioxide, and sulfur dioxide, but not ozone.[30] Lack of
physical activity,[3] psychosocial factors including, low socioeconomic status, social isolation and
negative emotions increase the risk of and are associated with worse outcomes after MI.
Socioeconomic factors such as a shorter education and lower income (particularly in women), and
unmarried cohabitation are also correlated with a higher risk of MI.[31] Alcohol — prolonged
exposure to high quantities of alcohol can increase the risk of heart attack.
There is little evidence that reducing dietary saturated fat or increasing polyunsaturated fat intake
affects heart attack risk.[32] Trans fats do appear to increase risk.[32]
DISEASE

Diabetes mellitus (type 1 or 2),[33] high blood pressure,[29] dyslipidemia/hypercholesterolemia

(abnormal levels of lipoproteins in the blood), particularly high low-density lipoprotein, low high-
density lipoprotein and high triglycerides[29] Obesity[34] (defined by a body mass index of more
than 30 kg/m², or alternatively by waist circumference or waist-hip ratio).
A number of acute and chronic infections including: Chlamydophila pneumoniae, influenza,
Helicobacter pylori, and Porphyromonas gingivalis among others have been linked to
atherosclerosis and myocardial infarction.[35] As of 2013, there is no evidence of benefit from
antibiotics or vaccination, however, calling the association into question.[35][36]
GENETIC

Genome-wide association studies have found 27 genetic variants that are associated with an
increased risk of myocardial infarction.[37] Strongest association of MI has been found with the
9p21 genomic locus, which contains genes CDKN2A & 2B, although the single nucleotide
polymorphisms that are implicated are within a non-coding region.[37] The majority of these
variants are in regions that have not been previously implicated in coronary artery disease. The
following genes have an association with MI: PCSK9, SORT1, MIA3, WDR12, MRAS,
PHACTR1, LPA, TCF21, MTHFDSL, ZC3HC1, CDKN2A, 2B, ABO, PDGF0, APOA5,
MNF1ASM283, COL4A1, HHIPC1, SMAD3, ADAMTS7, RAS1, SMG6, SMG6, SNF8, LDLR,
SLC5A3, MRPS6, KCNE2.[37]
OTHER

At any given age, men are more at risk than women, particularly before menopause,[38] but
because in general women live longer than men, ischemic heart disease causes slightly more total
deaths in women.[3] Family history of ischaemic heart disease or MI, particularly if one has a
first-degree relative (father, brother, mother, sister) who suffered a 'premature' myocardial
infarction (defined as occurring at or younger than age 55 years (men) or 65 (women).[3]
Oral contraceptive pill–women who use combined oral contraceptive pills have a modestly
increased risk of myocardial infarction, especially in the presence of other risk factors, such as
smoking.[39]
An increased incidence of a heart attack is associated with time of day especially in the morning
hours, more specifically around 9 am.[40][41][42]
Old age increases risk of a heart attack.[3]