Myocardial infarction (MI) or 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).

Signs and Symptoms:

-sudden chest pain (typically radiating to the left arm or left
side of the neck)

-shortness of breath -weakness

-nausea & vomiting
-palpitations
-sweating
-anxiety (often described as a sense of impending doom).
-weakness
-fatigue

Diagnostic Procedures:
-electrocardiogram(ECG) a transthoracic interpretation of
the electrical activity of the heart over timecaptured and
externally recorded by skin electrodes

-Echocardiography is an ECHO, is a sonogram of the heart.

-Blood tests. markers creatine kinase-MB (CK-MB)

troponin levels.

Immediate treatment for suspected acute myocardial

infarction:
-oxygen
-aspirin
-sublingual nitroglycerin.

Causes
Heart attack rates are higher in association with intense
exertion,
-psychological stress or physical exertion, especially if the
exertion is more intense than the individual usually performs.
-Atherosclerosis

Risk factors
Diabetes
Tobacco smoking
Hypercholesterolemia (more accurately
hyperlipoproteinemia, especially high low density lipoprotein
and low high density lipoprotein)
-High Triglycerides (fatty acids: animal fats and vege oils)
-High blood pressure
-Family history of ischaemic heart disease (IHD)
-Obesity (defined by a body mass index of more than 30
kg/m², or alternatively by waist circumference or waist-hip
ratio).
-Age:
Men acquire an independent risk factor at age 45
Women acquire an independent risk factor at age
-Hyperhomocysteinemia (high homocysteine, 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)
-Chronic drinking of Alcohol Studies show that prolonged
exposure to high quantities of alcohol can increase the risk
of heart attack
-Males are more at risk than females

Prevention

-Evidence supports the consumption of polyunsaturated fats

instead of saturated fats as a measure of decreasing
coronary heart disease.
Foods:
-Fish, Whole grain wheat, Peanut butter (14.2 grams per
100 grams)
-Margarine (around 24 grams per 100 grams, but may also
contain some trans fat)
-Bananas, Sunflower seeds, Sesame oil.
-Omega-3 fatty acids, commonly found in fish, have been
shown to reduce mortality post-MI.
-Antiplatelet drug therapy such as aspirin and/or clopidogrel
should be continued to reduce the risk of plaque rupture and
recurrent myocardial infarction.

Hypertension (HTN) or high blood

pressure
-is a chronic medical condition in which the systemic arterial
blood pressure is elevated. It is the opposite of hypotension.
It is classified as either primary (essential) or secondary.
About 90–95% of cases are termed "primary hypertension",
which refers to high blood pressure for which no medical
cause can be found. The remaining 5–10% of cases
(Secondary hypertension) are caused by other conditions
that affect the kidneys, arteries, heart, or endocrine system.

S/S
-headache, drowsiness, confusion, vision disorders, nausea,
and vomiting symptoms

2 n d HPN
-Some additional signs and symptoms suggest that the
hypertension is caused by disorders in hormone regulation.
Hypertension combined with obesity distributed on the trunk
of the body

Causes:
Essential hypertension is the most prevalent hypertension
type, affecting 90–95% of hypertensive patients. Although no
direct cause has been identified, there are many factors
such as:
-sedentary lifestyle (tambay)
-smoking (chain smokers)
-stress
-potassium deficiency (hypokalemia)
-obesity(more than 85% of cases occur in those with a body
mass index greater than
-salt (sodium)
-alcohol intake
-Vitamin D deficiency that increase the risk of developing
hypertension.

Risk also increases:

-aging
-some inherited genetic mutations,
-family history of hypertension

++
-Arterial Pressure

-Cardiac Output

-Stroke Volume -Myocardial Contractility

-Heart Rate
Angina Pectoris commonly known as Angina,
-severe chest pain due to ischemia
* ischemia (a lack of blood, hence a lack of oxygen
supply) of the heart muscle, generally due to obstruction or
spasm of the coronary arteries (the heart's blood vessels).

-Coronary artery disease, the main cause of angina, is due

to atherosclerosis of the cardiac arteries.
* atherosclerosis characterized by the deposition of
plaques containing cholesterol and lipids on the innermost
layer of the walls.
S/S
-chest discomfort rather than actual pain the discomfort is
usually described as a pressure, heaviness, tightness,
squeezing, burning, or choking sensation.
-apart from chest discomfort, anginal pains may also be
experienced in the epigastrium (upper central abdomen),
back, neck area, jaw, or shoulders.

Major risk factorsinclude

-cigarette smoking
-diabetes
-high cholesterol
-high blood pressure
-sedentary lifestyle
-family history of premature heart disease.

Other cardiac problems

-tachyarrhythmia
-bradyarrhythmia
-valvular heart disease
-hypertrophic cardiomyopathy
Pathophysiology

-Angina results when there is an imbalance between the

heart's oxygen demand and supply.This imbalance can result
from an increase in demand (e.g. during exercise) without a
proportional increase in supply (e.g. due to obstruction or
atherosclerosis of the coronary arteries).

Treatment
-Nitroglycerin. It is a potent vasodilator that makes more
oxygen available to the heart muscle.
-Beta-blockers and calcium channel blockers act to decrease
the heart's workload, and thus its requirement for oxygen.

M e dic a t ions
- A C E i nh i b i to r s (e .g ., Ca p to p ri l ) (A n g io te n si n Co n ve rti ng En zyme ) An g io te n s i n II
c a u s e s a r te ri e s to con stri cts a nd the re b y ra i se s B P
- A l ph a bl o c ke rs (e .g ., P ra zo si n ) rel a xe s ca rdi a c mu scl e th e re b y de cre si n g B P
- A n gi o te n s in II re ce p to r a n ta g on i s ts (e .g ., L o sa rta n ) cau se s a rte ri e s to co n s tr i c ts an d
th e r e b y r ai s e s B P
- B e ta b l o c ke r s (e .g ., P ro p ra no l ol ) tre a tin g h yp e rten si o n o r a rrh yth mi a ; de c r e a se s
fo r c e a n d r a te o f he a rt co n tra cti o n .
- C al c i u m c h an n e l bl o cke rs (e .g ., V e ra p a mil )
A dr u g th a t bl o cks th e e n try o f cal ci u m i n to th e mu scle ce l l s o f th e he a rt an d th e
a r te r i e s .
It i s th e e n tr y o f cal ci u m i n to th e se cel l s th a t cau se s th e he a rt to con tra ct a nd a r te ri e s
to na r r o w .
B y bl o c ki n g th e e n try o f cal ci u m, ca l ciu m ch a n ne l b l o cke r (C C B s) d e crea s e th e
c o n tr a c ti on o f th e h e a rt a nd di l a te (wi d e n )
th e a r te r i e s . B y di l a tin g th e arte ri e s, C C B s re du ce th e pre ssu re in th e a rte ri e s . Th i s
m a k e s i t e a s ie r fo r th e h e a rt to pu mp b lo o d ,
a n d , a s a r e s u l t, the he a rt ne e d s le ss oxyg e n . B y re d u cin g th e he a rt' s n e ed fo r
o x y g en , CC B s pre ve n t o r re li e ve a n gi n a .
- D iu r e ti c s ( e .g . h yd ro ch lo ro th i a zi d e )