HEART CONDITIONS

& CORONARY ARTERY

DISEASE
 MYOCARDIAL INFARCTION

A myocardial infarct is an area of heart tissue in

which the cardiac cells have died (heart attack)
it is generally a result of ischemia.
Ischemia (is-ke'me-ah), is lack of an adequate
blood supply to the heart
Abnormalities in the shape of the electric waves
changes in their timing send signals that something
may be wrong with the intrinsic conduction system
or may indicate a myocardial infarct has occurred
(present or past).
Heart Attacks
MI
 Heart Attacks
myocardial (rni-O-KAR-de-al) infarction (MI), or heart attack
part of the coronary circulation becomes blocked and cardiac muscle cells die from lack of oxygen
The affected tissue then degenerates, creating a nonfunctional area known as an infarct
Heart attacks most commonly result from severe coronary artery disease (CAD)
The consequences depend on the site and nature of the circulatory blockage. If it occurs near the start of one
of the coronary arteries, the damage will be widespread and the heart may stop beating. If the blockage
involves one of the smaller arterial branches, the individual may survive the immediate crisis but may have
many complications, all unpleasant. As scar tissue forms in the damaged area, the heartbeat may become irregu
lar and other vessels can become constricted, creating additional circulatory problems.
Myocardial infarctions are generally associated with fixed blockages, such as those seen in CAD.

coronary thrombosis - thrombus (clot) formation at a plaque.

smooth muscle spasm - A vessel already narrowed by plaque formation may also become blocked by a
sudden SPASM of the vascular wall. The individual then may experience intense pain, but persisting even at
rest
silent heart attacks painless MAY be even more dangerous because the condition may go undiagnosed and
may not be treated before a fatal MI occurs
Roughly 25 percent of heart attacks are not recognized when they occur.
 The cytoplasm of a damaged cardiac muscle cell differs from that of a normal muscle cell. As the supply
of oxygen decreases, the cells become more dependent on anaerobic metabolism to meet their energy
needs. Over time, the cytoplasm accumulates large numbers of enzymes involved with anaerobic energy
production. As the membranes of the cardiac muscle cells deteriorate, these enzymes enter the surrounding
intercellular fluids. The appearance of such enzymes in the circulation thus indicates that an infarct has
occurred.
The enzymes that are tested for in a diagnostic blood test include
lactate dehydrogenase (LDH)
serum glutamic oxaloacetic transaminase (SGOT, also called aspartate aminotransferase)
creatine phosphokinase (CPK or CK)
a special form of creatine phosphokinase that occurs only in cardiac muscle (CKMB)

About 25 percent of MI patients die before obtaining medical assistance

65 percent of MI deaths among those under age 50 occur within an hour after the initial infarct
 TREATMENT
o The goals of treatment are to limit the size of the infarct and to avoid additional complications
o preventing irregular contractions
o improving circulation with vasodilators
o providing additional oxygen
o reducing the cardiac workload
o eliminating the cause of the circulatory blockage if possible.
o Anticoagulants (even aspirin chewed and swallowed at the start of an MI) may help prevent the formation
of additional thrombi
o clot-dissolving enzymes may reduce the extent of the damage if they are administered within six hours
after the MI
o tissue plasminogen activator (t-PA), which is relatively expensive, is more beneficial than other fibrinolytic
agents,
o such as urokinase or streptokinase.
o Follow-up treatment with heparin, aspirin, or both is recommended
o without further treatment, the circulatory blockages will reappear in about 20 percent of patients.
o Roughly 1.3 million MIs occur in the United States each year
o half the victims die within a year of the incident
o factors appear to increase the risk of a heart attack:
o (1) smoking
o (2) high blood pressure
o (3) high blood cholesterol levels
o (4) high circulating levels of low-density lipoproteins (LDLs)
o (5) diabetes
o (6) male gender (below age 70)
o (7) severe emotional stress
o (8) obesity
o (9) genetic predisposition
o (10) a sedentary lifestyle
o Although the heart attack rate of women under age 70 is lower than that of men, the mortality rate for women
is higherperhaps because heart disease in women is neither diagnosed as early nor treated as aggressively as
that in men.
o The presence of two risk factors more than doubles the risk of heart attack, so eliminating as many risk factors
as possible will improve the chances of preventing or surviving a heart attack. Changing the diet to limit
cholesterol, exercising to lower weight, and seeking treatment for high blood pressure are steps in the right
direction.
o It has been estimated that a reduction in coronary risk factors could prevent 150,000 deaths each year in the
United States alone.