Life Health Sciences – Science Rules it All

Myocardial Infarction (MI) is a disease of heart due to blockage of coronary arteries by blood clots (thrombi) or dislodged blood clots (emboli). The blood flow to heart muscle (myocardium) is stopped resulting in irreversible damage (infarction) to myocardium if patient does not get urgent medical treatment. The damage to myocardium can be protected with urgent treatment as it takes several hours to damage myocadium permanently.

Symptoms

Severe prolonged chest pain with feeling of tightness, constriction, or heaviness is the cardinal symptom. It may be the most severe pain patient has experienced in life time. The pain can also be felt at other sites like, shoulder, neck and back. Other symptoms are breathlessness, syncope, nausea, vomiting and fear of death due to severe anxiety. Elderly and diabetic patients may have only one symptom and that is breathlessness.

Investigations

Electrocardiography (ECG) shows ST elevation or depression, T wave inversion, Q wave and decreased size of R wave.

Blood tests detect presence of increased amount of enzymes and proteins that are normally found in cardiac cells. These include raised blood level of creatine kinase (CK) and  CK-MB. Other blood tests show rise in ESR, leukocytosis and raised C-reactive protein.

Chest X-ray may show fluid around heart, lung and enlargement of heart.

Echocardiography can detect abnormalities of heart structure and fluid around it.

Management

When myocardial infarction is suspected immediate medical intervention is required. An ambulance service with coronary care equipment fitted inside is needed for patient. The urgent treatment of patient includes oxygen, morphine or diamorphine injection with antiemetic to relieve pain, continuous ECG monitoring and maintenance of intravenous line. Aspirin 75-300 per day is given to prevent clot formation in the blood. Thrombolytic treatment includes i.v injection of streptokinase 1.5 million units diluted in saline. Ateplase is non antigenic and more effective than streptokinase. Other thrombolytic agents are Reteplase and Tenecteplase. Anticoagulants like heparin and warfarin can be used with aspirin. Beta blockers can be used for pain and arrhythmias. Nitrates are useful for recurrent and persistent pain due to ischemia.

When patient has survived the acute attack of MI, the secondary measure of prevention is used for further treatment. These include removing risk factors of ischemia to heart by stopping smoking, modifying diet to lose weight and lower blood cholesterol and regular exercise. The drugs used are aspirin for its anti platelet effects, beta blockers for arrhythmias and ACE inhibitors for heart failure. Patient can gradually increase physical activities after 2^nd day and returns to work in 4-6 weeks. Patient and his/her family need emotional support and counseling. A personal rehabilitation program with graded exercises is helpful to return to normal life.

Prognosis

Twenty five percent patients die within few minutes of onset of MI. Forty percent patients die within first month of onset of symptoms due to complication of disease. Patients who receive hospital care have more chances of survival. Those who survive acute attack, 75% live for 5year, 50% for 10 year and 25% for 20 year.

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