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Acute myocardial infraction is a sudden obstruction in the blood flow to the heart muscle.

Acute myocardial infraction is a sudden obstruction in the blood flow to the heart muscle. It is an emergency condition in which the plaque formed due to the deposition of fat, cholesterol, calcium, or cellular waste products is ruptured leading to the formation of thrombus. This leads to the obstruction of the coronary vessels resulting in an acute reduction of blood supply.

Signs and Symptoms:

The symptoms of Acute myocardial infraction include:

Chest Pain- Uninterrupted and intense chest pain often radiates to the neck, shoulder, jaw, and down to the left arm. The chest pain is usually experienced as pressure, squeezing, aching, or burning sensation, and can also be presented as a feeling of indigestion or fullness of gas.

The important signs of the patient to be considered include the following:

Increase in the heart rate
Irregular pulse
Elevated blood pressure
Coughing and wheezing
Nausea and vomiting
Shortening of breath
Distended neck veins
Production of frothy sputum
Excessive sweating, light headedness and palpitations.
Loss of consciousness due to inadequate blood flow to the brain

Causes:

Coronary artery blockage is the primary cause of acute myocardial infarction. It is due to the accumulation of cholesterol in the arteries. The increase in LDL levels (bad cholesterol) in the body leads to plaque formation in the arteries. Saturated and trans fats are other types of fats which also lead to the formation of plaque in the arteries and obstruct the blood flow. Certain dairy products including butter and cheese, meat, beef, and processed foods are the main sources of saturated and trans fats.

During a heart attack, the plaque gets ruptured and spills cholesterol into the bloodstream. This leads to the formation of blood clots, when are big enough can block the artery at the site of rupture and deprives the heart muscle from obtaining enough oxygen and nutrients. There can be a partial block of the artery or a complete block of the artery. A complete block refers to an ST level elevation Myocardial Infraction (STEMI) and a partial block refers to a non-ST elevation Myocardial Infraction (NSTEMI).

Risk Factors:

Some of underlying risk factors of the acute myocardial infraction are modifiable.

Sex
Age
Family History
Male Pattern Baldness
Smoking
Diabetes Mellitus
Hypertension
Obesity
Lack of exercise
Poor oral hygiene
Presence of peripheral vascular disease
Elevated levels of homocysteine

Other factors include

Trauma
Drug use (Cocaine)
Vasculitis
Coronary artery anomalies
Coronary artery emboli
Aortic dissection
Hyperthyroidism, anemia

Diagnosis:

Electrocardiogram
Electrocardiogram remains a crucial tool used to diagnose a patient with acute myocardial infraction. One of the significant finding is the presence of the raised ST segment.

Cardiac Imaging
The coronary cardiac imaging is used to check for the presence or to rule out the coronary artery disease. The test is considered for the individuals who are at risk of having an acute myocardial infraction.

Laboratory procedures:

The laboratory tests should include identification of marker known as cardiac troponins, complete blood picture, lipid profile, renal function and metabolic panel.

Treatment:

Any patient diagnosed with acute myocardial infraction advised to take aspirin 165 mg – 325 mg immediately regardless of their condition (STEMI or NSTEMI). In STEMI the patient should receive dual antiplatelet agents, including heparin infusion. This should immediately be followed by a reperfusion with the percutaneous coronary intervention (PCI). If PCI is unavailable within 90 minutes of diagnosis of STEMI, an intravenous thrombolytic agent should be considered for reperfusion. NSTEMI in a stable asymptomatic patient can be managed with antiplatelet agents.

Prevention:

Any individual can improve heart health and prevent the occurrence of current heart condition by following the below-mentioned lifestyle changes:

Avoid smoking.
Go for regular health checkups.
Control blood pressure and cholesterol levels.
Get regular exercise and maintain a healthy weight.
Keep diabetes under control.
Manage stress.
Consume alcohol in moderation.

Your heart needs to work 24/7 to keep your body systems working. Like any other body tissue, the heart too needs oxygen and nutrients to function efficiently. For this, we have a network of arteries that supply blood to the heart muscles which are called the coronary arteries. There are two chief coronary arteries:

the left and right coronary arteries, that branch out from the aorta near the point where the aorta and the left ventricle meet.

The right coronary artery supplies blood to the right atrium, the right ventricle, a small bottom area of the left ventricle and the back portion of the septum.

The left coronary artery supplies blood to the left atrium and ventricles and the front portion of the septum.

These coronary arteries give out various branches that supply blood to different parts of the heart.

Coronary artery disease:

When there is high level of unhealthy fats in the blood, they gradually start depositing in the insides of the coronary artery vessel wall and form a fatty plaque(atherosclerosis). This gradually narrows the lumen of the coronary arteries which obstructs blood supply to the heart. This condition is called as coronary artery disease. disruption of blood supply to the heart gives rise to a cluster of symptoms, the most important being chest pain or angina.

Warning signs of heart disease
Risk factors for heart disease
Possible complications of heart disease

There are an array of heart diseases but they do share some common symptoms. If you experience any of these symptoms, it is perhaps a good idea to get yourself tested. Check these out here:

Angina or chest pain described as heaviness, pressure, aching, burning, fullness, squeezing, or painful feeling in your chest.It is often accompanied by pain in the n the neck, jaw, throat, upper abdomen or back
Shortness of breath
Easy fatiguability
Palpitation and rapid heartbeat
Weakness/dizziness
Sweating
Nausea and vomiting
Swelling in the lower extremities
Fainting(syncope)
Coughing and wheezing

For continuous circulation, the left and the right side of the heart must work together. Here are the series of steps that causes the blood to flow in the heart, lungs and body.

The right atria receives deoxygenated blood from two large veins- the superior and inferior venacava.
When the atria contracts and the blood passes from the right atrium to the right ventricle through the tricuspid valve.
When the ventricle fills, the tricuspid valve closes.
Next, the ventricle contracts and pushes blood to the pulmonary artery through the pulmonary valve.
The pulmonary artery carries the blood to the lungs where the blood gets oxygenated.
This oxygenated blood enters the left atria of the heart through the pulmonary vein.
Next, the left atria contracts and the blood flows from left atrium into your left ventricle through the open mitral valve.
When the ventricle is full, the mitral valve shuts,
Next, the ventricle contracts and oxygenated blood is passed to the aorta through which it is sent to various parts of the body.

Life is precious and to live life to the fullest, one should pay a little attention to his/her health- physical and mental. So, what do we do to be healthy- eat right and exercise, isn’t it? Actually, that isn’t it, though diet and exercise are very important for fitness but there is many more measures that we should take to keep ourselves healthy in and out. So, let us understand them one by one:

1. Let food be the medicine:

Ensuring that what goes inside your body is right- is the best thing you could do for your body. For a healthy heart, a 2000 calorie diet is recommended. Keep these points in mind:

Eat at least 4.5 cups of vegetables and fruits a day
At least two 3.5 oz. servings of fish per week, preferably oily fish
At least three 1-ounce servings of fiber-rich whole grains per day
Limit sodium intake to less than 1,500 milligrams a day
Don’t drink more than 36 ounces/week of sweetened beverages

2. Let exercise be a part of your daily life:

All of us should spare atleast 30 minutes each day for exercise. Exercise doesn’t necessarily mean you should hit the gym, it means you need to keep your body moving- do brisk walk in the park, do yoga, or the best option would be, switch on your favorite music and groove on the beats.

3. Explore ways to be more physically active:

In addition to exercises, inculcating physical activity in your daily routine like using stairs instead of the elevator, parking your car further and walking down to office, using a manual bike to go to office, or having standing desks to work on.

4. Be a weightwatcher:

Obesity is a killer. You need to keep your weight in check. The best way to find out if your weight is just right is to measure the body mass index.The BMI calculation is very easy, divide your weight in kilograms by their height in metres squared. If your BMI is:

below 18.5 – you’re in the underweight range
between 18.5 and 24.9 – you’re in the healthy weight range
between 25 and 29.9 – you’re in the overweight range
between 30 and 39.9 – you’re in the obese range

5. Check your health numbers:

Go for regular health checks. Remember these numbers:

Blood pressure < 120/80
Fasting blood sugar< 100 mg/dL
Total cholesterol < 200 mg/dL

6. Smoking:

Smoking is one of the chief risk factors for not only heart disease but also deadly cancers, lung diseases and chronic disorders like high blood pressure. Quitting smoking is one of the best gift that you could give your body today.

7. Switch off your stress mode:

People with stress and mental illnesses like depression are at greater risk of heart diseases. Have a good social life, spend time with friends and family, explore new places, give some time to your hobbies and interests- do anything that relaxes you. A relaxed mind and body makes you a more productive person and helps you stay healthy.

8. Laugh your way to health:

Research suggests laughing lowers stress hormones, decreases inflammation in your arteries, and raises good cholesterol levels.

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Heart is a complex organ and can get affected by diseases that can affect various systems of the heart. The common heart ailments that would be observed include:

Coronary Artery Disease (CAD) – accumulation of cholesterol plaques within the walls of the blood vessels (coronary arteries) supplying the heart. This leads to obstruction to blood flow of the heart that can cause chest pain or heart attack.

Valvular heart disease: Heart valves are flap-like structures akin to doors between rooms. They control the blood flow between various chambers of the heart. They play a key role in blood circulation.

There are four valves in the heart

mitral and aortic valves on the left side of the heart

tricuspid and pulmonary valves on the right.

These valves can either get narrowed (stenosis) or get “leaky” (regurgitation).

Cardiomyopathy: This disease affects the heart muscle leading to inefficient heart pumping efficiency. Cardiomyopathy can be either due to:

Direct heart muscle diseases – Hypertrophic Cardiomyopathy, Dilated Cardiomyopathy and Restrictive Cardiomyopathy.
Indirect heart muscle diseases –
- Consequent to
  - heart attack (ischemic cardiomyopathy)
  - infective (myocarditis) and
  - heart rhythm problems
Heart Rhythm problems (Arrhythmias)- Normal heart rate is between 50-100 beats per minute. The maintenance of heart rhythm within a specific range is possible due to an efficient electrical system of the heart also called the conduction system.
- Slow heart rate – Bradycardia usually due to retardation of conduction within the conduction system of the heart. The most common cause is due to age related degeneration of the conduction system. The garden variety disease causing slow heart rate is called complete heart block.
- Fast heart rate – Tachycardia in this disease there is an accelerated conduction of electrical impulses – if the fast heart arises in the lower chambers of the heart (ventricles) it is called ventricular tachycardia if it arises in the upper chambers (atria) of the heart it is called supraventricular tachycardia.

Doctors usually recommend a battery of tests based on the system of the heart that has been affected. Based on a detailed history followed by a detailed physical examination, appropriate battery of tests would be suggested. The diagnosis of the heart ailment is critically dependent on the results of tests.

In addition to confirming the diagnosis, test results might indicate the disease complications and thus your doctor is able to stage the disease and the possible outcomes.

Related : Basics about Heart Failure

Blood tests:

Complete blood count (CBC): A complete blood count helps to detect infection, anaemia and other blood disorders. Anaemia is a common finding in heart failure, plus it also contributes to worsening of heart failure. A low platelet count may be caused by medications such as diuretics or heparin.
Cardiac troponins (cTn1, cTnT, high sensitivity troponins): It is an important blood biomarker useful for the detection and predicting outcomes of chest pain or heart attack. Cardiac troponins may also be high in other heart related conditions like acute myocarditis, coronary vasospasm and non-cardiac conditions (e.g. sepsis, chronic kidney disease).
Electrolytes, urea and creatinine: Assessment of kidney function is essential in all cardiac patients. Both kidney and cardiac disease share the same risk factors and either disease can lead to poor outcomes of the other disease. In addition, cardiac drugs’ doses need to be modified considering the kidney function.
Liver function tests:: Certain drugs such as statins and amiodarone, which are commonly prescribed for patients with heart disease, can trigger liver failure. Liver failure could also be a consequence of heart failure.
Thyroid function test: Medication for heart disease like amiodarone may cause hyper or hypo thyroidism. Altered thyroid hormone can also cause heart dysfunction and responsible for coronary artery disease.
Brain Natriuretic Peptides (BNP or N-terminal pro BNP): BNP is a useful tool to differentiate between cardiac and non-cardiac causes of shortness of breath. High levels of BNP and N terminal pro BNP is associated with increased severity of heart disease and greater risk of hospitalization.

Related: Types of Heart Failure

Electrocardiography(ECG):

This test detects and records the electrical activity of the heart. This is a simple, non-invasive test which is very useful to determine abnormalities in the heart rate, rhythm and to identify risk of damaged heart muscle or other structural changes in the heart. This test detects the presence of arrhythmias and coronary artery disease.

Exercise stress testing:

Exercise makes your heart work harder. Exercise stress testing is done either on a treadmill or cycle ergometry with the patient connected to an electrocardiogram. Exercise stress testing may identify myocardial ischaemia, haemodynamic/ electrical instability, or other exertion-related signs or symptoms. When an individual is not able to exercise, medications are given to stress the heart and the response is evaluated.

Chest X-ray:

Chest X ray is very useful to differentiate whether shortness of breath is due to a respiratory disease or heart disease. It can also help in detecting complications of heart failure such as cardiomegaly, interstitial oedema, pulmonary oedema and pleural effusions.

Coronary angiography:

Coronary angiography is useful to determine the health of the coronary arteries. In this test, a catheter is inserted into the coronary arteries and a dye is injected to produce clear X ray images of the coronary arteries. This helps to find out the presence, location and extent of vessel narrowing. The results also help to decide which type of treatment would be most appropriate for correction of heart problem.

Echocardiography:

This test gives an ultrasound image of the heart. Echocardiography can provide information about the size and shape of heart chambers, blood flow velocities, heart muscle function when they contract and relax, abnormalities of the movement of the heart wall, valve function, and presence of thrombus (blood clot) in the heart.

Stress echocardiography helps in detecting decreased blood flow to heart during exertion. In this test, echocardiography is done immediately post stress. The stress can be exercise or could be induced by medications.

Myocardial perfusion scanning (MPS):

MPS is a non-invasive test which helps to determine how well blood flows through your heart muscles. In this test, a small amount of a radioactive substance is injected into the blood. The test evaluates the severity of coronary artery disease and provides guidance regarding the need as well as success of invasive procedures like angioplasty and stent insertion.

Cardiac Computerized Tomography (CT):

Cardiac CT provides detailed images of the heart. This helps to identify structural abnormalities in the heart and blood vessels such as aneurysms, valve dysfunction and damage to the pulmonary vasculature. Cardiac CT also provides information about patency of grafts following coronary artery bypass graft.

Cardiac Magnetic Resonance Imaging (MRI):

Cardiac MRI uses strong magnetic fields and radiofrequency to provide detailed 3D images of the heart and surrounding structures. The image provides accurate information about cardiac volumes, muscle mass, contractility, and how efficiently the heart is pumping. Like cardiac CT, cardiac MRI also helps to provide information about patency of grafts following coronary artery bypass graft.

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