You are on page 1of 31

Contents

PREFACE

CONTENTS

CHAPTER I - INTRODUCTION

1.1 Background 1.2 Problems 1.3. Limitation of problems 1.4 Objectives 1.5. Method of writing CHAPTER II - ANOREXIA NERVOSA

2.1 Definition 2.2 History 2.3 Causes 2.4 Statistics and Prevalence 2.5 Symptomatology 2.6 Side Effects and Complication 2.7 Diagnosis 2.8 Therapy and Treatment 2.9 Prognosis 2.10 Prevention CHAPTER III - ACUTE MYOCARDIAL INFRACTION ( AMI )

3.1. 3.2. 3.3.

Definition Epidemiology Symptomatology

3.4.

Risk Factors Diagnosis Therapy and Treatment Prognosis Prevention

3.5.
3.6. 3.7. 3.8.

CHAPTER IV - THE CORRELATION BETWEEN ANOREXIA NERVOSA AND ACUTE MYOCARIDAL INFARCTION ( A M I )

CHAPTER V - CONCLUSION

BIBLIOGRAPHY

CHAPTER I Introduction
1.1 BACKGROUND The true incidence and prevalence of anorexia nervosa still are not known despite study of the condition spanning 100 years. Nor has the impression been confirmed that its frequency is increasing. Anorexia nervosa occurs in 5% to 10% of the population; about 95% of those affected are women. This disorder occurs primarily in adolescents and young adults but may also affect older women. The occurrence among males is rising. The prognosis varies but improves if the patient is diagnosed early or if she wants to overcome the disorder and seeks help voluntarily. Mortality ranges from 5% to 15% the highest mortality associated with a psychiatric disturbance. One-third of these deaths can be attributed to suicide. Anorexia nervosa estimated 0.1% adults (USSG); estimated 0.5 to 3.7 percent females or woman in productive age (NIMH); 1% of adolescent girls (NWHIC) approximately 1 in 1,000 or 0.10% or 272,000 people in USA are having this eating disorder. National Institute of Mental Health estimates that one in ten anorexic cases ends in death from starvation, suicide or medical complications like kidney failure or heart attacks (Acute Myocardial Infarction). 1.2 PROBLEMS Anorexia nervosa is a mental illness. A women who gets anorexic have a preoccupation with food and body image to the extreme: she dont eat. Despite being underweight, she continue to try to lose weight. The syndrome is more common in women than in men, and most often begins between the ages of 13 - 30 years. The medical complications brought about by this psychiatric disorder can be severe. She may die.

In this paper, I would like to discuss about the correlation between Anorexia nervosa and acute myocardial infraction. The discussion about the definition until the treatments of the disease and the complications on it. Especially, this discussion will talk about Anorexia nervosa on woman in productive age in America year 2000 2005. 1.3 LIMITATION OF PROBLEMS The topics that I would like to discuss in this paper are :

What is Anorexia Nervosa? What is Acute Myocardial Infraction? How do we diagnose a woman in Anorexia Nervosa? How do we diagnose someone with Acute Myocardial Infarction?

Why does Anorexia nervosa can influence the risk of getting

the acute myocardial infraction? What is the treatment Anorexia nervosa and what is the

correlation between the prevention of Acute Myocardial Infarction? 1.4 OBJECTIVES After reading this paper, the writer hopefully is successful on giving greater information regarding to the correlation between Anorexia nervosa and Acute myocardial infraction. From this paper, reader can get more information about Anorexia nervosa and acute myocardial infraction. Because this paper tells us about the definition, etiology, signs and symptoms, diagnosis, treatments, and prevention. It also discuss the correlation between Anorexia nervosa and acute myocardial infraction, especially on woman in productive age. 1.5 METHOD OF WRITING I look up these materials of Anorexia nervosa and Acute myocardial infraction in many textbooks in the library. I also collect many information and journals by using internet on - line.

C H A P T E R II Anorexia Nervosa

2.1 DEFINITION The term "anorexia" literally means absence of appetite. But most of the people who suffer from Anorexia Nervosa do not at all have lack of appetite, they are only scared of putting on weight. Therefore, the term " selfstarving " would be more suitable, or even better expressed " weightfobia ". Anorexia nervosa involves an aversion to food that leads to a state of starvation and emaciation. It is a very serious illness that some doctors believe this disorder should be not be diagnosed as a simple eating disorder.

Anorexia Nervosa is a syndrome in which the primary features include excessive fear of becoming overweight, body image disturbance, significant weight loss, refusal to maintain minimal normal weight, and amenorrhea. This disorder occurs most frequently in adolescent females.

APA, Thesaurus of Psychological Index Terms, 1994 -

One of the psychiatry from America said that Anorexia Nervosa is a psychological disorder characterized by somatic delusions that you are too fat despite being emaciated. People who intentionally starve themselves or severely restrict their food intake suffer from an eating disorder called anorexia nervosa. The disorder, which usually begins in young people around the time of puberty, involves extreme weight loss -- at least 15 percent below a young womans normal body weight. Those experiencing anorexia

nervosa also have an intense fear of becoming fat, even though they are underweight. Many people with the disorder look emaciated but are convinced that they are overweight. Sometimes they must be hospitalized to prevent starvation, yet they often continue to deny the condition. Food and weight become obsessions. For some, the compulsiveness shows up in strange eating rituals or the refusal to eat in front of others. It is not uncommon for people with anorexia to collect recipes and prepare lavish gourmet feast for family and friends, but not partake in the meals themselves. They may adhere to strict exercise routines to keep off weight. Ninety percent of all anorexics are women. Anorexia nervosa once labelled as "the little rich girls' disease", research now shows that it cuts across all age and class boundaries. 2.2 HISTORY Anorexia Nervosa is more common today, than a century ago. There are different reasons for this:

The thin ideal has become "fashionable", an ideal which almost all type's of media advocate. This leads people to believe that this is the ideal way to look like, and the right way to live their life. Many people try different slimming methods, one after the other, and unsuitable slimming methods is the most common factor which starts an eating disorder.

Modern technology hels us so much that we do not need to exert our bodies physically as much as before. Most work is performed in a sitting position. People handle the reduced need for with less and/or healthy food.

The media also focus a lot on sport and exercise, which can lead to an extreme focus on ones body, and on an almost unreachable body ideal. In 1684 Anorexia Nervosa was described for the first time, but it was not until 1870 that it became identified and described with its own diagnosis. The birth of the "new" disease was not only related to the new way to look at medicine, but also an effect of the changes in the society, and on the new ideal for young women. The history of Anorexia Nervosa is partly an

effect of the culture we live in, and partly an effect of the social structure in our society. A study based on clinical research in the 1970s showed that Anorexia Nervosa is a disease related to the culture we live in. This means that the disease is most common in the Western world, and a lot is depending on the different factors. Today, there are many clinics around the world, with specialized psychologists and psychiatrists, in order to try to help women and men that suffer from Anorexia Nervosa. 2.3 CAUSES At this time, no definite cause of anorexia nervosa has been determined. However, research within the medical and psychological fields continues to explore possible causes. Some experts feel that demands from society and families could possibly be underlying causes for anorexia. For many individuals with anorexia, the destructive cycle begins with the pressure to be thin and attractive. A poor self-image compounds the problem. Other researchers feel that this disorder can stem from a particular dysfunction often seen in families of anorexia patients. In one particular type of dysfunction, family members become so interdependent that each cannot achieve their identity as an individual. Thus, family members are unable to function as healthy individuals and are dependent on other family members for their identity. In children, part of this dysfunction includes a fear of growing up (especially girls). Restrictive dieting may prevent their bodies from developing in a normal manner, and in their thinking, restricts the maturational process and maintains the parent-child relationship that the family has come to rely on. Other family situations that have been suggested, but not proved, as possibly being related to the development of anorexia nervosa include high parental expectations, poor communications skills, and problems with conflict management.

Some studies also suggest that a genetic (inherited) component may play a role in determining a person's susceptibility to anorexia. Researchers are currently attempting to identify the particular gene or genes that might affect a person's tendency to develop this disorder. Although no organic cause for anorexia has been identified, some evidence points to a dysfunction in the part of the brain (hypothalamus) which regulates certain metabolic processes. Other studies have suggested that imbalances in neurotransmitter levels in the brain may occur in people suffering from anorexia. 2.4 STATISTICS AND PREVALENCE There are no reliable statistics concerning the number of people with eating disorders because:

Many people are ashamed and don't want to talk about it. Sometimes they are not even aware of their problem. This is similar to the situation with alcohol, where also many people are not aware that they have a problem.

Doctors sometimes treat illnesses caused by eating disorders without realizing that the patient suffers from an eating disorder. Probably only about ten percent of those with eating disorders get a proper diagnosis and treatment. On the average there is a delay of about eight years before the start of an eating disorder and medical recognition and treatment of the disorder.

There are typical cases such as extreme anorexia or compulsive eating, and there are many intermediate ones. Overweight may be caused by eating disorders but also by other reasons. Psychological factors may even be involved so that similar treatment as for eating disorders can help also for obesity in these cases.

Anorexia Nervosa is listed as a " rare disease " by. This means that Anorexia Nervosa, or a subtype of Anorexia Nervosa, affects less than 200,000 people in the US population.

the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH)

Of all people with Anorexia nervosa, different investigations estimate that approximately 95% of those affected by anorexia are female, but males can develop the disorder as well. One investigation found only 70 % to be women, but that investigation deviates from most others. Symptoms of anorexia are by different investigations found in between 0,5 % and 1,0 % of teenage girls. One study reported that more than 10 % of all young productive age women have some kind of eating disorder, even if it does not always fit into any of the standard categories of anorexia nervosa. While anorexia typically begins to manifest itself during early

adolescence, it is also seen in young children and adults. In the U.S. and other countries with high economic status, it is estimated that about one out of every 100 adolescent girls has the disorder. Caucasians are more often affected than people of other racial backgrounds, and anorexia is more common in middle and upper socioeconomic groups. According to the U.S. National Institute of Mental Health (NIMH), an estimated 0.5% to 3.7% of women will suffer from this disorder at some point in their lives. Many experts consider people for whom thinness is especially desirable, or a professional requirement (such as athletes, models, dancers, and actors), to be at risk for eating disorders such as anorexia nervosa. 2.5 SYMPTOMATOLOGY Anorexia can have dangerous psychological and behavioral effects on all aspects of an individual's life and can affect other people around her as

well. A woman who is anorexic have some possible warning signs, include :
o

Deliberate self starvation with weight loss

Greater amounts of hair on the body or the face

Intense fear of gaining weight Refusal to eat Denial of hunger Constant exercising

o o

Sensitivity to cold Absent or irregular periods Loss of scalp hair A self-perception of being fat when the person is already too thin

o o o

o o

This is the list of signs and symptoms mentioned in various sources for Anorexia Nervosa includes the 79 symptoms that usually used as a standard for diagnose an anorexic woman :
Weight changes o o

Weight loss Thinness Unusual eating habits Eating rituals Excessive care in Playing with food

o o

Low body weight Emaciation Weighing foods Intentional starvation Cooking - some anorexics will prepare food for others but not eat it themselves

Obession with food and eating o o o o o o

eating
o

Obsession with weight o o o

Fear of gaining weight Desire to lose weight Denial of hunger

Intense body dissatisfaction Repeatedly checking weight

10

Distortion of body image Believing too fat even when thin Excessive exercise Purging Vomiting

Denial of low body weight Wearing layered clothing - used to hide weight loss Laxative abuse Enema abuse Diuretic abuse

Abusing other weight control methods o o o o o o

Menstrual abnormalities o o o

Irregular menstrual periods Absent menstrual periods Delayed first period Esophagus Dry skin Thinning hair Cold sensitivity Vulnerable to Anemia Heart palpitations Bone loss Tooth decay Soft body hair (lanugo) Excess body hair Excess facial hair Hair loss Balding scalp Low breathing rate Slow pulse Low blood pressure Low thyroid function Low body temperature Excessive thirst Excessive urination Dehydration Constipation Muscle mass loss Swollen joints Light-headedness Secrecy Interpersonal conflicts Resistance to Denial that they are ill

Physical symptoms - mainly from malnutrition and starvation o o o o o o o o o o o o o o o

inflammation
o o o o

infections
o o o o o o o

Emotional symptoms o o o o

Low self-esteem Depression Social Withdrawal Isolation

o o o

treatment
o

11

Suicidal tendency Excessive Consider themselves

Absence of Hyperactivity Depression Excessive exercise Malnutrition

preoccupation with food

menstruation

overweight despite being the contrary


Self-starvation Binge eating

A woman with anorexia can become irritable and easily upset and have difficulty interacting with others. Her sleep can become disrupted and lead to fatigue during the day. And also her attention and concentration can decrease. Most woman with anorexia become obsessed with food and thoughts of food. They think about it constantly and become compulsive about eating rituals. They may collect recipes, cut their food into tiny pieces, prepare elaborate calorie-laden meals for other people, or hoard food. Additionally, they may exhibit other obsessions and/or compulsions related to food, weight, or body shape that meet the diagnostic criteria for an obsessive compulsive disorder. Other psychiatric problems are also common in people with anorexia nervosa, including affective (mood) disorders, anxiety disorders, and personality disorders. Generally, a woman with anorexia are compliant. Sometimes, they are overly compliant, to the extent that they lack adequate self-perception. They are eager to please and strive for perfection. They usually do well in school and may often overextend themselves in a variety of activities. The families of anorexics often appear to be "perfect." Physical appearances are important to them. Performance in other areas is stressed as well, and they are often high achievers.

12

While control and perfection are critical issues for individuals with anorexia, aspects of their life other than their eating habits are often found to be out of control as well. Many have, or have had at some point in their lives, addictions to alcohol, drugs, or gambling. Compulsions involving sex, exercising, housework, and shopping are not uncommon. In particular, people with anorexia often exercise compulsively to speed the weight-loss process. All of these features can negatively affect one's daily activities. Diminished interest in previously preferred activities can result. Some individuals also have symptoms that meet the diagnostic criteria for a major depressive disorder. 2.6 SIDE EFFECTS AND COMPLICATIONS There are many side effects of anorexia nervosa. A woman with anorexia usually stop having menstrual periods; this is a condition called amenorrhea. Anorexia may lead to dry skin and thinning hair. Anorexics may have a growth of fine hair all over their body as a natural defense mechanism against extreme weight loss. A woman suffering from anorexia may feel cold and are easily susceptible to illness. Mood swings are typical.

One in ten anorexic cases ends in death from starvation, suicide or medical complications like Acute myocardial infarction, cardiac arrest, and kidney failure as one of the type of kidney disease. Physical problems also include anemia, infection, heart palpitations, bone loss, tooth decay, as well as inflammation of the esophagus. Estimated by : The National Institute of Mental Health

Complications of Anorexia Nervosa are secondary conditions, symptoms, or other disorders that are caused by Anorexia Nervosa. In many cases

13

the distinction between symptoms of Anorexia Nervosa and complications of Anorexia Nervosa is unclear or arbitrary. This is the list of complications that have been mentioned in various sources for Anorexia Nervosa :
Weight loss Starvation Death - about 10% of Cardiac arrest Electrolyte imbalance Suicide Osteoporosis - in the

cases end this way.


Infections Kidney failure

short-term or later in life.

Anorexia nervosa can cause some other diseases, include :

Muscle wasting Delayed puberty Constipation Hyponatraemia Hypokalaemia Erectile dysfunction Female infertility Osteoporosis Purpura Hypothermia
2.7 DIAGNOSIS

QT lengthening Pathological fracture Hypercarotinemia Sex hormone binding


globulin raised (serum)

Lanugo hair Amenorrhoea Hypogonadotrophic


hypogonadism

Hypercholesterolaemia Acanthocytosis

Anorexia nervosa is a complicated disorder to diagnose. Individuals with anorexia often attempt to hide the disorder. Denial and secrecy frequently accompany other symptoms. It is unusual for an individual with anorexia to seek professional help because the individual typically does not accept that she has a problem (denial). In many cases, the actual diagnosis is not made until there are other medical complications.

14

The individual is often brought to the attention of a professional by family members only after a marked weight loss has occurred. When anorexics finally come to the attention of the health professional, they often lack insight into their problem despite being severely malnourished and may be unreliable in terms of providing accurate information. Therefore, it is often necessary to obtain information from parents or other family members in order to evaluate the degree of weight loss and extent of the disorder. When doctors suspect someone has anorexia, they typically run a battery of tests and exams. These can help pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

Physical exam. This may include measuring height and weight;

checking vital signs, such as heart rate, blood pressure and temperature; checking the skin for dryness or other problems; listening to the heart and lungs; and examining the abdomen.

Laboratory tests. These may include a complete blood count

(CBC), as well as more specialized blood tests to check electrolytes and protein as well as functioning of the liver, kidney and thyroid. A urinalysis also may be done.

Psychological can

evaluation.

doctor feelings

or and

mental eating

health habits.

professional

assess

thoughts,

Psychological self-assessments and questionnaires also are used. Other studies. X-rays may be taken to check for broken bones, pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities. Testing may also be done to determine how much energy your body uses, which can help in planning nutritional requirements. The actual criteria for anorexia nervosa are found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). There are four basic criteria for the diagnosis of anorexia nervosa that are characteristic:

15

1.

The refusal to maintain body weight at or above a minimally normal weight for age and height. Body weight less than 85% of the expected weight is considered minimal.

2. 3.

An intense fear of gaining weight or becoming fat, even though the person is underweight. Self-perception that is grossly distorted and weight loss that is not acknowledged. In women who have already begun their menstrual cycle, at least three consecutive periods are missed (amenorrhea), or menstrual periods occur only after a hormone is administered.

4.

2.8 THERAPY AND TREATMENT Anorexia is a mental problem manifested in a physical form. Treatment for any eating disorder should include both a mental health professional as well blood cell count with manual differential, lymphocyte as a primary health care physician. Essential components of successful treatments are ongoing medical care, regular therapy, nutritional counseling, and possibly medication. Eating disorders can be treated with antidepressants, however, this is less effective for anorexia nervosa. Physicians help monitor bone density loss and hear heart rhythm disturbances. Psychologists help identify the important issues and replace destructive thoughts and behaviors with more positive ones. Support groups also play a role in treating anorexia. Often groups of patients will meet weekly to discuss their fears and help each other recover. Most cases of anorexia can be treated successfully, but not instantly. For many patients, treatments may need to be long-term. Talk to physicians and/or counselors for help in determining the best way to approach and deal with the situation. People with anorexia will beg and lie to avoid eating and gaining weight; it means giving up the illness and giving up the control. Family and friends should not give in to the pleadings of an anorexic patient, but should not nag them incessantly. Anorexia is an illness that can not be controlled by simple willpower - but

16

rather

needs

professional

guidance.

Most

important,

support

the

individual without supporting their actions. The most important thing that family and friends can do to help a person with anorexia is to unconditionally love them. - NWHIC And this is the list of treatments mentioned in various sources for Anorexia Nervosa that usually used for diagnose an anorexic woman.
Normal weight restoration o o o Interpersonal therapy

Supplemental feeding Electrolyte imbalance treatments Nutritional counseling

(IPT)
o Support groups

Medications - usually only

after normal weight has been re-established.


o Antidepressants o Selective serotonin

reuptake inhibitors (SSRIs)


Psychotherapy o Cognitive-behavioral

therapy (CBT)

17

Although we know how to treat an anorexic, we have to always seek professional medical advice about any treatment or change in treatment plans. 2.9 PROGNOSIS Anorexia is among the psychiatric conditions with the highest mortality rate, with an estimated 6% of anorexia victims dying from complications of the disease. The most common causes of death in people with anorexia are medical complications of the condition including cardiac arrest and electrolyte imbalances. Suicide is also a cause of death in people with anorexia. Early diagnosis and treatment can improve the overall prognosis in an individual with anorexia. With appropriate treatment, about half of those affected will make a full recovery. Some people experience a fluctuating pattern of weight gain followed by a relapse, while others experience a progressively deteriorating course of the illness over many years and still others never fully recover. It is estimated that about 20% of people with anorexia remain chronically ill from the condition. As with many other addictions, it takes a day-to-day effort to control the urge to relapse. Many individuals will require ongoing treatment for anorexia over several years, and some may require treatment over their entire lifetime.

2.10 PREVENTION
There's no guaranteed way to prevent anorexia or other eating disorders. Doctors may be in a good position to identify early indicators of an eating disorder and prevent the development of full-blown illness. They can ask patient questions about their eating habits and satisfaction with their appearance during routine medical appointments, for instance. If you notice a family member or friend with low self-esteem, severe dieting and dissatisfaction with appearance, consider talking to her about

these issues. Although you may not be able to prevent an eating disorder from developing, you can talk about healthier behavior or treatment options.

C H A P T E R III Acute Myocardial Infarction(A MI)


3.1 DEFINITION Myocardial infarction (MI or AMI for acute myocardial infarction), commonly known as a heart attack, occurs when the blood supply to part of the heart is interrupted causing some 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 (like cholesterol) 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 and / or death (infarction) of heart muscle tissue (myocardium). Classical symptoms of acute myocardial infarction include sudden chest pain (typically radiating to the left arm or left side of the neck), shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety (often described as a sense of impending doom). Women may experience fewer typical symptoms than men, most commonly shortness of breath, weakness, a feeling of indigestion, and fatigue. Approximately one quarter

of all myocardial infarctions are silent, without chest pain or other symptoms. A heart attack is a medical emergency, and people experiencing chest pain are advised to alert their emergency medical services, because prompt treatment can be crucial to survival. Heart attacks are the leading cause of death for both men and women all over the world. Important risk factors are previous cardiovascular disease (such as angina, a previous heart attack or stroke), older age (especially men over 40 and women over 50), tobacco smoking, high blood levels of certain lipids (triglycerides, low-density lipoprotein or "bad cholesterol") and low levels of high density lipoprotein (HDL, "good cholesterol"), diabetes, high blood pressure, obesity, chronic kidney disease, heart failure, excessive alcohol consumption, the abuse of certain drugs (such as cocaine and methamphetamine), and chronic high stress levels. 3.2 EPIDEMIOLOGY Myocardial infarction is a common presentation of ischemic heart disease. The WHO estimated that in 2002, 12.6 percent of deaths worldwide were from ischemic heart disease. Ischemic heart disease is the leading cause of death in developed countries, but third to AIDS and lower respiratory infections in developing countries. In the United States, diseases of the heart are the leading cause of death, causing a higher mortality than cancer (malignant neoplasms). Coronary heart disease is responsible for 1 in 5 deaths in the U.S.. Some 7,200,000 men and 6,000,000 women are living with some form of coronary heart disease. 1,200,000 people suffer a (new or recurrent) coronary attack every year, and about 40% of them die as a result of the attack. This means that roughly every 65 seconds, an American dies of a coronary event. 3.3 SYMPTOMATOLOGY

The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and rarely instantaneous. Chest pain is the most common symptom of acute myocardial infarction 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 epigastrium, where it may mimic heartburn. Levine's sign, in which the patient localizes the chest pain by clenching their fist over the sternum, has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed that it had a poor positive predictive value. Women and older patients experience atypical symptoms more frequently than their male and younger counterparts. Women also have more symptoms compared to men (2.6 on average vs 1.8 symptoms in men). 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 which 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. Approximately one fourth of all myocardial infarctions are silent, without chest pain or other symptoms. These cases can be discovered later on electrocardiograms or at autopsy without a prior history of related complaints. A silent course is more common in the elderly, in patients with diabetes mellitus and after heart transplantation, probably because the donor heart is not connected to nerves of the host. In diabetics, differences in pain threshold, autonomic neuropathy, and psychological factors have been cited as possible explanations for the lack of symptoms. The American Heart Association says these are the most common warning signals of a heart attack:

Uncomfortable pressure, fullness, squeezing or pain in the center Pain spreading to the shoulders, neck or arms. Chest discomfort with lightheadedness, fainting, sweating, nausea

of the chest lasting more than a few minutes.


or shortness of breath. Less common warning signs of heart attack:


Atypical chest pain, stomach or abdominal pain. Nausea or dizziness. Shortness of breath and difficulty breathing. Unexplained anxiety, weakness or fatigue. Palpitations, cold sweat or paleness.

3.4 RISK FACTORS Risk factors for atherosclerosis are generally risk factors for myocardial infarction, they are :

Diabetes (with or without insulin resistance) - the single most Tobacco smoking Hypercholesterolemia high low (more accurately hyperlipoproteinemia, low high density density lipoprotein and

important risk factor for ischaemic heart disease (IHD)


especially lipoprotein)

High blood pressure Family history of ischaemic heart disease (IHD) Obesity (defined by a body mass index of more than 30 kg/m, or Old age Stress (occupations with high stress index are known to have

alternatively by waist circumference or waist-hip ratio).


susceptibility for atherosclerosis) Many of these risk factors are modifiable, so many heart attacks can be prevented by maintaining a healthier lifestyle. Physical activity, for example, is associated with a lower risk profile. Non-modifiable risk

factors include age, sex, and family history of an early heart attack (before the age of 60), which is thought of as reflecting a genetic predisposition. Socioeconomic factors such as a shorter education and lower income (particularly in women), and unmarried cohabitation may also contribute to the risk of AMI. To understand epidemiological study results, it's important to note that many factors associated with AMI mediate their risk via other factors. For example, the effect of education is partially based on its effect on income and marital status. 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. Baldness, hair greying, a diagonal earlobe crease (Frank's sign) and possibly other skin features have been suggested as independent risk factors for AMI. Their role remains controversial; a common denominator of these signs and the risk of AMI is supposed, possibly genetic. 3.5 DIAGNOSIS The diagnosis of myocardial infarction is made by integrating the history of the presenting illness and physical examination with electrocardiogram findings and cardiac markers (blood tests for heart muscle cell damage). A coronary angiogram allows visualization of narrowings or obstructions on the heart vessels, and therapeutic measures can follow immediately. At autopsy, a pathologist can diagnose a myocardial infarction based on anatomopathological findings. A chest radiograph and routine blood tests may indicate complications or precipitating causes and are often performed upon arrival to an emergency department. New regional wall motion abnormalities on an echocardiogram are also suggestive of a myocardial infarction. Echo may be performed in equivocal cases by the on-call cardiologist. In stable

patients whose symptoms have resolved by the time of evaluation, technetium-99m 2-methoxyisobutylisonitrile (Tc99m MIBI) or thallium-201 chloride can be used in nuclear medicine to visualize areas of reduced blood flow in conjunction with physiologic or pharmocologic stress. Thallium may also be used to determine viability of tissue, distinguishing whether non-functional myocardium is actually dead or merely in a state of hibernation or of being stunned. Mistakes in interpretation are relatively common, and the failure to identify high risk features has a negative effect on the quality of patient care. WHO criteria have classically been used to diagnose AMI; a patient is diagnosed with myocardial infarction if two (probable) or three (definite) of the following criteria are satisfied: 1. 2. Clinical history of ischaemic type chest pain lasting for more than Changes in serial ECG tracings Rise and fall of serum cardiac biomarkers such as creatine kinase-

20 minutes

3.

MB fraction and troponin 3.6 THERAPY AND TREATMENT Acute Myocardial Infarction is amedical emergency which demands both immediate attention and activation of the emergency medical services. The ultimate goal of the management in the acute phase of the disease is to salvage as much myocardium as possible and prevent further complications. As time passes, the risk of damage to the heart muscle increases; hence the phrase that in myocardial infarction, "time is muscle," and time wasted is muscle lost. Oxygen, aspirin, glyceryl trinitrate (nitroglycerin) and analgesia (usually morphine, although experts often argue this point), hence the popular mnemonic MONA, morphine, oxygen, nitro, aspirin) are usually

administered as soon as possible. In many areas, first responders are trained to administer these prior to arrival at the hospital. Once the diagnosis of myocardial with infarction and is confirmed, other

pharmacologic agents are often given. These include beta blockers, anticoagulation (typically heparin), possibly additional antiplatelet agents such as clopidogrel. While these agents can decrease mortality in the setting of an acute myocardial infarction, they can lead to complications and potentially death if used in the wrong setting. Cardiac rehabilitation aims to optimize function and quality of life in those afflicted with a heart disease. This can be with the help of a physician, or in the form of a cardiac rehabilitation program. Physical exercise is an important part of rehabilitation after a myocardial infarction, with beneficial effects on cholesterol levels, blood pressure, weight, stress and mood. Some patients become afraid of exercising because it might trigger another infarct. Patients are stimulated to exercise, and should only avoid certain exerting activities such as shovelling. Local authorities may place limitations on driving motorised vehicles. Some people are afraid to have sex after a heart attack. Most people can resume sexual activities after 3 to 4 weeks. The amount of activity needs to be dosed to the patient's possibilities. 3.7 PROGNOSIS The prognosis for patients with myocardial infarction varies greatly, depending on the patient, the condition itself and the given treatment. Using simple variables which are immediately available in the emergency room, patients with a higher risk of adverse outcome can be identified. For example, one study found that 0.4% of patients with a low risk profile had died after 90 days, whereas the mortality rate in high risk patients was 21.1%.

Prognosis is significantly worsened if a mechanical complication (papillary muscle rupture, myocardial free wall rupture, and so on) were to occur. 3.8 PREVENTION The risk of a recurrent myocardial infarction decreases with strict blood pressure management and lifestyle changes, chiefly smoking cessation, regular exercise, a sensible diet for patients with heart disease, and limitation of alcohol intake. Patients are usually commenced on several long-term medications postAMI, with the aim of preventing secondary cardiovascular events such as further myocardial infarctions, congestive heart failure or cerebrovascular accident (CVA). Unless contraindicated, such medications may include:

Antiplatelet drug therapy such as aspirin and/or clopidogrel

should be continued to reduce the risk of plaque rupture and recurrent myocardial infarction.

Beta blocker therapy such as metoprolol or carvedilol should be Omega-3 fatty acids, commonly found in fish, have been shown to

commenced.

reduce mortality post-AMI.

C H A P T E R IV The Correlation Nervosa Infarction on Between in Anorexia and Acute women Myocardial productive age

in

America year

2000

- 2005

Anorexia nervosa as one of the serious eating disorder problem commonly raise the risk for having an Acute Myocardial Infarction. Anorexia nervosa creates huge imbalances in the electrolytic balance of the blood, things like hyperkalemia and hypocalcemia, either of these two issues can instigate an Acute Myocardial Infarction. Anemia, chemical poisoning, and electrolyte abnormality has been said as three of the important elements that have a role in causing anorexia and heart attacks. But most of the case of mortality in anorexic woman in America year 2000 - 2005 which caused by acute myocardial infarction is because of the electrolyte abnormality. In a medical terms, electrolyte abnormality is an imbalance in the level of any of a number of chemicals (electrolytes) in the blood stream e.g. chloride, sodium, magnesium, potassium, calcium, phosphate and bicarbonate. Symptoms can vary depending on which electrolyte is involved and the severity of the imbalance - severe cases can readily lead to death. An electrolyte abnormality can be caused by such things excessive loss of body fluid through vomiting or diarrhea, kidney conditions, malabsorption and various drugs such as diuretics and chemotherapy drugs. When the body is starved of calories and nutrients, many of the anorexic organs begin to fail, including the heart. Frequent purging or vomiting can cause dehydration and a loss of essential electrolytes, which can result in irregular heartbeats and life-threatening arrhythmias. Too much dieting with sudden weight losses and gains can also cause fatty deposits to accumulate in your arteries, causing hardening and blockages also known as atherosclerosis. Atherosclerosis is the most common form of coronary artery disease and will lead to an acute myocardial infarction if left untreated.

In America, Acute Myocardial Infarction is the most common medical cause of death in woman in productive age with severe anorexia. In long-term, severe anorexia, heart disease is very likely to occur. The effects of eating disorders on the heart are numerous and difficult to reverse. Mineral and electrolyte imbalances, common with bulimia, can lead to cardiac arrest. Although unlikely, there is a risk of acute myocardial infarction the very first time someone purges. For woman with eating disorders, the only way to lower ones risk of an acute myocardial infarction is to receive prompt, professional treatment. In the case of someone with long-term, severe anorexia, heart disease is very likely to occur. An acute myocardial infarction may in fact be the most common form of death for people with eating disorders. In the case of someone with long-term, severe anorexia, heart disease like acute myocardial infarction is very likely to occur. Acute Myocardial Infarction may in fact be the most common form of death for anorexics.

Acute Myocardial Infarction is one of the types of heart disease conditions that can take place as a result of eating disorders like anorexia.

So how Anorexia nervosa treatment can prevent serious heart complications like Acute Myocardial Infarction? First of all, we have to know the signs of her heart condition. Secondly, we have to know the other body conditions. Symptoms which may indicate the above conditions include:

Lowered blood pressure High cholesterol Dizziness Poor blood flow

Swelling in the legs and feet Anxiety Feeling short of breath

Pain in the heart or upper body Exhaustion

Stomach pain Poor sleep quality Decrease in heart size

For a woman with anorexia nervosa, it may be difficult to prevent conditions such as Acute Myocardial Infarction. It is often very helpful to seek out anorexia nervosa treatment at an eating disorder treatment center. Anorexia nervosa residential programs offer specialized therapy programs and can provide a healthy diet and important nutritional information. For a woman who desire to prevent heart disease, the following steps should be considered:

Appropriately deal with stress through healthy coping methods. Avoid excessive drinking. If you struggle with alcohol addiction, consider attending alcohol rehab at an alcohol rehabilitation center. Keep your weight at a healthy level. This may be especially difficult for those with an eating disorder. Test herself for diabetes. Diabetics are at a higher risk for heart disease and require specialized care for their condition. Avoid smoking. Keep cholesterol levels normal. Having these and levels of triglyceride tested may be helpful in keeping you aware of higher than normal levels.

Regularly exercise. Maintain a normal blood pressure level by regularly monitoring blood pressure levels in order to keep them in a healthy range, you will better be able to prevent severe heart conditions.

Eating disorders put a woman at high risk for heart disease and those with eating disorders like anorexia should seek out eating disorder treatment at an anorexia treatment facility in order to prevent health consequences such as Acute Myocardial Infarction.

CHAPTER V Conclusion

Anorexia nervosa

is an

eating

disorder

and,

more

importantly,

psychological disorder. The cause of anorexia has not been definitively established, but self-esteem and self-image issues, family dynamics, societal pressures, and even genetic factors may each play a role. Anorexia affects females far more often than males and is most common in adolescent females / woman in productive age. The disorder affects about 1% of adolescent girls in the U.S. Based on the research year 2000-2005, many anorexics woman in America suffer from errors in thinking or perceptions. They incorrectly believe they need to lose weight to find happiness. Body image distortions are common place among anorexics. Others have had difficulties in relationships and manifest these problems through their eating habits. Anorexia can also be the delayed result of unresolved conflicts or painful experiences from childhood. People with anorexia tend to show compulsive behaviors and may become obsessed with food.The extreme dieting and weight loss can lead to a potentially fatal degree of malnutrition. Other possible consequences that can of anorexia anemia, include and heart-rhythm hormonal and Myocardial

disturbances, electrolyte Infarction.

digestive

abnormalities,

imbalances

possibly

caused

Acute

The treatment of anorexia must focus on more than just weight gain but also the family, friends, and the closest people approaches. So that she would not tend to be more serious in complications such as heart attacks or acute myocardial infarction.

The prognosis of anorexia is variable, with some people making a full recovery. Others experience a fluctuating pattern of weight gain followed by a relapse, or a progressively deteriorating course over many years. Anorexia nervosa effects are harmful and can be lethal. To avoid the worst, one should start doing something immediately. In conclusion, both having Anorexia nervosa and Acute Myocardial Infraction, as the complication of anorexia, can potentially be life threatening and cause life-long complications and ailments. If left untreated, while having an Anorexia nervosa can lead to increases the risks for heart attack, and many other things, including death. The obvious assumption can be drawn that the combination of both and Anorexia nervosa and Acute Myocardial infraction is particularly dangerous and lifethreatening.

You might also like