Myocardial Infarction

By : Abram Nathaniel M. Bunoan BS Nursing Graduate, Administrative Assistant II for the Food and Drug Administration, (National Center for Pharmaceutical Access Management) Department of Health

Introduction
Myocardial Infarction or popularly known as Heart Attack. It occurs everyday producing countless victims around the globe. In this presentation we will take a journey in understanding what is myocardial infarction.

Contents: Cardiovascular System Types and classifications of MI Signs and symptoms Causes Risk Factors Pathophysiology Diagnosis Prevention Management

Heart
- Is a hollow muscle that pumps blood throughout the blood vessels by repeated, rhythmic contractions. The term cardiac means related to the heart - The average human heart beating is 72 beats per minute - It weighs approximately 250 to 300 grams

Pericardium
- double walled sac containing the heart and the roots of the great vessel

Pericardium Fluid
- its function is to permit them the easy slide with the heart movements

Fibrous Pericardium
- most superficial layer of the pericardium in the heart. It is

Three Layers of the Human Heart

Epicardium the outermost layer of the heart. It is also known as the visceral pericardium since it is also the inner wall of the pericardium. Myocardium also known as cardiac muscle, it is an involuntary striated muscle tissue found only in this organ and responsible for the ability of the heart to pump blood. The cells that comprise cardiac muscle are called cardiomyocytes or myocardiocytes. Coordinated contractions of cardiac muscle cells in the heart propel blood out of atria and ventricles to the blood vessels. This complex actions makes up the systole of the heart. Endocardium innermost layer tissue that lines the chambers of the heart, it has become evident that the

Four chambers of the heart

Right and Left Atrium - They are the receiving chambers Right and Left Ventricle - They are the discharging chambers

Pulmonary Artery carries blood away from the heart to the lungs Pulmonary Vein carries blood back to the heart from the lungs
Tricuspid Valve the valve between the right atrium and right ventricle Mitral Valve the valve between the left atrium and left

Blood Circulation in the heart

All the blood from the superior parts of the body goes through the Superior Vena cava, while the blood from the inferior parts of the body goes through the Inferior Vena cava.

Two Basic Classifications of Acute MI

Transmural associated with artherosclerosis involving a major coronary artery. It can be subclassified into anterior, posterior, inferior, lateral or septal. Transmural extend through the whole thickness of the heart muscle and are usually a result of complete occlusion of the areas blood supply. Subendocardial involving a small area in the subendocardial wall of the left ventricle, ventricular septum or papillary muscles. The subendocardial area is particularly susceptible to ischemia.

Types of MI
Type 1 Spontaneous myocardial infarction related to ischemia due to a primary coronary event such as plaque or rupture. Type 2 Myocardial Infarction secondary to ischemia due to either increased oxygen demand or decreased supply. Type 3 Sudden unexpected cardiac death, including cardiac arrest. Type 4 associated with coronary angioplasty or stents Type 5 Myocardial Infarction associated with CABG (Coronary Artery Bypass Surgery)

Signs and symptoms

Chest Pain Dyspnea Diaphoresis Weakness Light headedness Nausea Vomiting Palpitations These symptoms are likely induced by a massive surge of catecholamines from the sympathetic

Areas of Pain

Causes
Psychological stress Physical exertion Pneumonia Chlamydophila pneumoniae a bacteria that causes pneumonia that contributes in artherosclerosis.

Risk Factors
Age Hyperhomocysteinemia Gender Periodontitis Diabetes Mellitus Coronary Heart Disease High Blood Pressure Dyslipidemia Tobacco Smoking Air Pollution Family History Obesity Lack of Physical Activity Psychosocial Factors Alcohol Oral Contraceptive Pill

Pathophysiology
A myocardial infarction occurs when anatherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, causing catastrophicthrombus formation, totally occluding the artery and preventing blood flow downstream.

Diagnosis
Myocardial Perfusion Imaging procedure that illustrates the function of the myocardium Echocardiogram refered as the cardiac echo Chest Radiograph commonly known as x-ray Electrocardiogram transthoracic interpretation of the electrical activity of the heart

Electrode label (in the USA) RA

Electrode placement On the right arm, avoiding thick muscle.

LA

In the same location where RA was placed, but on the left arm.

RL

On the right leg, lateral calf muscle.

LL

In the same location where RL was placed, but on the left leg.

V1

In the fourth intercostal space(between ribs 4 and 5) just to the right of the sternum (breastbone).

V2

In the fourth intercostal space(between ribs 4 and 5) just to the left of the sternum.

V3

Between leads V2 and V4.

V4

In the fifth intercostal space(between ribs 5 and 6) in the mid-clavicular line

V5

Horizontally even with V4, in the left anterior axillary line

V6

Horizontally even with V4 and V5 in the midaxillary lin

Prevention and Management

Antiplatelet Drug Therapy (Aspirin and Clopidogrel) to reduce the risk of plaque Beta Blocker Therapy Ace Inhibitor Therapy Statin Therapy Aldosterone Antagonist Agent Heparin Nitroglycerin to reduce angina symptoms Mildronate clinically used pharmacological preconditioning and anti-ischemic drug