Myocardial infarction
Dr. Ramya N
Assistant Professor
• Myocardial infarction is defined as irreversible necrosis of a
portion of the myocardium caused by prolonged ischemia due
to sudden reduction or cessation of coronary blood flow, most
commonly following coronary artery thrombosis.
Characteristics -
• Prolonged myocardial ischemia
• Irreversible myocardial necrosis
• Usually due to complete coronary artery occlusion
• Loss of contractile function of affected area
• Inflammatory response in necrotic myocardium
• Elevated cardiac enzymes (Troponin, CK-MB)
Etiology
• Atherosclerosis of coronary arteries
• Rupture of atherosclerotic plaque
• Coronary artery thrombosis
• Coronary artery spasm
• Embolism of coronary artery
• Severe hypotension or shock
• Increased myocardial oxygen demand
• Smoking, diabetes, hypertension, hyperlipidemia
Signs and Symptoms
• Severe, persistent chest pain
• Pain radiating to left arm, shoulder, neck, jaw, or back
• Pain not relieved by rest or nitrates
• Shortness of breath
• Profuse sweating (diaphoresis)
• Nausea and vomiting
• Anxiety or feeling of impending doom
• Palpitations
• Fatigue or weakness
• Syncope
Risk Factors
• Atherosclerosis
• Smoking
• Hypertension
• Diabetes mellitus
• Hyperlipidemia
• Obesity
• Physical inactivity
• Stress
• Increasing age
• Family history of coronary artery disease
Types
• ST-Elevation Myocardial Infarction (STEMI):
A type of myocardial infarction characterized by complete occlusion of a coronary
artery, leading to transmural myocardial necrosis with ST-segment elevation on
ECG.
• Non-ST-Elevation Myocardial Infarction (NSTEMI):
A type of myocardial infarction caused by partial coronary artery occlusion,
resulting in subendocardial myocardial necrosis without ST-segment elevation on
ECG.
• Transmural Myocardial Infarction:
Myocardial infarction involving the full thickness of the ventricular wall, usually due
to complete coronary artery obstruction.
• Subendocardial Myocardial Infarction:
Myocardial infarction involving the inner one-third to one-half of the myocardium,
caused by partial or transient reduction in coronary blood flow.
• Coronary Atherosclerosis
The process starts with plaque formation in the coronary arteries
due to cholesterol deposition.
This narrows the arteries, reducing blood flow to the myocardium.
• Rupture of Atherosclerotic Plaque
The plaque can rupture suddenly, exposing its contents to blood.
This triggers platelet aggregation and clot formation (thrombosis).
• Coronary Artery Thrombosis
The thrombus can partially or completely block the coronary artery,
further reducing blood flow.
Sometimes, coronary artery spasm can contribute to obstruction.
• Coronary Blood Flow Obstruction
The obstruction leads to prolonged ischemia of the myocardium supplied
by that artery.
Without oxygen, heart muscle cells cannot function properly.
• Prolonged Myocardial Ischemia
If blood flow is not restored quickly, irreversible myocardial cell death
(necrosis) occurs.
This is the actual myocardial infarction.
• Other Contributing Factors
Coronary artery embolism or additional artery spasm may worsen
ischemia.
The size and severity of MI depend on the artery involved and duration of
ischemia.
Management- Non-Pharmacological
Treatment
• Low-fat, low-cholesterol diet
• Reduce saturated fat and trans fat
• Increase fruits and vegetables
• High-fiber diet (whole grains)
• Limit salt intake
• Avoid excess sugar and junk food
• Regular moderate exercise (as tolerated)
• Smoking cessation
• Weight reduction and BMI control
• Stress management
Pharmacological Treatment
• Antiplatelet drugs – Aspirin, Clopidogrel
• Anticoagulants – Heparin
• Nitrates – Nitroglycerin
• Beta-blockers – Metoprolol, Atenolol
• ACE inhibitors / ARBs – Enalapril, Losartan
• Statins / Lipid-lowering drugs – Atorvastatin
• Analgesics – Morphine (for severe pain)