1. Prevention
1.1. Lifestyle Modifications: Healthy diet (low saturated fats, salts, and sugars), regular exercise, smoking cessation, and weight management.
1.2. Medications: Statins to lower cholesterol, antihypertensive drugs to control blood pressure, antiplatelet therapy (aspirin) for high-risk individuals, and diabetes medications (Metformin)
1.3. Screenings: Regular monitoring of cholesterol, blood pressure, and blood sugar
1.4. Management of Comorbidities: Diabetes, hypertension, and hyperlipidemia
2. Treatment
2.1. Immediate Management:
2.1.1. Aspirin: antiplatelet to reduce clotting. Nitroglycerin: to relieve chest pain and reduce myocardial oxygen damage. Oxygen Therapy: improves oxygen supply to the heart muscle. Anticoagulants: Heparin to prevent clot formation. Morphine: pain relief and anxiety reduction
2.2. Reperfusion Therapy:
2.2.1. Thrombolytics (TPA): Medications to dissolve the clot (if hospital treatment is delayed) Percutaneous Coronary Intervention: Angioplasty or stenting to open the blocked arteries.
2.3. Coronary Artery Bypass Graft (CABG):
2.3.1. Surgery to bypass the blocked coronary arteries.
2.4. Medications:
2.4.1. Beta-Blockers: to reduce the heart's workload. ACE Inhibitors: to prevent further damage and improve outcomes Statins: to lower cholesterol and prevent future blockages.
2.5. Referals:
2.5.1. Cardiologist: to manage acute and long-term cardiac care. Dietitian: for nutritional advice to manage risk factors like hyperlipidemia, HTN, and diabetes.
3. Complications
3.1. Arrhythmias/ dysrhythmias, heart failure, cardiogenic shock, pericarditis (inflammation of the lining around the heart), ventricular aneurysm, thromboembolism (clots that travel to other organs), recurrent MIs.
4. Diagnosis
4.1. Basic health and history assessment, along with a physical exam.
4.2. Electrocardiogram (ECG): identifies changes in heart rhythm and electrical activity, such as ST elevation or depression.
4.3. Blood Tests: elevated biomarkers such as Troponin levels (most specific indicator) and CK-MB levels indicating myocardial injury.
4.4. Chest X-ray: to assess for lung congestion or signs of heart failure.
4.5. Echocardiogram: to assess heart function and visualize areas of reduced movement.
4.6. Coronary Angiography: used to detect blockages in coronary arteries (the gold standard for diagnosing).
4.7. Stress Test: performed after the acute phase to assess heart function under stress.
5. What is an MI?
5.1. Myocardial Infractions (MIs) are also known as heart attacks. It is the damage or death of heart muscle due to a blockage in one or more coronary arteries, cutting off the supply of oxygenated blood to the heart muscle. An MI can be subdivided into non-ST- elevation MI (non-STEMI) and ST elevation MI (STEMI).
6. Pathophysiology of an MI
6.1. Plaque progression: leads to the buildup of plaque (atherosclerosis), blocking the blood flow to the heart. When the plaque ruptures, a blood clot forms cutting off the blood and oxygen supply to the heart.
6.2. Ischemia: the lack of oxygen causes the heart muscle to be unable to produce ATP in the mitochondria, which triggers an ischemic cascade. This leads to cell death (apoptosis) of the heart muscle.
6.3. Irreversible damage: can begin within 30 minutes of the blockage. If left untreated, the heart can become so damaged it will never function normally again.
7. Causes and Risk Factors
7.1. Atherosclerosis, thrombosis, spasm of the coronary artery, hypertension (HTN), high cholesterol (hyperlipidemia), diabetes, smoking, drug use (cocaine), family history, age & gender.
8. Signs & Symptoms
8.1. Chest pain: sudden, severe chest pain. Often described as an "elephant sitting on my chest."
8.2. Radiating pain: neck, jaw, back, shoulder, left arm, or stomach.
8.3. Shortness of Breath (SOB): due to reduced heart function.
8.4. Nausea and Vomiting: often seen in women and diabetics.
8.5. Sweating (Diaphoresis): in response to pain or shock.
8.6. Dizziness, Syncope, and Fatigue: due to the decreased blood flow to the brain.
8.7. Anxiety: often experienced due to the sudden nature of the event.
9. Other potential diagnoses that may present similarly to an MI:
9.1. Pulmonary Embolism (PE): a blood clot that travels to the lungs often from a deep vein thrombosis (DVT) that has broken off, obstructing pulmonary circulation and leading to decreased oxygen.
9.1.1. Presents with sudden-onset chest pain, worsened with breathing, SOB, tachypnea, and hypoxia.
9.1.1.1. Key Differentiators: Often present with pleuritic pain (sharp pain with breathing), symptoms of a DVT (leg swelling or redness), and tachypnea.
9.2. Musculoskeletal Chest Pain: a strain of the muscles in the chest wall can cause chest pain.
9.2.1. Presents with localized chest pain or tenderness, exacerbated by palpation, coughing, or movement.
9.2.1.1. Key Differentiators: pain is reproducible with movement or palpation and the absence of signs of ischemia.
9.3. Anxiety/ Panic Attack: sudden onset of intense fear or discomfort, leading to physical symptoms like chest pain.
9.3.1. May present with chest tightness or discomfort, palpitations, sweating, dizziness, and SOB.
9.3.1.1. Key Differentiators: typically triggered by stress or anxiety, with no structural cardiac issues. Symptoms often resolve with relaxation or reassurance.