1. 1. Disease/Conditon overview
1.1. Definition
1.1.1. A heart attack happens when blood flow to the heart muscle is blocked, often by a blood clot, leading to damage in the heart tissue
1.1.1.1. Partial or complete blockage of coronary arteries
1.1.1.1.1. Insufficient oxygen delivery to cardiac tissue
1.2. Risk Factors
1.2.1. Non-Modifiable Risk Factors
1.2.1.1. Age: Men** >45 years; Women >55 years
1.2.1.2. Sex/Gender: Men are at higher risk earlier in life; women's risk increases post-menopause.
1.2.1.3. Family History: Early cardiovascular disease in first-degree relatives (men <55 years, women <65 years).
1.2.1.4. Genetic Predisposition: Such as high cholesterol
1.2.2. Modifiable Risk Factors
1.2.2.1. Lifestyle-Related Risk Factors
1.2.2.1.1. Smoking
1.2.2.1.2. Sedentary Lifestyle: Lack of physical activity leads to obesity and etc
1.2.2.1.3. Unhealthy Diet: Diets high in saturated fats, trans fats, cholesterol, and sodium.
1.2.2.2. Medical Conditions
1.2.2.2.1. Hypertension: Chronic high blood pressure strains the heart and damages arteries.
1.2.2.2.2. Dyslipidemia: High LDL ("bad cholesterol"), low HDL ("good cholesterol"), or high triglycerides.
1.2.2.2.3. Diabetes Mellitus: Promotes accelerated atherosclerosis due to chronic hyperglycemia.
1.2.2.2.4. Obesity (especially central obesity): Increases the risk of hypertension, dyslipidemia, and diabetes.
1.2.2.3. Psychosocial Factors Stress:
1.2.2.3.1. Stress: Chronic stress elevates cortisol levels and can worsen hypertension and arrhythmias.
1.2.2.3.2. Depression and Anxiety: Associated with poor cardiovascular outcomes and reduced medication adherence.
2. 2. Etiology
2.1. Primary Causes
2.1.1. Atherosclerosis of coronary arteries.
2.1.2. Plaque rupture triggering thrombosis.
2.2. Additional Causes
2.2.1. Coronary artery spasm (e.g., Prinzmetal angina).
2.2.2. Coronary embolism or dissection
2.2.3. Increased myocardial oxygen demand (e.g., thyrotoxicosis, hypertensive crisis) in the setting of insufficient supply.
2.2.4. Drug use such as Cocaine or stimulant-induced vasospasm.
3. 3.Pathophysiology
3.1. Plaque progression, disruption, and subsequent clot formation are the same for myocardial infarction as they are for unstable angina
3.1.1. STEMI
3.1.1.1. Marked elevations in the ST segments on ECG,
3.1.1.1.1. Transmural infarction usually causes marked elevations in the ST segments on ECG
3.1.1.1.2. STEMI are at highest risk for serious complications and require immediate intervention
3.1.2. non-STEMI
3.1.2.1. ST depression and T-wave inversion
4. 4. Sign and Symptoms
4.1. Chest pain (angina): Intense, crushing, or squeezing pain often radiating to the left arm, neck, or jaw.
4.2. Lightheadedness or dizziness.
4.3. Shortness of breath (dyspnea)
4.4. Palpitations
4.5. Nausea and vomiting.
4.6. Fatigue or weakness, especially in women and elderly patients.
4.7. Diaphoresis (sweating).
5. 5. Diagnosiic Criteria/tests
5.1. Laboratory Tests
5.1.1. Cardiac Biomarkers (Gold Standard)
5.1.1.1. Troponin I or T: Most sensitive and specific biomarker.
5.1.1.1.1. Creatine Kinase-MB (CK-MB): Less specific but may be used if troponins are unavailable.
5.2. Other Labs
5.2.1. Complete blood count (CBC): Rule out anemia or infection.
5.2.1.1. Basic metabolic panel: Assess kidney function and electrolyte levels.
5.2.1.1.1. Lipid profile: Evaluate cholesterol levels.
5.3. Electrocardiogram (ECG/EKG)
5.3.1. Non-ST-Segment Elevation MI (NSTEMI): ST-segment depression or T-wave inversion without elevation.
5.4. Imaging Studies
5.4.1. Echocardiography
5.4.2. Coronary Angiography (Gold Standard for Coronary Assessment)
5.4.3. Cardiac Magnetic Resonance Imaging (MRI)
5.4.4. Chest X-ray
6. 6. Complications
6.1. Acute Complications
6.1.1. Cardiac arrest: Often due to arrhythmias like ventricular fibrillation.
6.1.1.1. Pericarditis: Inflammation of the pericardium (e.g., Dressler syndrome).
6.1.1.1.1. Papillary muscle rupture: Can lead to acute mitral regurgitation. Ventricular septal rupture: Rare but life-threatening.
6.2. Chronic Complications
6.2.1. Chronic heart failure: Persistent pump dysfunction.
6.2.1.1. Ventricular aneurysm: Thinning and dilation of ventricular wall.
6.2.1.1.1. Recurrent myocardial infarction: Due to underlying atherosclerosis.
6.3. Thromboembolic Events
6.3.1. Deep vein thrombosis (DVT) or pulmonary embolism due to immobility.
6.3.1.1. Stroke: Embolization from mural thrombus or atrial fibrillation
7. 7. Treatments & Procedures
7.1. Treatments & Medications
7.1.1. Antiplatelets:
7.1.1.1. Aspirin: Reduces platelet aggregation and prevents clot progression.
7.1.1.2. P2Y12 inhibitors (e.g., clopidogrel, ticagrelor, prasugrel): Prevent further thrombus formation.
7.1.2. Anticoagulants
7.1.2.1. Heparin or Low-Molecular-Weight Heparin (LMWH): Prevent clot expansion.
7.1.2.2. Direct oral anticoagulants (DOACs): Used in specific situations such as atrial fibrillation post-MI.
7.1.3. Thrombolytics (if PCI is unavailable):
7.1.3.1. Alteplase (tPA), reteplase, or tenecteplase: Break down existing clots (used in STEMI if PCI cannot be performed within 90 minutes).
7.2. Procedures
7.2.1. Coronary Artery Bypass Grafting (CABG): Surgical bypass for severe multivessel disease
7.2.2. Percutaneous coronary intervention (PCI)
7.2.3. Clot-dissolving drugs (thrombolysis), balloon angioplasty, surgery or a combination of treatments
8. 8. Patient education
8.1. Regular Follow-Up and Referrals
8.2. Long-Term Management
8.2.1. Beta-Blockers (e.g., metoprolol)
8.2.2. ACE Inhibitors (e.g., enalapril, lisinopril
8.2.3. Angiotensin II Receptor Blockers (ARBs, e.g., losartan)
8.3. Symptomatic Treatment
8.3.1. MONA
8.3.1.1. Pain management:
8.3.1.2. Oxygen therapy
8.3.1.3. Nitroglycerin (tell men avoid Viagra)
8.3.1.4. Aspirin
8.4. Lifestyle Modifications
8.4.1. Smoking Cessation
8.4.2. Healthy Diet
8.4.3. Regular Exercise
8.4.4. Weight Management
8.4.5. Managing Stress
8.5. How to recognizing Warning Signs
8.5.1. Teach each patient the warning Signs of a Heart Attack:
8.5.1.1. Chest pain or discomfort, radiating pain to arm/jaw, shortness of breath, or sudden fatigue.
8.5.1.1.1. "If patient suspect a heart attack, call 911 immediately."