I am Krishna Kumar, student of DBRU, Agra

1. Presented By-
Krishna Kumar
Department of Pharmacy,
Dr. B. R. Ambedkar University, Agra
282002
Submitted To-
Mr. Manoj Yadav

2. INTRODUCTION
 Myocardial infarction (MI)
refers to the process by which
areas of myocardial cells in the
heart are permanently destroyed.
 It occurs when myocardial
tissues are abruptly and
severely deprived of oxygen.

3. DEFINITION
 Myocardial infarction is a
diseased condition which is
caused by reduced blood flow
in a coronary artery due to
atherosclerosis and occlusion
of an artery by an embolus or
thrombus.

6. NON-MODIFIABLE RISK
FACTORS
FACTOR
AGE
SEX
FAMILY
HISTORY

7. AGE: More than 40 years.
FAMILY HISTORY:
Myocardial infarction can
be inherited from parents
to children.
GENDER: Myocardial
infarction is 3 times more in
men than women.

8. MODIFIABLE RISK FACTORS
FACTOR
HIGH
BLOOD
LIPIDS
LEVEL
HYPER-
TENSION
SMOKING
PHYSICAL
INACTIVITY
OBESITY
DIABETES
MELLITUS
STRESS

9. HIGH BLOOD CHOLESTROL LEVEL
LOW DENSITY
LIPOPROTEIN
(LDL)
DANGEROUS
HIGH DENSITY
LIPOPROTEIN
(HDL)
LIPIDS
(LIPOPROTIENS)

10. HDL is not dangerous because it contains more
proteins & very less lipids.
Secondly it carry lipids away from arteries to the liver
for metabolism. So it prevents lipids accumulation
within arteries.
LDL is dangerous because it contains more lipids &
has capacity to deposit fat within arteries.
So, LDL level more than 160mg/dl will place a person
at a risk of myocardial infarction.

11. HYPERTENSION
If a person’s blood pressure is more than 140/90
mmHg continuously for 4-5 years
Sustained stress on arterial walls injury to
endothelial lining atherosclerosis narrowed &
thickened arterial walls risk of M.I.
Also salt consumption 5gms/ day cause M.I.

12. SMOKING
Smoking nicotine catecholamine (epinephrine & nor
epinephrine) release increases heart rate & blood
pressure increases cardiac workload.
+
CO decreases O2 available to myocardium
Injury to myocardium

13. PHYSICAL INACTIVITY
Improper lipid metabolism
LDL level increases
Starts accumulating
in blood vessels
Risk of M.I.

14. OBESITY
More lipids are produced
LDL level increases
Atherosclerosis
Risk of M.I.

15. DIABETES MELLITUS
Glucose molecules may stick to lumen of
artery
Blockage of artery
Risk of having M.I.

16. STRESS
SNS stimulation
Release of catecholamine
Increases heart rate & intensify the force of
myocardial contraction
Increases O2 demand
Cell death
Risk of M.I.

17. PATHOPHYSIOLOGY

18. Causative factor: Obesity
Atherosclerosis
Narrowing of lumen
ed heart insufficient blood flow to myocardium
Contractility ed O2 demand of myocardial cells
Inadequate creates an O2 deficit
Blood supply
myocardial cell death inflammation
Oliguria
CK-MB & Troponine released Fever

19. Anaerobic glycolysis
Accumulation of lactic acid
Irritation of myocardial nerve fibers
Transmission of pain massage to myocardium
Chest pain & radiation towards shoulder & arm

20. Stimulation of vomiting SNS Stimulation
center
increased
Nausea & Vomiting catecholamine
Diaphoresis Increased
(perfuse sweating) Heart Rate
Cold & Clammy skin
“Cold Sweat”

21. CLINICAL MANIFESTATIONS
 Cardiovascular-
 Chest pain/Discomfort
 Palpitations
 Elevated BP
 ECG may show tachycardia, bradycardia and
dysarrythmia

22. CONTD…..
 Respiratory-
 Shortness of breath
 Dyspnea/Tachypnea
 Crackles
 Pulmonary edema-may be present
 Gastrointestinal-
 Nausea
 Vomiting

23. CONTD…..
 Genitourinary-
 Decreased urinary output
 Skin-
 Cool, clammy skin
 Diaphoresis
 Pallor, Cyanosis
 Coolness of extremities

24. CONTD…..
 Neurogenic-
 Anxiety, restleness
 Light- headedness
 Headache
 Visual Disturbances
 Altered speech
 Altered motor functions
 Altered level of consciousness

25. CONTD…..
 Psychosocial-
 Fear feeling
 Pt. may deny that anything is wrong

26. PAIN
Characteristics: Severe, immobilizing
chest pain.
Usually prescribed as heaviness,
pressure, tightness, burning.
Radiation: It may radiate to neck, jaw,
arm or back.
Duration: Lasts for 20 minutes or more.

27. NAUSEA & VOMITING
Stimulation of vomiting center by severe pain causes
nausea & vomiting.
FEVER
100.4 to 102.2°F
It is due to inflammatory process caused by
Myocardial cell death.

28. DIAGNOSTIC TESTS

29. ASSESSMENT/DIAGNOSTIC FINDINGS
 It is generally based on presenting symptoms, ECG and
laboratory test results.
 Patient history-it includes
• Description of presenting
symptoms
• History of previous illness,
family health history

30. CONTD…..
 Electrocardiogram-
ECG provides information that
assists in diagnosing acute MI.
 The classic ECG changes are-
 T wave inversion
 ST segment elevation
 Abnormal Q wave

31. ECHOCARDIOGRAM
PURPOSE: it is useful to assess the ability of heart
muscles to contract & relax.
It is done to evaluate ventricular function by checking
ejection rate.
MEGNATIC RESONANCE IMAGING (MRI)
PURPOSE: To detect site & extent of myocardial cells.

32. ANGIOGRAPHY
To detect percentage of blockage & type of MI.
CHEST X-RAY
To detect cardiomegaly.

33. MEDICAL MANAGEMENT
DRUG
THERAPY
FIBRINOLYTIC
THERAPY
MEDICAL
MANAGEMENT

34. How Can Myocardial Infarction Be Prevented?
 One way to lower your risk is to eat a heart-healthy diet. This diet
should largely consist of:
 whole grains
 vegetables
 fruits
 lean protein
 You should also reduce the amount of the following in your diet:
 sugar
 saturated fat
 trans fat
 cholesterol

35. THANKSTHANK
YOU