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Myocardial infarction

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MI, TYPES, PATHOPHYSIOLOGY, DIAGNOSIS & MANAGEMENT

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Myocardial infarction

  1. 1. MYOCARDIAL INFARCTION Presented by, Aiswarya.A.T, I year M.Pharm, Department of pharmacy practice, Grace college of pharmacy, Kodunthirapully, Palakkad.
  2. 2. CONTENTS: 1. Definition 2. Types of infarcts 3. Epidemiology 4. Etiology 5. Etiopathogenesis 6. Pathophysiology 7. Clinical manifestations 8. Diagnosis 9. Management: Non-pharmacological Pharmacological
  3. 3. MYOCARDIAL INFARCTION MI is defined as a diseased condition which is caused by reduced blood flow in a coronary artery due to atherosclerosis & occlusion of an artery by an embolus or thrombus. MI or heart attack is the irreversible damage of myocardial tissue caused by prolonged ischaemia & hypoxia.
  4. 4. TYPES OF INFARCTS 1. According to anatomic region of left ventricle invoved:  Anterior  Posterior  Lateral  Septal  Circumferential  Combinations- Anterolateral, Posterolateral, Anteroseptal 2. According to degree of thickness of ventricular wall involved:  Transmural (full thickness)  Laminar (subendocardial) 3. According to age of infarcts:  Newly formed (acute, recent, fresh)  Advanced infarcts (old, healed, organised)
  5. 5. EPIDEMIOLOGY:  In industrial countries MI accounts for 10-25% of all deaths.  Incidence is higher in elderly people, about 5% occurs at people under age 40.  Males have higher risk.  Women during reproductive period have low risk.  In 2006, studies revealed a prediction that India would account for 40-60% of cardiovascular diseases burden within next 10-15 years.  Over last 30 years, the rate of diseases increased from 2- 6% in rural population and 4-12% in urban population.
  6. 6. Tobacco smoking Hypertension Drug abuse  Obesity Stress  Alcohol ETIOLOGY
  7. 7. Age Gender  Diabetes  Hyperlipoproteinaemia  Family history of Ischaemic Heart Disease  Hyperhomocysteinemia  Chronic kidney disease
  8. 8. ETIOPATHOGENESIS: 1. Mechanism of myocardial ischaemia. 2. Role of platelets. 3. Acute plaque rupture. 4. Non-atherosclerotic causes. 5. Transmural versus subendocardial infarcts.
  9. 9. PATHOPHYSIOLOGY Atherosclerosis Arterial spasm Atherosclerosis+Plaque split+Thrombus gradual sudden not usually reversible Obstruction sudden reversible occlusion obstruction ISCHAEMIA Hypoxia Reduced oxygen demand Angina Thrombolysis Unstable angina Permanent thrombus Necrosis MYOCARDIAL INFARCTION
  10. 10. CLINICAL MANIFESTATIONS: • Chest pain / chest discomfort • Dyspnea • Fatigue • Other symptoms include: Increased sweating Weakness Nausea Vomiting Light-headedness Palpitation • Anxiety, sleeplessness, hypertension or hypotension, arrhythmia. • Chest pain is less in women, their common symptoms are weakness, fatigue & dyspnea.
  11. 11. Complications include:  Arrhythmia  Cardiogenic shock (10%)  Congestive heart failure  Thromboembolism  Rupture (5%)  Cardiac aneurism (5%)  Pericarditis
  12. 12. DIAGNOSIS: 1.Clinical features: Pain Indigestion Apprehension Shock Low grade fever 2.Serum cardiac markers: Creatinine phosphokinase (CK) Lactic dehydrogenase (LDH) Cardiac specific troponins (cTn)
  13. 13. 3.ECG changes:  ST segment elevation  T wave inversion  appearance of wide deep Q waves.
  14. 14. MAGNETIC RESONANCE IMAGING (MRI) CHEST X- RAY ANGIOGRAPHY POSITRON EMISSION TOMOGRAPHY (PET scan):
  15. 15. MANAGEMENT: 1.NON-PHARMACOLOGICAL: Counselling and education of patients Life style measures Smoking cessation Avoid Alcohol intake Diet and nutrition Salt restriction
  16. 16. 2.PHARMACOLOGICAL: Thrombolytic agents Anticoagulants Antiplatelet agents Antihypertensive agents Lipid lowering drugs Vasodialators Others i) Analgesics ii) Antiulcer drugs iii) Antidepressants
  17. 17. TREATMENT ALGORITHM FOR MI: Myocardial Infarction Pre-hospital or on arrival GTN spray, Oxygen, Pain relief, Admission to hospital, Aspirin, Thrombolytics During hospital admission Add: beta blocker, ACE inhibitor, insulin Consider: Revascularization (Angioplasty, Stenting, Arterial bypass) Long term Rehabilitation classes: Aspirin, beta blocker, ACE inhibitor, Statins
  18. 18. PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) STENT PLACEMENT
  19. 19. ATHERECTOMY CORONARY ARTERY BYPASS GRAFT (CABG)
  20. 20. THANK YOU…..

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