Heart attack : Myocardial Infarction
DIMP; JSD; AMP;
MBBS; ,MRCP(UK); AM (Mal); FIAMIS
Consultant Physician in Internal Medicine & Gastroenterologist
Clinical Specialist Geriatric Medicine
What is Heart attack?
Heart attack -- a sudden interruption in the heart's blood supply. This happens when
there is a blockage in the coronary arteries, the vessels that carry blood to the heart
muscle. When blood flow is blocked, heart muscle can be damaged very quickly and die.
Prompt emergency treatments have reduced the number of deaths from heart attacks in
Heart attack symptoms
A heart attack is an
emergency even when
symptoms are mild.
Warning signs include:
-Pain or pressure in the
-Discomfort spreading to the
back, jaw, throat, or arm
-Nausea, indigestion, or
-Weakness, anxiety, or
shortness of breath
-Rapid or irregular
Heart attack symptoms in women
Women don't always feel chest pain with a heart attack. Women are
more likely than men to have heartburn, loss of appetite, tiredness or
weakness, coughing, and heart flutters. These symptoms should not be
ignored. The longer you postpone treatment, the more damage the
heart may sustain.
What happens in a Heart attack ?
In more than 90% of the patients with acute MI an acute thrombus often
associated with plaque rupture occludes the artery (previously partially
obstructed by an atherosclerotic plaque) that supplies the damaged area
Signs of Coronary Artery Disease
A precursor to a heart attack, coronary artery disease or CAD occurs when sticky
plaque builds up inside the coronary arteries. This narrows the arteries, making it more
difficult for blood to flow through. Many people don't know they have CAD until a heart
attack strikes. But there are warning signs, such as recurring chest pain caused by the
restricted blood flow. This pain is known as angina.
Inside a heart attack
The plaque deposited in your arteries is hard on the outside and soft and mushy on
the inside. Sometimes the hard outer shell cracks. When this happens, a blood clot
forms around the plaque. If the clot completely blocks the artery, it cuts off the blood
supply to a portion of the heart. Without immediate treatment, that part of the heart
1/15/2014 could be damaged or destroyed. G.Selvaraju
Don’t wait to be sure ….
The best time to treat a heart attack is as soon as symptoms begin. Waiting
to be sure can result in permanent heart damage or even death. If you
think you may be having a heart attack, call for an ambulance. And don't
try driving yourself to the hospital.
Tests for Coronary Heart Disease
Test to detect Coronary block
What is CT Angiogram?
• A computerized tomography (CT) coronary angiogram
is an imaging test to look at the arteries that supply
your heart muscle with blood.
• Unlike a traditional coronary angiogram, CT
angiograms don't use a catheter threaded through
your blood vessels to your heart. Instead, a coronary
CT angiogram relies on a powerful X-ray machine to
produce images of your heart and heart vessels.
• CT angiograms don't require the recovery time needed
with traditional angiograms.
• Coronary CT angiograms are becoming a common
option for people with a variety of heart conditions.
• CT angiograms will expose you to a small amount of
Who should get CT Coronary Angiogram?
• In patients at high risk for developing coronary disease (cigarette
smokers, those with genetic risk, high cholesterol levels,
hypertension, or diabetes),
• who have unclear results with treadmill or other testing, or who
have symptoms suspicious of coronary disease,
• CT angiography is an excellent next step in the diagnosis. If the CT
scan is normal or only mildly abnormal, it makes the likelihood of a
severe blockage of the coronary arteries extraordinarily small.
• Conversely, if the CT scan is significantly abnormal, cardiac
catheterization and angiography are then indicated, to see if
angioplasty, stenting, or coronary bypass surgery may be indicated.
• In people who have had bypass surgery, CT angiography is very
effective at evaluating the patency of the bypass grafts.
• In people who have had coronary stents , it is sometimes difficult to
image the inside of the stent to see if it is narrowed.
How is it done?
• This procedure use intravenous dye which
contains iodine and CT scanning to image the
coronary arteries. While the use of catheters is
not necessary (thus the term "noninvasive"
test applies to this procedure), there are still
some risks involved
What are the risks?
• In people allergic to iodine, pre-treatment with medications
is necessary to prevent allergic reactions to the dye.
• In people with abnormal kidney function and/or diabetes,
the dye may worsen kidney function.
• Finally, there is radiation exposure which is similar to, if not
greater than, that received with a conventional coronary
• Nonetheless, this is generally a very safe test for most
people, but should only be undergone when ordered by a
physician familiar with the patient and their underlying
• Special care is needed for people with history of Bronchial
To see positive as positive is easy;
To see negative as positive is Coronary CT Angiogram
Risk Factors – age & sex
Men have a higher risk of having a heart attack than women, and at
an earlier age. But it's important to note that heart disease is the No.
1 killer of women, too. People with a family history of heart ailments
also have a higher risk of heart trouble.
Risk Factors –high BP & cholesterol
High cholesterol and high blood pressure are major risk factors for heart disease. Being
overweight, obese, or physically inactive all increase your risk. So does diabetes,
especially if your glucose levels are not well controlled. Discuss your risks with your
doctor and develop a strategy for managing them. There are many steps you can take to
protect your heart.
Risk Factors – Smoking
If you smoke, your risk of heart disease is 2 to 4 times greater than a non-smoker's.
And if you smoke around loved ones, you're increasing their risk with second hand
smoke.. But it's never too late to quit. Within 24 hours of quitting, your heart attack
risk begins to fall.
Prevention of heart diseases – the ABCs
Blood Pressure control
Diabetes control : Self Care
Food : healthy food
Games : for body & mind
Healthy Life style &
Heart disease prevention- Fitness
The key to preventing heart disease is a healthy lifestyle. This includes a nutritious diet, at
least 30 minutes of exercise most days of the week, not smoking, and controlling high
blood pressure, cholesterol, and diabetes. If you drink alcohol, do so in moderation -- no
more than one drink a day for women, two drinks a day for men. Ask your friends and
family for help in making these changes. They'll benefit, too.
Heart disease prevention – diet
What you eat makes a difference. Be sure you get plenty of whole grains,
vegetables, legumes, and fruits to help keep your heart healthy. Plant oils,
walnuts, other nuts, and seeds can also help improve cholesterol levels. And
don't forget to eat fish at least a couple of times each week for a good source
of heart-healthy protein.