Myocardial infarction, also known as a heart attack, occurs when blood flow to the heart is blocked, damaging heart muscle tissue. The blockage is usually due to a buildup of plaque in the coronary arteries. Risk factors include age, gender, family history, smoking, hypertension, diabetes, obesity, diet, stress, and high cholesterol. Symptoms include chest pain and discomfort, shortness of breath, nausea, and fatigue. Diagnosis involves ECG, cardiac enzyme tests, and coronary angiography. Treatment includes medications to open arteries, prevent clotting, and reduce blood pressure and cholesterol, as well as procedures like angioplasty, stenting and coronary artery bypass grafting to restore blood flow.

1. JOHNY WILBERT, M.SC[N]
LECTURER,
APOLLO INSTITUTE OF HOSPITAL
MANAGEMENT AND ALLIED SCIENCE

2. myocardial infarction is a life-threatening
condition that occurs when blood flow to the
heart muscle is abruptly cut off, causing tissue
damage(necrosis).
 This is usually the result of a blockage in one
or more of the coronary artery .
 A blockage can develop due to a buildup of
plaque, a substance mostly made of
fat, cholesterol, and cellular waste products.

3. Etiology
Non modifiable factor
Age –above 45
Gender-men at higher risk
Race-hispanic has higher incidence
Hereditary

4. Modifiable factor
Arthrosclerosis
Smoking
Hypertension
Diabetes mellitus
Obesity
Lack of exercise
Stress
Hypercholesterolemia
Diet-high fat conception
Use of alcohol
the use of certain drugs, including cocaine and
amphetamines

5. Clinical manifestation
pain in the chest, back, jaw, and radiating
towards left shouder
Dyspnea
Palpitation
Tachycardia
Tachypnea
Diaphoresis
shortness of breath

6. Fatigue
weakness
Syncope
Anxiety
Chest tightness
Nausea
Vomiting
Dizziness

7. Diagnostic evolution
History collection
Physical examination
ECG- shows ST changes
Coronary angiography –to identify the block
Cardiac markers-elevated in MI

8. Management.
Bed rest
O2 administration
Pharmacological management
NTG sublingual the first drug of choice, it
dilates blood vessels
Thrombolytic therapy (streptokinase,
urokinase, ateplase ) to dissolve the clot
Antiplatlets (plavix, clopidogrel) to prevent
clot formation

9. Analgesis (Morphine) to reduce the intensity of
pain
Antihypertensive drug(beta blockers, ACE
inhibitor) to reduce BP and workload of heart
Lipid lowering agent (storvas, atorvastatin) to
reduce the cholesterol level
Heparin is given to prevent clot formation
Anti anxiety medication(alprazolam) are given
to reduce anxiety

10. Interventional management
 Percutaneous transluminal coronary
angioplasty (PTCA) is a non-surgical procedure
used to treat narrowing (stenosis) of the coronary
arteries in coronary artery disease. After accessing
the blood stream through the femoral or radial
artery, the procedure uses coronary
catheterization to visualise the blood vessels on
radiography imaging. After this, an interventional
cardiologist can perform a coronary angioplasty,
using a balloon catheter in which a deflated
balloon is advanced into the obstructed artery and
inflated to relieve the narrowing; a stents can be
deployed to keep the blood vessel open.

12. Atherectomy is a minimally
invasive endovascular surgery technique for
removing atherosclerosis from blood vessels
within the body. atherectomy cuts plaque from
the wall of the artery with help of special
tipped catheter

13. Surgical management
Coronary artery bypass grafting
Coronary artery bypass grafting (CABG) is a type
of surgery that improves blood flow to the heart.
 CABG is one treatment for coranary artery
disease.
 During CABG, a healthy artery or vein from the
body is connected, or grafted, to the blocked
coronary artery.
The grafted artery or vein bypasses (that is, goes
around) the blocked portion of the coronary artery.
This creates a new passage, and oxygen-rich blood
is routed around the blockage to the heart muscle.

15.  Types of Coronary Artery Bypass Grafting
 Traditional Coronary Artery Bypass Grafting
 This is the most common type of coronary artery bypass
grafting (CABG). It's used when at least one major
artery needs to be bypassed.
 During the surgery, the chest bone is opened to access
the heart. Medicines are given to stop the heart, and a
heart-lung bypass machine is used to keep blood and
oxygen moving throughout the body during surgery.
This allows the surgeon to operate on a still heart.
 After surgery, blood flow to the heart is restored.
Usually, the heart starts beating again on its own. In
some cases, mild electric shocks are used to restart the
heart.

16. Off-Pump Coronary Artery Bypass Grafting
This type of CABG is similar to traditional
CABG because the chest bone is opened to
access the heart. However, the heart isn't
stopped, and a heart-lung bypass machine isn't
used. Off-pump CABG is sometimes called
beating heart bypass grafting.

17. Minimally Invasive Direct Coronary Artery
Bypass Grafting
This surgery is similar to off-pump CABG.
However, instead of a large incision (cut) to open
the chest bone, several small incisions are made
on the left side of the chest between the ribs.
This type of surgery mainly is used for bypassing
the blood vessels in front of the heart. It's a fairly
new procedure that's done less often than the other
types of CABG.
This type of CABG isn't for everybody, especially
if more than one or two coronary arteries need to
be bypassed.

18. Life style modification
Quit smoking
Diet control- fat, salt restriction
Stress control measures
 regular aerobic exercise

19. Compilications
1Congestive heart failure
2Myocardial rupture
3Arrhythmia
4Pericarditis
5Cardiogenic shock