details about myocardial infarction including diagnosis, treatment, pre-hospital management are availabele here

1. Presentation on
Myocardial Infarction (MI)
Submitted to:
Dr. Md. Ashrafur Rahman
Assistant Professor, Department of Pharmaceutical Sciences, NSU.
Submitted by:
Name ID
Humayra Bintha Haque 1610605049
Md. Toukir Ahamed Tanvir 1320245046
Israt Mowla Liya 1321183046
Rumman Moyashir 1530493049
Tazbin Mostafa 1520828646
Kazi Samanta Jerin 1611690049

2. Content will be cover up:
• Definition of Myocardial Infarction,
• Complication of Myocardial Infarction,
• Risk factors,
• Epidemiology,
• Sign and symptoms associated with Myocardial
Infarction,
• Classification of Myocardial Infarction,
• Diagnosis, and
• Treatment.

3. MYOCARDIAL INFARCTION
• Heart attack or Myocardial Infarct
• Myocardial referring muscle of the heart
• Infarct referring to lack of oxygen causing
death of heart muscle
• Atherosclerotic plaque rupture with
thrombus formation in coronary arteries
• Interruption of blood supply to the part of
the heart
• Necrosis of some heart cells

4. COMPLICATIONS AFTER MYOCARDIAL INFARCTION
• Hypotension→reduced
perfusion of other
arteries Ischemia
• Cardiogenic shock
Decreased
contractility
of ventricles
• Disorganized ion movement or
disrupted electrical conduction
system within the
cardiomyocytes
• Arrhythmias
Electrical
instability

5. CONTINUED ……..
• Pericarditis
• Ventricular wall rupture
• Ventricular septal defect→hypoxemia
and damage of lung vessels
• Papillary muscle rupture→mitral
regurgitation
Tissue
necrosis
of heart
Reduced contractility or mitral regurgitation or septal defect
can develop CONGESTIVE HEART FAILURE

6. Risk Factor of Myocardial Infarction (MI)
Two groups.
Non-modifiable:
Increasing age.
Male sex.
Family history of HTN, DM,
IHD
Genetic abnormalities.

7. Risk Factor of Myocardial Infarction (MI)
Modifiable:
 Hypertension.
 Diabetes mellitus.
 Hyperlipidemia.

8. Dietary habit

10. Epidemiology of MI

11. Epidemiology of MI
So, in case of any cardiac complication patient must be
hospitalized immediately

12. MI Classification
MI’s can be subcategorized by anatomy and clinical diagnostic
information.
Anatomy
• Transmural
• Subendocardial
Diagnostic
• ST elevations (STEMI)
• non ST Elevations (NSTEMI)

13. According To Anatomy
These endocardial and
subendocardial MI affect
different surface and site of the
myocardium of the heart that
may lead to the dangerous
condition.
They are:
• Anterior MI
• Lateral MI
• Septal MI
• Inferior MI
• Entensive MI

14. According To The Diagnostic
Overview of the clinical classification of MI
Type Clinical classification of MI
Type 1 Spontaneous MI
Type 2 MI secondary to ischaemic imbalance
Type 3 MI resulting in death without biomarkers
Type 4a MI related to PCI
Type 4b MI related to stent Thrombosis
Type 5 MI related to CABG

15. Signs and Symptoms of MI

17. Diagnosis of Acute Myocardial
Infarction
• Clinical symtoms
Chest pain
• ECG changes
ST elevation or depression
• Elevated cardiac biomarkers
cardiac troponin I or T
CK isoenzyme MB
Myoglobin
 creatinine kinase (CK)

18. Repeated blood sampling and measurements are required 6–12 h after
admission and after any further episodes of severe chest pain
Three types of tests conducted:
ECG
EET
echocardiogram

19. The clinical circumstances such as:
 Anaemia
 Infection
 Inflammation
 Fever
 Metabolic or endocrine disorders
Intense prolonged pain at rest - retrosternal pressure or heaviness
(‘angina’) radiating up to the neck, shoulder and jaw and down to the
ulnar aspekt of the left arm

20. Physical Examination
• Tachycardia (rapid heart rate)
• Bradycardia (slow heart rate)
- The heart rate and blood pressure may be elevated due to increased
sympathetic tone .
• Hypotension ↓ 100/60 mmhg
- The blood pressure can be low due to cardiogenic shock depending on
the extent of the attack
• Relatively non-specific.
Physical symptoms are quite similar to those of stable angina, unstable
angina in both STEMI and NSTEMI.
BP measurement

21. Treatment
Pre hospital management
• Antiplatelet therapy
• Acetylosalicid acid 400-500 mg (i.v. or p.o.),
• Clopidogrel 600mg or ticagrelor 180mg or
prasugrel 60mg
• Antithrombin therapy
• Heparin 5 000 - 10 000 IU i.v. or enoxaparine
• Resolve pain and fear
• analgesic drugs
• benzodiazepine
• Nitrate - pain, hypertesion, heart failure
• Nitroglycerin.
• Betablockers - tachycardia, hypertension
• Metoprolol - dose 25-50mg oral or 2 mg i.v.
• ACE inhibitors - hypertension
• Perindopril - dose 5 mg oral
• Diuretic - heart failure
• Furosemide 20 - 40mg i.v.
• Anti-arrhythmic drugs
• Mesocain 1% 10 mL i.v.

22. Life long treatment of MI patients
• Antiplatelet therapy
-Aspirin - dose 100 mg p.o.
-Clopidogrel 75mg or ticagrelor 90mg twice a day or prasugrel 10mg
• Statins –
-Atorvastatin 40 - 80mg, rosuvastatin 20 - 40mg
• ACE inhibitors - more expressed in left ventricular dysfunction
-perindopril - dose 5-10 mg oral
• Betablockers - 1 - 3 years after MI, longer for pts. With left ventricular dysfunction,
tachyarrhythmia
-Bisoprolol- dose 2.5mg

23. What is angiogram?
• A coronary angiogram is a
procedure where a type of dye
that's visible by an X-ray machine
is injected into the blood vessels
of the heart to see them.
• It is done to see if there's a
restriction in blood flow going to
the heart.
• Helps diagnose heart conditions
and is the most common type of
cardiac catheterization procedure.

24. Surgical Treatment Of Myocardial Infraction
1.Balloon Angioplasty:
Placement of guiding catheter
Introduction of guidewire and
crossing the lesion
Introduction of balloon catheter
Inflation of balloon catheter
Deflation and removal of balloon
catheter

25. A stent is a
metal
mash tube
Inserted
into
narrowed
artery
Acts as an
internal
support
framewor
k
Keeps
the
artery
open
Presses
plaque
back
against the
artery wall
Allows
blood to
flow
freely
2.Placement Of Stent:

26. Doctors use
blood vessels
taken from
the another
part of the
body
Repair the
damaged
arteries
Restores
blood and
oxygen flow
to the heart
Lowers the
risk for
heart attack
Coronary Artery Bypass Surgery:

27. Aspiration Thrombectomy:
This technique
eliminates
thrombus and
prevents
embolization
Catheter tip is
placed
immediately
proximal to the
clot
Negative
pressure is
applied at the
distant
catheter
Opens the
catheter by
suctioning
through a 50ml
or 60 ml syringe
Results in clot
aspiration into
the catheter

28. Take Home Message
Disease and
complication
• Causes necrosis of heart muscle, biomarker level becomes high in blood
• Can lead to congestive heart failure
Diet and
Diagnosis
• Healthy diet, daily a 30 minute walk can prevent Myocardial Infraction
• ECG, EET, Angiogram are some of the diagnosis process
Treatment
strategy
• Pre hospital medication can lower the risk of death
• Angioplasty, Stent placement, Bypass surgery are some of the common
surgical treatment strategy

29. Thank You