This document summarizes information about myocardial infarction (MI), also known as a heart attack. It discusses the causes of MI as being due to blockage of the coronary arteries, usually from atherosclerosis. It describes the symptoms of MI and risk factors such as age, sex, genetics, hypertension, high cholesterol, diabetes, and smoking. Treatment options for MI mentioned include coronary artery bypass graft surgery, percutaneous coronary intervention such as angioplasty and stenting, and fibrinolysis to break up blood clots in the heart.

1. Family Planning Association

2. Kandungan
 Pengenalan
 Faktor Risiko dan cara mencegah serangan jantung
 Rawatan

3. Introduction
 Myocardial Infaction
 results from the
interruption of blood
supply to a part of the
heart, causing heart
cells to die

4. Myocardial Infarction
 Most commonly due to occlusion (blockage) of a
coronary artery following the rupture of a vulnerable
atherosclerotic plaque

5. Artherosclerosis
 Gumpalan Kolestrol,
lemak dan sel-sel darah
putih di dalam dinding
salur darah,
menyebabkan
penyempitan salur darah
 Jika dibiarkan tidak
dirawat, akan
menyebabkan kematian
sel-sel jantung

6. Myocardial Infarction
 Typical symptoms of acute
myocardial infarction
include sudden chest pain
(typically radiating to the
left arm or left side of the
neck), shortness of breath,
nausea, vomiting,
palpitations, sweating, and
anxiety (often described as
a sense of impending
doom)
 Symptoms more then 20
minutes

7. Myocardial Infarction
 Women may experience
fewer typical symptoms
than men, most
commonly shortness of
breath, weakness, a
feeling of indigestion,
and fatigue.[2]

8. Myocardial Infarction
 ] A sizeable proportion of
myocardial infarctions
(22–64%)[3] are "silent",
that is without chest
pain or other symptoms
 Common - Elderly,
Diabetes Mellitus

9. Risk Factors

10. 10
Stress
 Continuous stress can promote and
accelerate the development of high
BP
 Anxiety and stress:
 cause narrowing of artery
 Increase BP
 Cause hypertension
 Stress:
 Releases hormones (catecholamines?)
 Causes increased LDL

11. Age
 Dominant influence
 Death rates increase with
each passing decade
 As Clinically evident in
middle age or later
 Between ages 40 – 60,
MI incidence 5 times

12. Sex
 Males more prone than
females
 Atherosc and sequelae
uncommon in pre
menopausal females
 After menopause incidence
increases
 Decreased natural
estrogen levels
 Estrogen improves
endothelial function thus
playing a protective role

13. Genetics

14. Hyperlipidaemia
 Major modifiable risk
factor
 Specifically
Hypercholesterolemia
 Elevated levels sufficient to
stimulate development of
AS in absence of other risk
factors
 LDL transports cholesterol
to peripheral tissues
 Increased LDL = increased
risk

15.  HDL mobilizes cholesterol
from developing and existing
atheroma and transports it to
liver for excretion in bile
 increased HDL = lower risk
 increased: after exercise,
moderate consumption of
alcohol
 decreased: in obesity &
smoking
LDL- Bad cholesterol
HDL –Good cholesterol

16. 16
Cholesterol
 Plants do not contain cholesterol
but contain beta-sitosterol, which
competes with cholesterol for
absorption
 Cholesterol is found only in
animal food sources, and is
associated with animal fat
Review

17. 17
Oxidants vs. Antioxidants: Tocotrienols
1. Oxidants promote the oxidation of
lipids, proteins and nucleic acids
2. Antioxidants prevent the oxidation of
lipids, proteins and nucleic acids
3. Antioxidants include vitamins C and E
 Vitamin E is grouped as tocotrienols
 Tocotrienols prevent breast cancer
 Tocotrienols act as statin

18. 18
Palm oil

19. 19
Coconut milk (santan)
Review
Santan is rich in long chain FA, especially myristic acid (C14:0)

20. 20
Breakfast
Review
Pengat pisang is bananas + santan + water + coconut sugar +pandan + cloves
Lompat tikam is pulut + pandan + coconut + sira
Nasi lemak is a balanced meal

21. 21
TFA in infant milk formulas
 TFA = trans FA
 Trans monoene level in
animal fat = 5 – 8%
 Should we reduce trans
monoene level in infant
milk formulas?
 Susu ibu adalah susu yang
paling baik untuk bayi
Manusia!

22. 22
FA, hypercholesterolemia & CVD risk
 Myristic acid (C14:0)
Medium chain FA
Forms medium chain triglycerides
(MCT)
Found in santan, palm kernel oil
 Coconut milk (santan) and
palm kernel oil (minyak kelapa
sawit) are rich in myristic acid

23. 23
Fruits do not contain cholesterol; they contain fibre &
antioxidants (vit. C & flavinoids)
Review

24. 24
Vegetables do not contain cholesterol; they
contain folic acid
Review
High folic acid lowers homocysteine in blood
High homocysteine (hyperhomocysteinaemia) is associated with CHD

25. 25
Milk, milkshakes and burgers contain high fat and
high cholesterol
Review
Burgers contain 22% fat
Egg banjo is fried in chicken fat
Milkshake is full cream
milk + egg + glucose +
cooking oil + water
Goat’s milk is low fatSkimmed milk is low fat
but fortified with vitamins

26. 26
Eggs have high phospholipids and high
cholesterol
Review
Maggi mee is egg noodles and high in cholesterol
Mi kuning is egg noodles and also rich in cholesterol

27. 27
Soy- & tofu-based foods have high
phospholipids but no cholesterol
Review
Soy sauce (kicap) is soy
bean + Aspergillus niger +
artificial sugar + MSG
Artificial sugar has been
linked to cancer

28. 28
Seafood has high cholesterol
Review
Seafood with high cholesterol include: cuttlefish, prawn, shrimp, lobster, crab
Sambal sotong … causes hypertension!

29. 29
Breakfast food is high fat, high
carbohydrate, variable cholesterol
Review
Bread & potatoes are low-fatSoft margarine is higher in PUFA and lower in
trans FA than hard margarine

30. 30
Glutinous rice (pulut) is high gluten, high
carbohydrate
Review
Pulut hitam has bran left on and is high in riboflavin
Pulut manis (wajik) is pulut rice + coconut sugar (gula melaka/ gula keret) + sugar
Nasi dagang rice is pulut rice with bran left on (high in riboflavin) + santan
All pulut rice are rich sources of gluten and carbohydrate, and are fattening

31. 31
Frying adds oil to food;
fried foods are fattening
Review
Fritters (cucur) are oily as they absorb frying oil

32. 32
Meat is high fat, high cholesterol
Review
Meat is dense, many muscle cells, highly
nucleated, source of uric acid from DNA
breakdown. High meat intake leads to gout
which often accompanies CHD
Beef soup is a rich source of
saturated FA and cholesterol

33. 33
Chicken has high saturated FA in the fat
under the skin and high cholesterol
Review
Chicken is safe if skin is removed and steamed to remove all traces of fat
Chicken curry is chicken + santan + water + curry powder + chicken cube
(chicken fat + MSG + salt)

34. 34
Fish has high PUFA and low cholesterol
Review
Sardine curry is sardine + chili + santan
Sardine sambal is sardine + chili
Fish ball is fish + starch +salt
Fried fish is very oily.
Pencicah ikan bakar is
chili + water + vinegar +
salt
Lemak ikan & fish curry is fish + santan +
fresh chili or curry powder
Dried fish causes GI cancer

35. 35
Malaysian 1999 Dietary Guidelines
Total dietary fat 20 – 30%
PUFA as LA (18:2, n-6) 4 – 7%
n-3 FA (ALA + EPA + DHA) 0.4 – 1.2% kcal
n-6:n-3 FA ratio 5 – 10:1
MUFA (eg, olive oil) Maximise
TFA (esp. t18-1 in hydrogenated oils) Minimise
Myristic acid (14:0) in santan & palm kernel oil Minimise
Hypercholesterolemic patients 6 – 7% LA
Dietary cholesterol
<300 mg/day
(1 egg yolk alternate day)
Use Palm olein-PUFA vegetable oil blends

36. Minyak Masak Campuran

37. 37
FA, cholesterolemia & CVD risk
TFA
Hard
margarine
C12, 16 SFA
14-0,
12-0,
16-0
Santan
Palm oil
Neutral
18:1
18:0
<12:0
Olive oil
N-3 FA
EPA
DHA
Cod
liver oil
PUFA
Linoleic acid
18:2; n-6
Seed oils
Habbatus sauda
Gamat
Soy milk
Cholesterol
raising
Cholesterol
lowering
Increases CVD risk
Lowers CVD risk

38. Hypertension
 Major risk factor at all
ages
 Both systolic and
diastolic levels are
important
 BP more than 169/95
mm of Hg has 5 fold
greater risk of IHD than
of 140/90 mm of Hg
 Antihypertensives
reduce the risk of IHD

39. Hypertension
Kurangkan Garam
Senyum Selalu

40. Cigarette smoking
 Well established risk
factor
 1 or more pack / day
increases risk by 200%
 Cessation of smoking
reduces risk
substantially

41. Berhenti Merokok Rawatan ada di Klinik
Kesihatan Sandakan,
PERCUMA!

42. Diabetes mellitus
 Induces
hypercholesterolemia –
increased predisposition
to AS
 Risk of MI twice in
diabetics when
compared to non
diabetics
 100 – fold increased risk
of atherosclerosis
induced gangrene of
lower extremities

43. Diabetes mellitus Pemanis Tiruan
1. Moden
2. Tradisional -
Stevia

45. Myocardial
Infarct
Cerebral
Infarct
Gangrene,
(extremeties)
Abdominal
aortic aneurysm
70
60
50
40
30
20
10
0
COMPLICATIONS:
Thrombosis
Plaque rupture
Hemorrhage
Wall weakening
Calcification
FIBROUS PLAQUE
? ?
FATTY STREAK
Ageinyears
C L I N I C A L H O R I Z O N

46. Coronary narrowing in atherosclerosis

47. calcification

48. Ulceration

49. Hemorrhage

50. Thrombosis

51. Aneurysm formation
due to atrophy of tunica media
1. circumscribed dilation of an artery or a
cardiac chamber, a direct communication
with the lumen, usually due to an acquired
or congenital weakness of the wall of the
artery or chamber.

52. Rawatan
 CABG
 PCI
 Fibrinolysis

53. Percutaneous
Coronary
Intervention(PCI)

54. Coronary Artery Bypass Surgery
(CABG)

55. Fibrinolysis
 Memecahkan darah
beku di dalam jantung

56. Sekian