Acute myocardial infarction

The watery myocardial infarction along with it is part of what is currently known as acute coronary syndrome. It assumes the irreversible death of heart tissue and it can lead to a failure in the function of the heart (relaxation and contraction) and the appearance of arrhythmias. It is one of the most frequent causes of mortality in developed countries.

How does acute myocardial infarction occur?

The heart is nourished by a series of arteries called coronary arteries that supply the heart muscle and allow it to exert its function as a heart pump, contracting and relaxing. Coronary atherosclerosis it is a slowly evolving disease In which there is a progressive narrowing of the walls of the arteries due to an accumulation of lipids (fats) and inflammatory cells (lymphocytes) forming plaques.

In 90% of cases, AMI is caused by occlusion of a coronary artery due to a clot It is produced by the detachment of a piece of atherosclerosis plaque. This complete occlusion prevents oxygen from reaching that area of ​​cardiac tissue, producing, if this lack of oxygen is prolonged, a death (necrosis) of the cardiac cells. There is a complete interruption of the coronary blood flow in a certain area of ​​the heart tissue.

There are a number of risk factor's that favor the appearance of AMI. These factors include: gender (more common in men), age (over 70 years old), smoking, diabetes, high cholesterol, being overweight, a family history of coronary heart disease, high blood pressure, and a sedentary lifestyle. It is important to know them because preventive measures are the main treatment weapon to avoid this disease.

In some cases, AMI may be the result of increased oxygen requirements of the heart in the absence of atherosclerosis. This can occur in: arrhythmias, trauma, drug and certain drug use, infections or coronary artery abnormalities.

heart attack symptoms

The key symptom of acute myocardial infarction is appearance of pain in the center of the chest. This pain is felt as "something that squeezes or weighs" and does not change with posture or muscle movements. The minimum duration of this pain is usually about 20 minutes. pain can extend to the left arm and jaw. Other symptoms such as nausea and discomfort, pain in the pit of the stomach, feeling short of breath, sweating and dizziness may appear. In a small percentage of patients, especially diabetics and the elderly, the symptoms may be different than usual.

Acute myocardial infarction can be the cause of sudden death, causing the sudden death of the patient.

Diagnosis of acute myocardial infarction

The diagnosis is based mainly on the symptoms that the patient presents and on a series of tests that allow them to be confirmed. It should be done without delay since early treatment decisively improves the prognosis.

• Conducting a electrocardiogram it is essential in all patients presenting with symptoms suggestive of acute myocardial infarction. The electrocardiographic record allows knowing the diagnosis in a high percentage of cases.
• Determination of markers of myocardial damage: cardiac enzymes. They are a series of substances that are eliminated into the blood when there is damage to the heart muscle (myocardium). They are measured with a blood test at regular intervals from the onset of symptoms and their elevation in the following hours allows the diagnosis of myocardial infarction to be established.

Imaging tests help complete the diagnosis and include:

• Chest x-ray to see the size of the heart and whether there is fluid in the lungs.
• With the images obtained by echocardiography the area of ​​infarction in the heart, alterations in its function and the existence of possible complications can be determined.
• Images of Myocardial Perfusion. This test is used to measure the size of the infarct, as it shows the areas of the heart where blood flow does not reach.
• The angiography It is a test that makes it possible to assess the anatomy of the coronary arteries and the extent of the disease. A catheter is inserted through a vein until it reaches the heart, through which a contrast is injected that allows us to see the coronary circulation and the narrowing or obstruction of the arteries.

Treatment of AMI

Patients with suspected AMI should receive urgent medical attention establishing treatment early. The insurances have a large medical staff of specialists in caridology. Before the appearance of prolonged chest pain, medical help should be sought and it is recommended that the patient take an aspirin and rest until they receive it. The treatment aims restore blood flow to the myocardium, reduce cardiac damage and reduce the risk of new onset and complications. Coronary revascularization allows the restoration of blood flow through the artery and can be performed by drugs (thrombolysis) or by angioplasty.

• In thrombolysis A drug is given intravenously (thrombolytic) that dissolves the clot that is blocking the artery. The main complications of this treatment is the appearance of bleeding in other areas, for example, in the brain.
• In coronary angioplasty A catheter is introduced into the area of ​​the coronary artery that is narrowed and dilated with a small balloon. To keep the artery open, a small metal device called a stent is placed inside it. This technique cannot always be performed.

The patient who has suffered a heart attack You must also follow a pharmacological treatment that includes drugs to combat the ischemic process of the heart muscle such as beta-blockers, nitroglycerin or calcium antagonists and drugs called antiaggregants (acetylsalicylic acid and clopidogrel) that prevent the formation of clots. May appear complications within 48 hours as are arrhythmias or reappearance of the So. in any patient with coronary artery disease, it is essential to treatment of risk factors cardiovascular:

• Tobacco cessation.
• Control of hypertension and diabetes. If necessary, pharmacological treatment will be given.
• Follow a healthy diet low in cholesterol and fat. In cases where it is necessary, it will be treated with drugs.
• Achieve an ideal body weight if you are overweight.
• Establish a physical exercise program appropriate to your ability.

After suffering a heart attack, modify unhealthy lifestyle habits. It is advisable to carry out adequate physical activity, progressive incorporation to active and working life according to the capacities of each patient, to resume sexual relations progressively depending on the evolution and to avoid stress.

Prevention of acute myocardial infarction

The precautionary measures They include avoiding the well-known risk factors: eating a healthy diet, exercising, losing weight if overweight, and controlling blood pressure, cholesterol, and diabetes.

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Intensive Medicine Specialist