myocardial infarction
TRANSCRIPT
![Page 1: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/1.jpg)
MYOCARDIAL INFARCTION
Presented by,
Aiswarya.A.T,
I year M.Pharm,
Department of pharmacy practice,
Grace college of pharmacy,
Kodunthirapully, Palakkad.
![Page 2: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/2.jpg)
CONTENTS:
1. Definition
2. Types of infarcts
3. Epidemiology
4. Etiology
5. Etiopathogenesis
6. Pathophysiology
7. Clinical manifestations
8. Diagnosis
9. Management:
Non-pharmacological
Pharmacological
![Page 3: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/3.jpg)
MYOCARDIAL INFARCTION
MI is defined as a diseased
condition which is caused by
reduced blood flow in a
coronary artery due to
atherosclerosis & occlusion of
an artery by an embolus or
thrombus.
MI or heart attack is the
irreversible damage of
myocardial tissue caused by
prolonged ischaemia &
hypoxia.
![Page 4: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/4.jpg)
![Page 5: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/5.jpg)
TYPES OF INFARCTS
1. According to anatomic region of left ventricle invoved:
Anterior
Posterior
Lateral
Septal
Circumferential
Combinations- Anterolateral, Posterolateral, Anteroseptal
2. According to degree of thickness of ventricular wall
involved:
Transmural (full thickness)
Laminar (subendocardial)
3. According to age of infarcts:
Newly formed (acute, recent, fresh)
Advanced infarcts (old, healed, organised)
![Page 6: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/6.jpg)
EPIDEMIOLOGY: In industrial countries MI accounts for 10-25% of all
deaths.
Incidence is higher in elderly people, about 5% occurs at
people under age 40.
Males have higher risk.
Women during reproductive period have low risk.
In 2006, studies revealed a prediction that India would
account for 40-60% of cardiovascular diseases burden within
next 10-15 years.
Over last 30 years, the rate of diseases increased from 2-
6% in rural population and 4-12% in urban population.
![Page 7: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/7.jpg)
Tobacco smoking
Hypertension
Drug abuse
Obesity
Stress
Alcohol
ETIOLOGY
![Page 8: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/8.jpg)
Age
Gender
Diabetes
Hyperlipoproteinaemia
Family history of Ischaemic
Heart Disease
Hyperhomocysteinemia
Chronic kidney disease
![Page 9: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/9.jpg)
ETIOPATHOGENESIS:
1. Mechanism of
myocardial ischaemia.
2. Role of platelets.
3. Acute plaque rupture.
4. Non-atherosclerotic
causes.
5. Transmural versus
subendocardial infarcts.
![Page 10: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/10.jpg)
PATHOPHYSIOLOGY
Atherosclerosis Arterial spasm Atherosclerosis+Plaque split+Thrombus
gradual sudden not usually reversible
Obstruction sudden reversible occlusion
obstruction
ISCHAEMIA
Hypoxia
Reduced oxygen demand Angina
Thrombolysis Unstable angina
Permanent thrombus
Necrosis MYOCARDIAL INFARCTION
![Page 11: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/11.jpg)
CLINICAL MANIFESTATIONS:
• Chest pain / chest discomfort
• Dyspnea
• Fatigue
• Other symptoms include:
Increased sweating
Weakness
Nausea
Vomiting
Light-headedness
Palpitation
• Anxiety, sleeplessness, hypertension or
hypotension, arrhythmia.
• Chest pain is less in women, their common
symptoms are weakness, fatigue & dyspnea.
![Page 12: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/12.jpg)
Complications include:
Arrhythmia
Cardiogenic shock (10%)
Congestive heart failure
Thromboembolism
Rupture (5%)
Cardiac aneurism (5%)
Pericarditis
![Page 13: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/13.jpg)
DIAGNOSIS:
1.Clinical features:
Pain
Indigestion
Apprehension
Shock
Low grade fever
2.Serum cardiac markers:
Creatinine phosphokinase (CK)
Lactic dehydrogenase (LDH)
Cardiac specific troponins (cTn)
![Page 14: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/14.jpg)
3.ECG changes:
ST segment
elevation
T wave inversion
appearance of
wide deep Q waves.
![Page 15: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/15.jpg)
MAGNETICRESONANCE IMAGING (MRI)
CHEST X- RAY
ANGIOGRAPHY
POSITRON EMISSION TOMOGRAPHY (PET scan):
![Page 16: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/16.jpg)
MANAGEMENT:
1.NON-PHARMACOLOGICAL:
Counselling and education of patients
Life style measures
Smoking cessation
Avoid Alcohol intake
Diet and nutrition
Salt restriction
![Page 17: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/17.jpg)
2.PHARMACOLOGICAL:
Thrombolytic agentsAnticoagulantsAntiplatelet agentsAntihypertensive agentsLipid lowering drugsVasodialatorsOthers
i) Analgesicsii) Antiulcer drugsiii) Antidepressants
![Page 18: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/18.jpg)
TREATMENT ALGORITHM FOR MI:
Myocardial Infarction
Pre-hospital or on arrival
GTN spray, Oxygen, Pain relief, Admission to hospital,
Aspirin, Thrombolytics
During hospital admission
Add: beta blocker, ACE inhibitor, insulin
Consider: Revascularization (Angioplasty, Stenting, Arterial bypass)
Long term
Rehabilitation classes: Aspirin, beta blocker, ACE inhibitor, Statins
![Page 19: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/19.jpg)
![Page 20: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/20.jpg)
PERCUTANEOUS
TRANSLUMINAL
CORONARY
ANGIOPLASTY (PTCA)
STENT PLACEMENT
![Page 21: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/21.jpg)
ATHERECTOMY
CORONARY ARTERY BYPASS
GRAFT (CABG)
![Page 22: Myocardial infarction](https://reader038.vdocuments.us/reader038/viewer/2022102712/55a713e61a28ab40358b463f/html5/thumbnails/22.jpg)
THANK YOU…..