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Myocardial Infarction: Key Issues

Abstract

Individuals with myocardial infarction experience abrupt blockage of coronary arteries leading to deficiency of oxygen supply in the heart. Due to numerous conditions arising from the reduction of blood flow in the coronary artery, doctors have adopted the use of acute coronary syndrome (ACS) to refer to the condition. Most importantly, ST-elevation MI (STEMI) and non-ST-elevation (NSTEMI) are the major types of acute coronary syndrome. The study discusses myocardial infarction in both children and the aging populace.

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Introduction

Myocardial infarction (MI) is a disease resulting from arterial blockage preventing the supply of blood through the major heart vessels. Myocardial infarction is mainly caused by thrombosis in the coronary artery. In addition, heart disease is common in aging individuals aged over fifty years. However, the disease is uncommon in younger individuals. Further, risk factors such as smoking, hypertension, lack of exercise, alcohol consumption, obesity, high cholesterol, family history of heart disease and diabetes as well as the use of cocaine can lead to the development of MI by forming atheroma thereby leading to acute MI. Individuals with the condition experience various signs and symptoms. Further, the diagnosis of heart disease involves a number of tests. Individuals with MI can develop a number of complications if not treated (Durstine, 2009). Therefore, electrocardiograms (ECGs) are invaluable in tracking electric pointers in the heart to enable the determination of MI existence in an individual.

Classification

Acute myocardial infarction (AMI) is classified into transmural and subendocardial AMIs. The former involves a major coronary artery and occurs due to absolute blockage of blood’s flow into the heart muscles. On the other hand, the latter is associated with the left ventricle’s subendocardial wall as well as papillary muscles. Further, considering the clinical perspective, MI occurs as ST-elevation MI (STEMI) and non-ST-elevation (NSTEMI) as diagnosed by ECG (Durstine, 2009). In STEMI, there is complete occlusion of the artery supplying blood to heart muscles. On the other hand, NSTEMI occurs when the artery supplying blood to heart muscles is partially obstructed.

Causes

The major cause of heart disease is thrombosis. In other words, a blood clot forms in the coronary artery thereby obstructing the flow of blood to heart muscles. Additionally, studies postulate that individuals with severe exertion such as psychological stress are associated with higher levels of heart disease. Further, inflammation of the coronary artery is also a rare cause of myocardial infarction (Durstine, 2009).

Risk Factors

Researchers postulate that smoking, obesity, lack of exercise and job stress is the major aspects linked to coronary artery diseases with each factor accounting for approximately 35%, 21%, 9% and 4% respectively. In addition, elderly population aged over fifty years is at higher risks of contracting heart disease compared to young people (Durstine, 2009). Further, sexual orientation is also a risk factor. For instance, men are at more risk compared to women because females subsist for longer periods. Moreover, diabetes mellitus, high blood pressure, excess lipoproteins in the blood and consumption of excess quantities of alcohol augment the possibility of myocardial infarction.

Pathophysiology

The disturbance of the normal flow of blood in coronary vessels due to atherosclerotic plaque is the major cause of arteriole obstruction. As a result, there is a steady upsurge of cholesterol and fibrous tissue in the plaques of the coronary wall leading to irregularity of blood flow within the heart. The volatility and cracking of the plaques in the coronary vasculature enhances the formation of blood clots in the coronary artery causing MI.

Moreover, longer periods of irregular blood flow initiates ischemic flow that leads to death of heart cells found in the obstructed area within the coronary artery. The death of heart cells causes the configuration of collagen scars that permanently damage the heart tissues thereby exposing patients to MI (Menahem & Venables, 2007). Further, when the heart is wounded, there is imbalance in the conduction of electrical impulses between wounded and uninjured tissues. The variation in conduction velocity can cause deadly arrhythmias such as ventricular fibrillation. The speedy and disordered heartbeat can lead to heart attack.

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Prevention

The prevention of MI encompasses modification of individual lifestyles and maintenance of stern hypertension management schedules (Menahem & Venables, 2007). In other words, termination of smoking, regular exercise, rational diet and restriction of excess alcohol consumption are significant preventive measures of MI risks.

Management

Administration of aspirin as well as nitroglycerin and morphine is important in saving and putting off the risks of myocardial infarction. Specifically, aspirin reduces adhesiveness of platelets. The utilization of percutaneous coronary intervention (PCI) and fibrinolysis are also recommended in the management of STEMI. Further, antiplatelet drugs including clopidogrel and ticagrelor are also administered. Moreover, timely administration emergency angioplasty and injection of clot-bursting drugs such as streptokinase are useful in reducing the risk of MI (Durstine, 2009). The patients can also be given oxygen to limit heart damage.

Prognosis

The treatment administered and the degree of heart injury as well as individuals’ health influences the prognosis after heart disease. The main risk factors emanate from age, high blood pressure and obesity. Additionally, studies contend that the number of deaths from myocardial infarction has reduced worldwide. Further, the complications of myocardial infarction are rapture of the myocardium, mitral regurgitation, arrhythmias and Dressler’s syndrome as well as heart failure (Celermajer et al., 1991).

Myocardial Infarction in the Elderly

Heart diseases account for the majority of mortality rates in people aged over sixty-five years. In fact, studies show that when age increases, mortality subsequent to STEMI is also augmented. Most importantly, the amplified numbers of deaths among aging populace arise from electrical and mechanical cataclysms including cardiogenic shock and rupture of the coronary walls. Additionally, with advanced age, numerous modifications take place in the cardiac structure. The changes include limited vascular compliance, ventricular hypertrophy and remodeling as well as diastolic dysfunction. Moreover, the elderly react slowly to adrenergic stimulation increasing exposure to myocardial infarction (Carro & Kaski, 2011). The major symptom of MI in the elderly is complaints of chest pain.

Myocardial Infarction in Children

The prevalence of myocardial infarction is unusual in children. In reality, younger people display exceptional cardiovascular health as well as nonappearances of arrhythmia thereby reducing the risk of MI. Chest pains due to MI are not reported in kids. Further, children exhibit excellent exercise acceptance due to the presence of healthy peripheral vessels, high compliance, low resistance and myocardial coupling. The common symptoms associated with myocardial infarction in offspring are dyspnea, vomiting and difficulty in feeding. Moreover, cases of early mortality are high in children with MI (Celermajer et al., 1991).

Conclusion

In summary, prevention of normal blood flow within the heart vessels is the cause of myocardial infarction. Essentially, individuals with myocardial infarction experience abrupt blockage of coronary artery leading to deficiency of oxygen supply in the heart. Further, heart diseases account for the majority of mortality rates in individuals aged over sixty-five years. On the other hand, the prevalence of myocardial infarction is unusual in children.

References

Carro, A. & Kaski, J. C. (2011). Myocardial infarction in the elderly. Aging and Disease, 2(2): 116–137.

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Celermajer, D. S., Sholler, G. F., Howman-Giles, R, & Celermajer, J. M. (1991). Myocardial infarction in childhood: Clinical analysis of 17 cases and medium term follow up of survivors. British Heart Journal, 65(6): 332–336.

Durstine, L. J. (2009). ACSM’s exercise management for persons with chronic diseases and disabilities. Illinois, IL: Human Kinetics.

Menahem, S. & Venables, A. W. (2007). Anomalous left coronary artery from the pulmonary artery: A 15 year sample. British Heart Journal, 58(3): 378-84.

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