Myocardial infarction
Myocardial infarction is also known as heart attack.

It is defined as myocardial cell death caused by an inadequate blood supply.

The commonest cause is occlusion of a coronary artery. The occlusion is caused by a rupture of an atheromatous plaque within the vessel wall, bleeding into the plaque and subsequent clot formation within the plaque. The clot then extends into the vessel and leads to blood flow obstruction.

The area of the heart supplied by the occluded artery becomes dysfunctional almost immediately. This dysfunction is reversible, provided the blood flow is restored. This may be achieved spontaneously by the body’s own mechanism or may need medical intervention. If flow is not restored, the affected part dies, becomes thinner and stops contributing to blood pumping.

Myocardial infarction can cause a wide variety of symptoms such as chest pain, dizziness, shortness of breath, palpitations, and fainting, while in some case it may be completely without symptoms. In about 20% of patients however sudden death is the first presentation of their disease.

By far the commonest symptom is chest pain. The majority of patients describe a heavy or pressure-like pain in the centre of the chest which may come on at rest or on exercise. It lasts for more than 20 minutes and may be associated with numbness in left arm (usually) and lower jaw. It can also be associated with dizziness, sickness, sweating and a non-specific feeling that something is wrong.

The pain of course may not be typical as described above and it is prudent to seek medical attention if, for example the pain is prolonged, “funny” in nature or associated with not feeling well.

The worst complication of myocardial infarction is of course death, which can be the first and only presentation of the disease before one seeks medical attention. Despite medical interventions, however, the mortality rates can be quite high.

Other potential complications include arrhythmias, heart failure, pericarditis, angina, mitral valve insufficiency as well as rarer syndromes such as wall rupture.

Patients with myocardial infarction need to be hospitalized for 3 to 7 days if there are no complications.

The main aim of treatment is to restore blood flow as soon as possible. TIME IS MUSCLE. This can be achieved with urgent angioplasty (balloon) or clot-dissolving medication. A large number of drugs can then be used to protect the heart muscle and prevent subsequent events.

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