What Is Myocardial Infarction?

A myocardial infarction means that the muscle fibers of the heart die. Because of its high death rate, it is considered a severe medical emergency.

A myocardial infarction, also called myocardial infarction, is an extreme medical emergency because it has a high death rate. Along with cancer, it is one of the most common causes of death.

From a myocardial infarction occurs when the muscle fibers of the heart die.

The findings of an ECG can be classified into two categories:

• ST elevation myocardial infarction
• Non-ST elevation myocardial infarction

It is very helpful to know these. The correct diagnosis is  crucial for the therapy that the doctor must prescribe for the patient.

Epidemiology of myocardial infarction

Every year around 13 million people die as a result of a heart attack.

In general, it affects more men than women. In Europe about 1/6 of men and 1/7 of women suffer from a heart attack.

Risk factors

Some factors increase your risk of having a heart attack. However, you can also control some of them yourself, for example by giving up harmful habits or at least limiting them.

The most common factors are:

• Age> 65 years
• Male
• Diabetes mellitus
• high blood pressure
• High cholesterol
• Obesity, smoking, drugs, sedentary lifestyle
• Pre-existing conditions of the heart

How does a myocardial infarction occur?

Most often it is a blood clot that clogs the heart vessels. This can happen when fat builds up in the arteries.

• First a type of cyst loosens and then migrates through the blood.
• It then reaches the heart vessels and clogs them.
• This means that no more blood can reach the heart.

Sometimes the clot can also be caused by excessive clotting of the blood. In rare cases, stratification of the main artery wall, anomaly, or trauma can also cause this condition.

How do we know when a heart attack is creeping up?

Most of us are familiar with the symptoms of a heart attack. Nevertheless, a medical finding must also confirm a heart attack.

This finding shows:

• Symptoms of a heart attack
• Result of the EKG
• Blood clots in the heart vessels
• Detection of heart damage in special tests

What are the symptoms of a heart attack?

• Chest pain. The sudden pain usually lasts longer than 30 minutes. You usually feel very strong pressure in the middle of the chest, which then extends over the left arm and shoulder to the neck and jaw.
• Heavy sweating
• paleness
• Shortness of breath and difficulty breathing
• Feelings of fear
• Gravity seems stronger than usual

Atypical signs

However, although it is the most common symptom, it is not always chest pain that indicates a heart attack. In the elderly and diabetics, however, completely different signs can occur.

• Silent heart attack (in 30% of cases). Extreme tiredness, profuse sweating, nausea with vomiting and shortness of breath can suddenly occur here, but all without pain.

• Pain may occur, but it is not typical of a heart attack. For example, they can occur in the stomach, throat, and jaw. Sometimes a patient with severe abdominal pain needs an EKG, which is rare.

What do you see on the EKG of a person who has just had a heart attack?

The changes in the ECG depend on when it was performed. Therefore, it changes constantly as the heart attack progresses.

However, the following characteristics are the most obvious:

• Change in the T-wave. It becomes very pointed and high. This stands for subendocardial ischemia.
• In ST elevation myocardial infarction, the wave goes up more than 1 mm. Different results appear with a non-ST-segment elevation myocardial infarction.
• Ultimately, Q-waves will be seen, indicating necrosis.

But there are also cases in which you have the symptoms of a heart attack, but none of them can be seen on the EKG. Nevertheless, a heart attack should not be ruled out.

What are biochemical markers?

Biochemical markers are the molecules in the blood that make it possible to make a  diagnosis. The concentration of these markers is measured, which the doctor can then use to determine more precisely.

In a heart attack, the relevant  markers are the proteins secreted by the muscle fibers as they die. These are:

• Myoglobin
• CPK-MB
• Troponins

Troponins are the only proteins that are only excreted by the heart cells. The other two are also excreted by the fibers of other muscles. That is why the troponins are mainly used for making the diagnosis.

How is a heart attack diagnosed?

A detailed medical history and a complete physical examination of the patient are important in properly assessing a heart attack.

In addition, the ECG is the most important instrument that is used. If a patient is suspected of having a heart attack, it should be used immediately.

In addition, the doctors can use biochemical analyzes as well as invasive and non-invasive procedures.

However, cardiac ultrasound is the best technique because it can be performed quickly and does not penetrate the organ (it is non-invasive). The best results for an invasive test (penetrates the heart) is coronary angriography.

Treatment of a heart attack

The goal of treatment is to make the infarct smaller and to start treatment immediately after the diagnosis is made.

Treatment for myocardial infarction must be immediate. About 30% of patients die from ventricular fibrillation within the first hour.

Measures for immediate treatment

• First, all signs of life need to be monitored : heart rate, respiratory rate, oxygen saturation and blood pressure
• Rest and Fluid Monitoring : Oxygen should be administered through a nasal cannula when saturation is below 95%.
• Treat pain and anxiety with sedatives and anxiolytics. Anxiety and pain put additional stress on the heart, which in turn affects the strength of the heart attack.
• Blood thinner : acetylsalicylic acid (250 mg) with P2Y12 inhibitor

• Beta blockers to control blood pressure
• Atropine, to control heart rate

Reperfusion therapy

The goal of this therapy is to re-expose the blocked artery. It is best for the patient within the first 12 hours.

• Administration of medicines that help dissolve the blood clot. They are indicated if the arteries cannot widen within the first 2 hours of diagnosis. After the medication is administered, the patient must be immediately taken to a hospital for an angioplasty to dilate the vessels and allow blood to flow again.
• Urgent angioplasty. This is the most popular technique if you can use it within the first two hours of making the diagnosis. Here, too, it is a question of the expansion of the blood vessels.