Neacsu Aurelia Simona-FMVB

Grupa 3215

Essay

Myocardial infarction (MI ) or acute myocardial infarction ( AMI) , commonly called and heart attack, is the interruption of blood flow to a portion of the heart , causing myocardial cell death . The most commonly produced by obstruction of a coronary artery as a result of rupture of an atherosclerotic plaque , which is a deposit of fat and white blood cells (particularly macrophages) in the arterial wall . Ischemia ( reduced blood flow ) and hypoxia results timely untreated , leads to death ( necrosis ) of the heart muscle ( myocardium ) .

The classic symptoms of acute myocardial infarction are sudden chest pain ( typically spreading to the left arm or left side of the neck ) , shortness of breath , nausea , vomiting , palpitations , sweating and anxiety (often described as a sensation of imminent death ) . Women may have less typical symptoms than men , the most common being dyspnea , weakness, abdominal discomfort condition and asthenia . Approximately one quarter of all myocardial infarctions are " silent " , without pain chest or other sympthomes.

Based on acute myocardial infarction pathology can be divided into two main categories:

Transmural myocardial infarction: atherosclerosis associated with the main involving a coronary artery. It subcategorisi the anterior, posterior, inferior, lateral and septal. Transmural infarction involves the entire thickness of the wall of the myocardium and is usually as a result of complete occlusion of the blood supply to the area.

Subendocardial infarction (non-transmural)

Subendocardial: involving a small area subendocardiac wall of the left ventricle, ventricular septum, or papillary muscles. Subendocardiacă area is particularly exposed to ischemia.

In the clinical context myocardial infarction based on ECG changes can be further subclassified into:

ST segment elevation (STEMI)

ST segment elevation ( non- STEMI ) .

Expression of heart attack is sometimes used incorrectly to describe sudden cardiac death , which may or not the result of acute myocardial infarction . A heart attack is different, but it can cause a heart attack (which means stopping the heart ), or cardiac arrhythmia ( abnormal ) . It is also different from heart failure, which is affected by the pumping action of the heart ; however severe heart attack can lead to heart failure .

A document from 2007, which gives the universal definition of myocardial infarction myocardial infarction classified into five main types:

Type 1 - spontaneous associated with myocardial ischemia due to coronary event the primary , such as, for example, the erosion of the plate and / or break , rupture or dissection of its.

Type 2 - secondary myocardial ischemia due to increased demand intake oxygen or low ( not enough ) , for example, coronary artery spasm , coronary artery embolism , anemia , arrhythmias , hypertension or hypotension

Type 3 - Sudden cardiac death , including cardiac arrest , often with symptoms suggestive of myocardial ischaemia , accompanied by ST segment elevation recent ( on ECG ) or BRS emerging evidence that fresh thrombus in a coronary artery found angiography and / or at autopsy , but the death occurring prior to sampling of blood or the occurrence of cardiac biomarkers before the blood.

Type 4 - Associated with coronary angioplasty or stents :

Type 4a - Myocardial infarction associated with PCI

Type 4b - Myocardial infarction associated with stent thrombosis as documented by angiography or at autopsy

Type 5 - Myocardial infarction associated with CABG

Signs and symptoms [ change | change source ]

Areas for pain in myocardial infarction ( dark red = areas typical light red = other possible areas ) - the previous view .

Rear view .

The onset of symptoms of myocardial infarction is usually gradually over a period of a few minutes , rarely is suddenly . before chest pain is the most common symptom of acute myocardial infarction is often described as a claw , a feeling of tightness or pressure . Chest pain due to myocardial ischemia ( insufficient flow of blood and therefore oxygen ) is called angina pectoris . Pain radiates most often to the left arm , but may radiate to the jaw and right arm , interscapular and epigastrium , where it may mimic heartburn. Levine 's sign ( patient locates the pain and shaking his fist over strernului ) has been described classically as being predictive of cardiac chest pain , but a prospective observational study showed that it has a poor predictive value .

Shortness of breath ( dyspnea ) occurs when myocardial damage reduces cardiac output of the left ventricle , causing left ventricular failure followed by pulmonary edema. Other symptoms include diaphoresis ( excessive sweating ) , asthenia (weakness ) , dizziness , nausea , vomiting, and

palpitations . These symptoms are most likely caused by massive blood discharge of catecholamines by the sympathetic nervous system in response to pain and the hemodynamic abnormalities that result from cardiac dysfunction . Loss of consciousness (due to inadequate cerebral perfusion and cardiogenic shock ) and sudden death ( frequently due to ventricular fibrillation ) can occur in myocardial infarctions.