Myocardial infarction: symptoms, diagnosis and effective treatments

Myocardial infarction (MI), commonly known as a heart attack, is a serious condition that occurs when blood flow to part of the heart muscle is blocked, resulting in damage or death of heart muscle cells.

Here are some statistics related to this phenomenon:

• According to the World Health Organization, cardiovascular disease (CVD) is the leading cause of death worldwide, and myocardial infarction is one of the leading CVDs.
• In the US, about 805,000 people have a heart attack each year, and about 1 in 5 heart attacks have no obvious symptoms.
• The death rate from myocardial infarction varies depending on several factors such as age, gender and race. According to the American Heart Association, the overall death rate from this disease in the United States is about 10%.
• Morbidity and mortality rates from myocardial infarction have declined in recent years due to improved medical care and increased awareness of risk factors and preventive measures.

The most common cause of a heart attack is atherosclerosis, which is a buildup of fatty deposits or plaque in the arteries that supply blood to the heart. When one of these plaques ruptures, a blood clot can form that blocks blood flow to the heart muscle.
Symptoms of myocardial infarction may include chest pain or discomfort, shortness of breath, sweating, nausea, vomiting, dizziness, and fatigue.
Risk factors for myocardial infarction include smoking, high blood pressure, high cholesterol, obesity, physical inactivity, and a family history of heart disease. Early initiation of treatment is critical to reduce damage in a heart muscle malnutrition condition. Many healthy lifestyle factors such as not smoking, maintaining a healthy weight, regular exercise, and a healthy diet can help reduce the risk of heart attack.

Symptoms of myocardial infarction

Symptoms of a heart attack can vary from person to person, but most commonly they include:

• Chest pain or discomfort: This is the most common symptom of a myocardial infarction. It is often described as a feeling of pressure, fullness, squeezing and/or pain in the chest. Discomfort may also be felt in the arms, back, neck, jaw, or abdomen. Often such pain gives to the left hand or is felt only in the left hand.
• Shortness of breath — may be associated with or without chest discomfort. This may be the only symptom in some people, especially women. Given that this variant of the development of the disease in women remains undiagnosed or untimely diagnosed, women need to pay attention to more pronounced shortness of breath than usual.
• Sweating, may be accompanied by cold, clammy skin. This is an additional symptom.
• Nausea or vomiting — may be accompanied by chest pain or shortness of breath.
  Unusual severe fatigue. It is rarely the main symptom of a heart attack, but is often seen in the days or weeks leading up to a heart attack, especially in women. It is important to note that not all people experience the same symptoms, and some people may not have any symptoms at all.

Signs of an impending myocardial infarction

A condition that can turn into a myocardial infarction is called angina pectoris and manifests itself in much the same way. Small differences in the intensity of symptoms can be noted.

Chest discomfort or pain: this can be like pressure, squeezing, a bursting feeling or pain in the center of the chest. It may last a few minutes or even go away completely. When compared with the pain manifestations of an already occurring myocardial infarction, the pain during a heart attack does not go away and does not become less, sometimes narcotic analgesics are required for relief. Before the onset of an attack, pain may be present for several days or even weeks with varying intensity.

• Discomfort in the upper body: Pain or discomfort may also be felt in one or both arms, back, neck, jaw, or abdomen.
• Shortness of breath — for the onset of a heart attack, severe shortness of breath or the so-called feeling of «fight for breathing» is characteristic, when the patient has to make significant efforts to inhale, spasm during breathing.
• Cold sweat — sudden, unexplained cold sweat can be a symptom of a heart attack. For angina pectoris without a heart attack, the appearance of cold sweat is less common.
• Nausea or vomiting — a feeling of stomach pain or vomiting even without chest pain can often be a symptom of an impending myocardial infarction, sometimes such patients are mistakenly sent to the infectious diseases department. With angina pectoris, nausea often occurs, but vomiting rarely occurs, especially repeated.
• Unusual lightness or dizziness — Unusual lightness in the body and / or severe dizziness are characteristic of myocardial infarction and are not characteristic of angina attacks, because they occur when the blood supply to the brain is interrupted.

If you suspect you’re having a myocardial infarction (heart attack), it’s important to seek emergency medical attention right away. Call the local emergency number (for example, 111 in Ukraine) or go to the nearest hospital emergency room.

Diagnosis of myocardial infarction

For primary diagnosis, simple methods are used, the equipment for which is available in any medical institution. To clarify the clinical picture and the degree of damage, expensive and invasive methods are used:

• Electrocardiogram (ECG): This is an instrumental examination that measures the electrical activity of the heart. It can detect changes in the heart’s rhythm and determine if there has been damage to the heart muscle.
• Blood tests are used to measure the levels of certain enzymes and proteins in the blood that are released when the heart muscle is damaged. The most commonly used blood test is called a troponin test.
• Imaging tests such as echocardiography or cardiac MRI can be used to get a detailed picture of the heart and identify any areas of damage or abnormalities.
• Coronary angiography is an invasive procedure where a thin tube is inserted into an artery and guided towards the heart. A special dye is injected into the artery and X-rays are taken to help identify any blockages in the coronary arteries.

Treatment of myocardial infarction

Treatment includes a combination of medications, medical procedures, and lifestyle changes. The main methods of treatment:

• Drug treatment is usually complex. Drugs commonly used in this process are aspirin, nitroglycerin, beta-blockers, ACE inhibitors, and statins. Aspirin and nitroglycerin are needed to relieve chest pain and prevent blood clots. Beta- blockers and ACE inhibitors are used to reduce the workload on the heart and lower blood pressure. Statins allow you to maintain lower cholesterol levels.
• Reperfusion or in other words restoration of blood flow to the affected area of the heart. This can be done with thrombolytic therapy or percutaneous coronary intervention (using a catheter to open a blocked artery).
• Coronary artery bypass surgery (CABG): In some cases, CABG may be required to restore circulation. This involves using a blood vessel from another part of the body to bypass a blocked artery and restore blood flow to the heart. Every patient who has survived a myocardial infarction or at high risk of this disease has to face lifestyle changes. Simple actions like quitting smoking, eating healthy, exercising regularly, and managing stress can help prevent future heart attacks.
• Rehabilitation — Cardiac rehabilitation programs can help patients recover by providing dietary advice, exercise programs, and support for lifestyle changes.

  

Complications of myocardial infarction

Myocardial infarction can lead to various complications that complicate the lives
of patients and lead to discomfort. Some of these complications are life-
threatening. These complications can be divided into acute and chronic.

Acute complications of myocardial infarction

Acute complications include heart failure, thrombosis, cardiogenic shock.

Heart failure is a condition in which the heart cannot pump enough blood to meet the body’s needs. It occurs when the heart muscle is damaged or weakened during a heart attack. It is accompanied by symptoms such as weakness, malnutrition of the brain, shortness of breath and cold. In this case, the functions of all organs suffer. Also often there are arrhythmias — a condition when the heart rhythm is not regular. In this case, the heart may contract too often, but not strong enough, or vice versa — too rarely. Arrhythmia can be either minor and manifested by little
shortness of breath or not at all, or deadly, leading to such a dangerous complication as fibrillation, which is deadly. Since arrhythmia may not occur simultaneously with a heart attack, but later, a patient who has had a myocardial
infarction needs to be under medical supervision for some time. A very formidable complication is cardiogenic shock — this is a serious condition when the heart cannot pump enough blood to the vital organs of the body. This can occur as a result of a severe heart attack and may require emergency treatment such as mechanical circulatory support.
Thrombosis is a very dangerous complication. During a heart attack, the rate of blood flow changes, most often slowing down. In addition, heart attacks are most common in the elderly and in people with atherosclerosis. These factors in combination provide a change in the rheological properties of blood (the properties of blood while it flows through the blood vessels) in the direction of thrombosis.
During a heart attack, most often blood clots form in large vessels, therefore, a frequent complication of myocardial infarction is a formidable complication – pulmonary embolism (PE) — blockage of the pulmonary artery by a thrombus. This complication often leads to the death of the patient. Chronic and delayed complications

Such complications also include arrhythmias, but only if they persist on an ongoing basis. The risks in this case remain the same as in the acute phase. Heart failure in almost all cases of myocardial infarction occurs in the acute phase and persists in one form or another for life. The degree of chronic heart failure is usually much less than in the acute phase, but it is no longer possible to completely get rid of it. There are even less common, but quite significant complications for patients — pericarditis and ventricular aneurysm. Pericarditis: Inflammation of the lining around the heart, known as pericarditis, can occur after a heart attack. This can cause chest pain, fever, and other symptoms. Ventricular aneurysm: A weakened area of the heart muscle may bulge, forming a ventricular aneurysm. Ventricular (less often atrial) aneurysm is usually the cause or additional cause of heart failure or arrhythmia.

Rehabilitation

Rehabilitation after a myocardial infarction is an important part of the recovery process. The state of health of the patient after a heart attack and the duration of his life depend on the quality of rehabilitation. The rehabilitation program usually includes a personalized exercise program designed to help patients gradually increase their physical activity. This may include aerobic exercise such as walking or cycling, as well as strength training to improve muscle strength. At the same time, patients should receive complete and accessible information about their condition, including information about risk factors, lifestyle changes and medication prescriptions. They can also learn stress
management techniques such as deep breathing and meditation. The rehabilitation program is usually long and includes regular visits to the doctor with adjustments to the rehabilitation plan as needed. Certain drug treatment is both an important part of the rehabilitation process and an element of the subsequent permanent lifestyle. Most patients will need to take medication on an ongoing basis to control their blood pressure, cholesterol levels, and other risk factors for heart disease.

Prevention

In conclusion, a few words should be said about the prevention of myocardial infarction. There are a few simple steps that can help prevent myocardial infarction:

• Smoking increases the risk of heart disease and is one of the main causes of myocardial infarction. Quitting smoking is a difficult but important step that will reduce your risk of developing heart disease.
• Eat a healthy diet: A diet low in saturated and trans fats, cholesterol and sodium can help reduce the risk of heart disease. Eating a diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats may help prevent heart attacks. Pay attention to the body mass index and adjust the diet if it increases significantly.
• Regular exercise can help improve cardiovascular health and reduce the risk of heart problems. If you do moderate-intensity physical activity (brisk walking, walking, stretching, light weight strength exercises, light running) for at least 150 minutes of exercise per week, you can significantly reduce the risk of atherosclerosis and heart attack.
• Blood pressure control — high blood pressure is a major risk factor for heart disease. If lifestyle changes are not enough to maintain healthy blood pressure levels, blood pressure should be controlled with medication.
• Cholesterol management — high cholesterol can increase the risk of heart disease.
• Lifestyle changes, such as healthy eating and exercise, as well as medications, can help keep cholesterol levels at healthy levels. Controlling blood sugar levels through lifestyle changes and medications can help reduce the risk of a heart attack.
• Stress management — chronic stress can increase the risk of heart disease. Techniques such as meditation, yoga, and deep breathing can help manage stress levels.
• Excessive alcohol consumption can increase the risk of heart disease. Limiting alcohol consumption to moderate levels can help prevent myocardial infarction.
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FAQ

1. What is the level of troponin in myocardial infarction?

Troponin levels are elevated during myocardial infarction and may remain elevated for days afterward. Normally, the level of this protein is 0.2 — 0.5 ng / ml, during a heart attack, its level rises 37-400 times.

2. What drugs are used in the treatment of myocardial infarction?

Medications used in the treatment of this condition may include aspirin, heparin, thrombolytic drugs, beta-blockers, and others.

3. What kind of nutrition should be in case of myocardial infarction?

Patients who survive this clinical situation should follow a diet rich in vegetables,
fruits, fish, whole grains, low in fat, sugar and salt.

Published: 29.03.2023

Updated: 29.03.2023

Medical author, Medical expert:

Kateryna Maliarchuk

Medical author:

Ilona Baidiuk

Information on this webpage verified by the medical expert

Medical Doctor, oncologist, PHD student

Kateryna Maliarchuk