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• Overview of Myocardial Infarction
• Risk Factors for Myocardial Infarction
• Warning Signs of Myocardial Infarction
• Diagnosing Myocardial Infarction
• Treating Myocardial Infarction
• Monitoring Patients with Cardiovascular Disease

Myocardial infarction (heart attack) is a serious result of coronary artery disease. Coronary artery disease occurs from atherosclerosis, when arteries become narrow or hardened due to cholesterol plaque build-up. Further narrowing may occur from thrombi (blood clots) that form on the surfaces of plaques. Myocardial infarction occurs when a coronary artery is so severely blocked that there is a significant reduction or break in the blood supply, causing damage or death to a portion of the myocardium (heart muscle). Depending on the extent of the heart muscle damage, the patient may experience significant disability or die as a result of myocardial infarction.

In addition to atherosclerosis, myocardial infarction may result from a temporary contraction or spasm of a coronary artery. When this occurs, the artery narrows and the blood flow from the artery is significantly reduced or stopped. Though the cause of coronary artery spasm is still unknown, the condition can occur in both normal blood vessels and those partially blocked by plaques.

The following risk factors have been associated with a higher incidence of myocardial infarction. Some of these risk factors are controllable (such as smoking and physical activity) while others are uncontrollable (such as age, genetics, family history).

• Age: Four out of five patients with coronary artery disease are 65 years of age or older. After menopause, females are more likely to die within the first year of having a myocardial infarction than males.

• Gender: Males are at higher risk of myocardial infarction than women, and males are also more likely to suffer myocardial infarction earlier in life. However, heart disease kills more females each year than any other disease, including breast cancer. An alarming survey reported by the American Heart Association found that only 8% of women perceive heart disease as the greatest threat to their health despite the fact that heart disease is the leading cause of death among both women and men. Over 500,000 American women die from cardiovascular disease each year--twice the number of deaths from all cancers combined. Also, women are more likely to die within the first year of a heart attack than men.

• Family history/race: A family history of heart disease increases the risk of coronary artery disease and myocardial infarction. In the United States, African Americans tend to have more severe high blood pressure than Caucasians, increasing coronary artery disease/myocardial infarction risk. The incidence of heart disease is also higher among certain population groups such as Mexican Americans, American Indians, native Hawaiians and some Asian Americans.

• Smoking: Cigarette smokers are twice as likely to experience myocardial infarction compared to non-smokers. Smokers also have a two to four time higher risk of sudden cardiac death (within an hour of a heart attack).

• High blood pressure (hypertension): Alone or in association with obesity, smoking, high blood cholesterol levels or diabetes, high blood pressure increases the risk of myocardial infarction and stroke.

• High blood cholesterol: High total and low-density lipoprotein (LDL cholesterol) levels and low HDL cholesterol levels increase the risk of myocardial infarction Cholesterol levels can be lowered with dietary/lifestyle modifications such as exercise or medications.

• Obesity: Obesity increases coronary artery disease, myocardial infarction, and stroke risk. Obesity increases strain on the heart, raises blood pressure and cholesterol, and increases diabetes risk. Weight reduction can be achieved with modifications to diet and increased physical activity.

• Diabetes: Approximately two-thirds of patients with diabetes die from heart or blood vessel disease. Adults with diabetes are three to seven times more likely to develop heart disease. A recent recommendation from the U.S. government advocates aggressive treatment of high cholesterol in people with diabetes.

• Lack of physical activity: Regular exercise reduces the risk of coronary artery disease and myocardial infarction by controlling blood cholesterol levels, decreasing the risk of obesity or diabetes, and lowering blood pressure levels in some patients.

• Stress: Research indicates a possible relationship between stress and coronary artery disease, which may lead to myocardial infarction Hypertension (high blood pressure) and high cholesterol are associated with stress, as are increased tendencies to smoke, gain weight and/or decrease physical activity.

When a heart attack occurs, time is essential. Patients have much better chances of survival if they proceed immediately to an emergency room when symptoms occur. The most common symptom of myocardial infarction is angina (chest pain). Myocardial infarction frequently occur from 4:00 a.m. to 10:00 a.m. since increased amounts of adrenaline are usually released in the morning. Adrenaline normally helps regulate blood pressure, heart rate, and blood glucose concentration.

Other signs of myocardial infraction may include:

• Sweating
• Jaw pain
• Heartburn or indigestion
• Upper back pain
• General feeling of illness

A recent survey reported by the American Heart Association reveals that the majority of American women do not understand the true threat of cardiovascular disease. Despite the fact that heart disease is the leading cause of death among women, a nationwide survey revealed that only 8% of women perceive heart disease as the greatest threat to their health. More than six out of 10 women falsely believe that they are more likely to develop cancer than heart disease.

Other statistics from the American Heart Association:

• Over 500,000 American women die of cardiovascular disease each year. This twice the number of deaths from all cancers combined (lung cancer, the leading cause of cancer deaths, claims approximately 65,000 deaths per year, and breast cancer kills around 40,000 women per year).
• One in five women have some form of heart or blood vessel disease.
• 38% of women who have heart attacks die within the first year compared to 25% of men.
• 35% of women have a second heart attack within six years of the first attack compared to 18% of men.
• Over 60,000 women die of stroke each year; approximately 60% of stroke deaths occur in women.

When symptoms are presented, patients should be evaluated quickly with blood tests and an electrocardiogram. After the patient is stabilized, an echocardiogram and nuclear medicine exam may be performed.

• Blood work: Blood tests will be performed to detect levels of creatine phosphokinase (CPK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and other enzymes released during myocardial infarction.

• Electrocardiogram (ECG or EKG): An electrocardiogram makes a graphic record of the cardiac activity, either on paper or a computer monitor. An ECG can be beneficial in detecting disease and/or damage.

• Echocardiogram (heart ultrasound): This diagnostic technique is an excellent first step in investigating congenital heart disease or in evaluating abnormalities of the heart wall. Echocardiography is a non-invasive exam in which images are acquired and viewed in real time without the use of radiation. Echocardiography is often useful in studying the beating heart and provides some information on functional abnormalities of the heart wall, valves and blood vessels. Doppler ultrasound can be used to measure blood flow across a heart valve. Abnormal operation of the valves can be detected by studying the opening and closing function versus normal valve function. Echocardiography may also be used to study congenital heart defects such as a septal defect (a hole in the wall that separates the two chambers of the heart).

• Nuclear medicine: Nuclear medicine (also called radionuclide scanning) allows visualization of the anatomy and function of an organ. The patient will be given a radionuclide which will assist in the acquisition clear images of the heart with a gamma camera. Nuclear medicine imaging may be used to detect coronary artery disease, myocardial infarction, valve disease, heart transplant rejection, check the effectiveness of bypass surgery, or to select patients for angioplasty or coronary bypass graft.

Treatment options for myocardial infarction include medications such as antiplatelets (aspirin), beta blockers, calcium channel blockers, ACE inhibitors, etc. Additional treatment with coronary angioplasty (may be followed with stenting—see below) may be necessary. Depending on the patient’s condition and reasons for suffering myocardial infarction, coronary artery bypass graft may or may not be performed.

The following chart summarizes types of drugs that may be used to help treat myocardial infarction. Brand names of drugs are shown in parentheses.

A note about heart attack prevention: While several studies have found that a low-dose aspirin regimen may reduce the risk of first heart attacks in men, a 2005 study conducted by researchers at the U.S. National Heart, Lung, and Blood Institute found that the effects of aspirin may not be the same in women. In the study of 45,000 women followed over a ten-year period, aspirin generally did not prevent first heart attacks or deaths from cardiovascular disease in women. However, the researchers did find some benefits of aspirin in women over 65 years of age. Most notably, these women had a significantly lower risk of stroke. An aspirin regimen typically consists of a 100 milligram aspirin on alternate days. The study suggests this regimen may be beneficial for women 65 years of age and older but for young women, the possible benefits of aspirin should be weighed against possible side effects including internal bleeding.

Medical procedures used to help treat myocardial infarction include:

• Coronary angioplasty: Involves placing a catheter with a small balloon on its tip into the patient’s narrowed artery. When properly positioned, the balloon is inflated and deflated, moving the plaque build-up further against the artery wall and thereby improving the flow of blood. This procedure may also be called percutaneous transluminal coronary angioplasty (PCTA), coronary artery balloon dilation or balloon angioplasty. Coronary angioplasty may be followed by stenting, a procedure in which a stent (expandable wire mesh tube) is permanently inserted into the artery to keep it open and restore normal blood flow.

• Coronary artery bypass graft: Involves grafting the ends of a healthy blood vessel (often taken from the chest or leg) above and below a narrowed artery, bypassing the flow of blood around the narrowed artery. Bypass surgery can relieve symptoms of coronary artery disease, such as angina (chest pain) and dyspnea (shortness of breath) and may be used to prevent or treat myocardial infarction.

Updated: August 2006

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