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NON-MODIFIABLE MODIFIABLE
RISK RISK
FACTORS FACTORS
NON-MODIFIABLE RISK
FACTORS
AGE: More than 40 years.
FAMILY HISTORY:
Myocardial infarction can
be inherited from parents
to children.
GENDER: Myocardial
infarction is 3 times more in
men than women.
MODIFIABLE RISK FACTORS
PATHOPHYSIOLOGY
Causative factor: Obesity ,DM,SMOKING ,HT etc..
Narrowing of lumen
Diaphoresis Increased
(perfuse sweating) Heart Rate
FEVER
100.4 to 102.2°F
It is due to inflammatory process caused by
Myocardial cell death.
SYMPATHETIC NERVOUS SYSTEM
STIMULATION
Shock
CHEST X-RAY
To detect cardiomegaly.
Positron emission tomography- (PET scan)
It is used to evaluate cardiac metabolism & to assess
tissue perfusion.
DRUG THERAPY IN MYOCARDIAL INFRACTION
Pharmacological therapy in MI has following
objectives.
1.To reduce pain, anxiety and apprehension .
2.Oxygenation .
3.Maintenance of blood volume, tissue perfusion, and
microcirculation .
4.correction of acidosis.
5.Prevention and treatment of arrhythmias.
6.To manage cardiac output .
7. Prevention of thrombus extension, embolism, venous
thrombosis
8.Thrombolysis and reperfusion.
9.Prevention of remodeling and subsequent CHF
10.Prevention of future attacks
a. platelet inhibitors.
b. beta blockers
c. control of hyperlipidemia .
1.To reduce pain anxiety and apprehension
1. After pain is not relieved by 3 doses of GTN given 5
min. apart , an opioid analgesic [morphine
/pethidine] or diazepam is administered parentally.
2.Prevention and treatment of arrhythmias.
Prophylactic i.v. infusion of beta blockers as soon as the
MI patient is seen ,reduces the incidence of arrhythmia
and mortality .
Beta blockers used early in evolving MI can reduce the
infract size and complications.
Tachyarrhythmias may be treated with i.v lidocaine,
procainamide, or amiodarone.
3. To manage cardiac output-
The objective is to increase c.o. and to decrease filling
pressure without increasing cardiac work or lowering
BP-
A. Furosemide- indicated if pulmonary wedge pressure
is > 20 mm Hg. It decreases cardiac preload.
B. Vasodilators – GTN or nitoprusside have been manily
used.
C. Inotropic agents- dopamin or dobutamine to
augment pumping action of heart.
4.Prevention of thrombus extension, embolism,
venous thrombosis-
1. Aspirin [162- 325 mg] as soon as MI is suspected. This is
continued at 80- 160 mg / day.
2. Anticoagulants [heparin followed by oral
anticoagulants ]are used to prevent deep vein thrombosis
and pulmonary or arterial embolism.
5.Thrombolysis and reperfusion
1. Fbrinolytic agents i.e. streptokinase /urokinase/
alteplase are used to achieve reperfusion of infracted
area
2.Thrombolysis should be started within 1- 2 hours of
MI symtom onset.
3. Primary percutaneous coronary intervention with
stenting is preferred revascularization procedure.
6.Prevention of remodeling and subsequent
CHF
1.ACE inhibitors/ARBs are of proven efficacy and
afford long- term survival benefit.
7.Prevention of future attacks-
Platelet inhibitors- asprine or clopidogrel.
Beta blockers- reduce risk of re infaraction, CHF, and
mortality.
Control of hyperlipidemia.
SURGICAL MANAGEMENT
PTCA (Percutaneous
Transluminal Coronary
Angioplasty)
STENT PLACEMENT
ATHERECTOMY