Health Sciences: Myocardial Infarction - Essay Example

?HEART ATTACK Introduction A heart attack is a cardiovascular condition also referred to as myocardial infarction (MI), acute myocardial infarction, coronary occlusion or coronary thrombosis (Heart Foundation of Australia. 2012a). This condition is brought about by insufficient supply of blood or oxygen going to the heart muscle, leading to the infarction or dying of tissues. When the blood vessel develops a blood clot, it can block the arteries, which will hinder the flow of blood to the heart. Spasms, which cause the arteries to narrow, can also stop the blood supply to the heart muscle (Medical News Today. 2009). Since the heart is depended on regular supply of oxygen through the blood in order to function, the damage caused by the sudden blockage of coronary arteries can be irreversible (Heart Foundation of Australia. 2012a). In 2008 and 2009, the cardiovascular diseases group composed of heart attack, stroke, and other diseases of the heart and blood vessel has been regarded as the biggest killer in Australia contributing to 33% of the total deaths (Australian Bureau of Statistics. 2009; AIHW. 2012). Patients who suffer heart attacks have coronary heart disease (CHD) or the “slow build-up of fatty deposits on the inner wall of the arteries that supply the heart muscle with blood.” (Heart Foundation of Australia. 2012a). The plaque, or the fatty deposits, fill up the arteries over the years until an area of the plaque create fissures. Eventually, blood cells will fill in the cracks and will form a clot. The process of plaque build-up takes years. For this reason, most patients are not aware that they have coronary heart disease until they suffer a myocardial infarction (Medical News Today. 2009). Data shows that at least 25% of coronary patients have nonfatal heart attack or sudden death without any warning symptoms (Stason and Fortess. 2010). The indications of a heart attack include sudden chest pains, dizziness, dyspnea, coughing, nausea, vomiting and restlessness. However, some people, particularly diabetes patients, do not feel any pain while having a heart attack, causing a number of undiagnosed and untreated progressive heart muscle damage (Medical News Today. 2009). Role of imaging and management requirements in diagnosis Patients rushed to the emergency department complaining of acute chest pains are immediately tested with validated algorithms that are intended to improve the decision making by doctors and identified markers of heart attack injury to properly diagnose the illness. Initially, the physicians will review the patient’s medical history concentrating on the symptoms of myocardial infarction, check the duration of the attack and examine the vital signs and status of the cardiovascular before subjecting the patient to imaging tests. The heart muscle will then be scanned with electrocardiogram (ECG). Myocardial infarction can be ruled out through a series of ECG and troponin tests, while acute coronary syndrome (ACS) can be ruled out by modern CT imaging for patients complaining of acute chest pains. The ECG test uses electrical leads to detect electrical signals on the patient’s chest to trace the electrical impulses on the heart muscle. After these processes, a double-blind trial will be conducted to assess the thromboylysis in myocardial infarction (TIMI) score. This data will check the safety levels of efficacy and unfractioned heparin in heart attacks cases. Next, the patient is subjected to a chest x-ray to make sure that the chest pains are not caused by other factors like fracture of the rubs or other malignancies (Lee and Goldman, 2000). After ruling out other causes of chest pains aside from possible myocardial infarction, the patient undergoes myocardial perfusion scintigraphy (MPS), a cardiac imaging tool that uses single photon emission computed tomography to assess the stressed and normal walls of the myocardium. Based on the results of the images gathered, physicians can be guided on the medical management to be set with the patient (Lee and Goldman, 2000). Cardiac radionuclide imaging is also utilized in the diagnosis and management of heart disease. The procedure involves “the diagnosis of coronary artery disease, evaluation of cardiac function abnormalities, verification of the diagnosis of acute myocardial infarction (heart attack), and monitoring of patients under treatment for establishing cardiac disease” (Stason and Fortess. 2010). This new non-invasive diagnostic modality injects a radiopharmaceutical to the coronary artery to and detects radioactivity through a gamma scintillation camera. The use of imaging modalities to emergency patients suffering chest pains “is critical for guiding initial therapy and decisions with regard to admission (Lee and Goldman, 2000). Recorded cases of malpractice in handling heart attack patients include “failure to perform electrocardiography, misinterpretation of an electrocardiogram, and failure to record date from the clinical evaluation.” (Lee and Goldman, 2000). Alarmingly, emergency case patients who are mistakenly discharged immediately have a 25% short term mortality rate. This is the reason why hospital emergency departments must focus on the progress of the efficiency of diagnosing and treating patients with chest pains, especially in handling and assessing imaging tests. Diagnosis and treatment of the disease Heart attack patients undergo a series of tests in order to correctly identify the underlying cause of the disease and the suitable treatment for it. Immediately, the patient will be subjected to a blood test or cardiac enzyme test, chest x-ray, electrocardiogram (ECG) test and andiogram scan (Heart Foundation of Australia. 2012a). Enzymes that entered the bloodstream during the heart attack can be detected through a blood test. Regular monitoring of the patient’s enzyme blood level is necessary to prove the occurrence of the heart attack. Chest x-ray is used to check the heart of any swelling (Medical News Today. 2009). Immediate medical response to heart attack patients is essential for patient survival and recovery. In the first sign of the attack, the patient must be sent to the nearest hospital right away. The treatment during a heart attack is cardio-pulmonary resuscitation (CPR), thrombolytics, painkillers and aspirin. Cases of heart attack patients not breathing or do not responding need CPR, which includes mouth-to-mouth and manual chest compressions and defibrillator. A defibrillator uses electricity to shock the patient’s heart to resume activity. This is the best treatment for cardiac arrest. Thrombolytics and a 300 mg dose of aspirin stop blood clot during the attack. Painkillers, specifically morphine, are administered to patients to reduce the pain and anxiety (Dickstein et al. 2008). After the heart attack, patients are required to take several medications to prevent possible recurrence in the future. Common treatments include taking anti-platelets and aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and statins. A daily dose of 75 mg of aspirin is prescribed to patients in order to lessen the stickiness of the platelets, therefore preventing the build-up of plaques that cause thrombosis. Asthma patients are given clopidogrel instead of aspirin. Beta-blockers, namely metoprolol, atenolol, propranolol and timolol, among others, are given to stabilize the electrical activity of the heart to relax its muscle. Like beta-blockers, ACE inhibitors are drugs that also relax the heart muscle, this time by lowering the blood pressure. Extra care is needed in prescribing these drugs, such as remipril, lisinopril and ramipril, since that may be harmful for the kidneys. Lastly, statins are drugs that lower blood cholesterol levels. Consequently, lowering blood cholesterol levels prevent further development of fatty deposits in the blood vessel. Examples of statins are rosuvastatin, simvastatin, atoravastatin, and fluvastatin (Stason and Fortess. 2010). Depending on the extent of the damage that the heart attack caused, surgery may be performed to the patient. Common surgeries include angioplasty and stent implantation and coronary artery bypass graft (CABG). In coronary angioplasty, the coronary artery is opened using a small wire that will reach the blood clot. The surgeon will then leave a stent or a bendable metal mesh inside to that the artery will stay open. On the other hand, CABG involves the by-passing of the damaged blood vessels with grafts from blood vessels, allowing blood to run through into the heart (Santolucito et al. 2008). Recovering heart attack victims are susceptible of developing arrhythmias or life threatening abnormal heart rhythms. If this occurs, the patient will be given an implantable cardiac defibrillator (ICD), a device to be placed into the chest and connected to the heart, to monitor and control heartbeat (Heart Foundation of Australia. 2012b). Follow up imaging tests are used for patients after a few days of being symptom-free of pain and cardiac abnormality. Patients are subjected to imaging of myocardial perfusion such as electrocardiography; injecting radionuclide tracer while pain occurs; echocardiography, to “detect wall-motion abnormalities consistent with substantial myocardial ischemia”; and coronary angiography for “patients who do not meet criteria for acute myocardial infarction despite suggestive symptioms.” (Lee and Goldman, 2000). Management and complications of the disease As pointed out earlier, many people are not aware that they have cardiovascular diseases until they suffer heart attacks. Hence, patients, especially those who already suffered heart attacks, are advised to properly take the medicines prescribed to them and to change their diet and lifestyle choices into a healthy one. The patients must commit themselves in a physically active lifestyle, avoid smoking, eat healthy food to lessen cholesterol level and control blood pressure, and lose weight. Heart attack patients with other conditions like diabetes must maintain normal blood glucose levels to avoid further complications. In addition, a person who suffered a heart attack is likely to have another one in the future; therefore the patient must be aware of the signs and symptoms of the disease (Haykowsky. 2011). During the first weeks, the patient is advised not to do any strenuous activity until the body gradually recovers. Hospitals usually offer exercise programs for heart attack patients until they recover their strength and continue the exercise routine at home or outside the institution. Depending on the patient’s degree of recovery, the doctor may allow him to go back to work or give the clearance to drive a vehicle again (Castilla and Vazquez. 2011). Some heart attack patients also suffer from depression and erectile dysfunction. The change of mood of patients is unavoidable because of the sudden loss of physical strength or function. Erectile dysfunction or sustaining an erection is common on men after experiencing heart attacks. Patients are prescribed medications like Viagra and Levitra to treat this incapacity (Parikh et al. 2010). Other complications that can occur shortly after a heart attack include arrhythmias or irregular heartbeat, pulmonary oedema or the accumulation of fluid in the lungs, hypoxemia or the drop of blood oxygen levels, cardiogenic shock or the sudden drop of blood pressure, deep vein thrombosis, ventricular aneurysm and myocardial rupture. Still, further complications may happen to the patient long after the heart attack like angina or the chest pains caused by limited oxygen supply to the heart, aneurysm or the build-up of scar tissue on the damaged wall of the heart, oedema or the swelling of the ankles and legs, future heart attacks and congestive heart failure, among others (Medical News Today. 2009). Conclusion In conclusion, heart attack is a serious condition that must be carefully diagnosed and immediately treated. The imaging modalities used today as well as the new innovations being researched at for the diagnosis of this disease are essential in identifying the extent of the damage brought by the infarction in the heart muscle and the possibility of its recurrence. Proper treatment, followed by physical rehabilitation, proper diet and change to a healthier lifestyle will help the patient recover and increase the chance of preventing a second heart attack. Since the underlying cause of heart attack is coronary disease, it is important that patients understand the warning signs and symptoms of the disease as well as its preventive measures. References AIHW. 2012. Australia's Health 2012: In Brief. Australian Bureau of Statistics. 2008. Year Book Australia No. 90. Castilla, C. and Vazquez, C. 2011. Stress-related symptoms and positive emotions after a myocardial infarction: a longitudinal analysis. European Journal of Psychotraumatology. 2:10.3420. Dickstein, K., Cohen-Solal, A., Filippatos, G., McMurray, J., Ponikowski, P., Poole-Wilson, P.A., Stro?mberg, A., van Veldhuisen, D., Atar, D., Hoes, A., Keren, A., Mebazaa, A. Nieminen, M., Priori, S., and Swedberg, K. 2008. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 29 (19): 2388-2442.  Haykowsky, M., Scott, J., Esch, B., Schopflocher, D., Myers, J., Paterson, I. Warburton, D., Jones, L. and Clark, A. 2011. 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