Cardiovascular diseases are the topmost cause of death overall in the world. Cardiovascular disease is a brief suitcase of pathological conditions that all are related to the heart. Each pathological condition has specific terminology to express itself.
In this article, some diseases related to the heart are described to enhance the understanding of readers about it.
1. Myocardial ischemia: what is it?
Myocardial ischemia is the term given to a disease, in which cardiac muscles of the heart don’t get enough oxygen and blood.
Major symptoms of Myocardial Ischemia
The major and most common symptom of ischemia is Angina. Angina pectoris is associated with the feeling of:
- Chest pain
- Burning heart
- Pressure on chest
Angina pectoris is mostly misunderstood with indigestion or acidity problems as all these share the common symptoms of:
- Hurt burn
- Pain in chest
- Pressure on heart
Types of Angina
Angina can be distributed in the following two types:
- Stable angina: It is short term and can easily be relieved by taking rest and medications.
- Unstable angina: It is long term and can happen when an individual is in a state of rest or sleeping. It may not be relieved when you take medications.
Other symptoms of Myocardial Ischemia
Less common symptoms associated with myocardial ischemia include:
- Trouble breathing
- Cold sweating
- Nausea & vomiting
- Pain in upper body parts like arm, shoulder, back, jaw, or stomach
- Irregular heartbeats
- Feeling choking or indigestion
Causes of Myocardial Ischemia
Two major reasons for myocardial ischemia are:
- Coronary artery disease: in which fat and cholesterol become deposited in the artery makes it narrower and reduce the supply of blood to the heart. This reduced supply makes the heart muscle starve for oxygen which results in ischemia and angina.
- Coronary spasm: it is associated with constriction of the coronary artery, resulting in a temporary cut down of blood supply to the heart muscle.
Diagnosis of Myocardial Ischemia
The diagnosis of myocardial ischemia is not so simple. Even after signs and symptoms, the doctor recommends the following physical examination for authentic evidence and correct diagnosis:
- Electrocardiogram: The electrical activity of heart is tested by attaching electrodes to the skin. Changes in the electrical activity of heart mark heart damage.
- Echocardiogram: It is used to determine the damaged area of the heart. Video images are produced by directing sound waves at heart.
- Stress test: It includes the examination of heart rhythms, breathing, and blood pressure while riding a stationary bike or walking on a treadmill.
- Stress echocardiogram: It is similar to a normal echocardiogram, except that this test is conducted after you exercise in a particular area on the treadmill.
- Coronary angiography: This test enables the doctor to have a detailed look inside your blood vessels, by injecting a dye in blood vessels of the heart and by generating a series of X-ray images that indicate the dye path. It helps to detect the exact location of the blockage in the blood vessels of your heart.
- Cardiac C.T scan: CT scanning of the heart enables the detection of calcium accumulation in the coronary artery. It is the major sign of coronary atherosclerosis.
2. Silent ischemia
Myocardial ischemia or even heart attack without any warning sign is termed as silent ischemia. It is most common in diabetic patients but also may happen to any individual with heart disease. This lack of appearance of any sign & symptom increases the motility & morbidity rate of patients, because the patient does not take any medical treatment at the time.
Etiology of Silent Ischemia
There are three further types of silent ischemia & the patient’s classification & treatment are done according to it. These are:
It is the least common type and occurs in the total absence of anginal symptoms. The patient is termed as symptomatic patient. This type of silent ischemia is associated with coronary artery disease (CAD) that may or may not be severe.
This type occurs in patients that are documented previously to have a myocardial infarction.
It is the most common form of silent ischemia. It occurs in patients with history of chronic stable angina, unstable angina & vasospastic angina
3. Myocardial Infarction
Myocardial infarction is generally known as a heart attack. It indicates a disease in which irreversible damage take place to the heart due to secondary, prolonged, and continue ischemia.
Three types of myocardial infarction
Myocardial infarction is not a single pathological disease. It is further subdivided into 3 types that are associated with different situations and symptoms, and therefore need a different type of treatment.
- ST-segment elevation myocardial infarction ( STEMI)
- Non-St segment elevation myocardial infarction (NSTEMI)
- Unstable angina or coronary spasm
The pattern that appears on electrocardiogram and shows heartbeats is termed as ST segments. Both STEMI and NSTEMI are considered as major heart-attack as they can damage the heart that can be observed by irregular ST patterns.
It is considered as a major or classic heart attack in which coronary artery that supplies the blood to the heart is completely blocked. This can be diagnosed very clearly by sharp irregular ST segments on Electrocardiogram during ECG testing. That’s why it is named as ST-elevation myocardial infarction. It is mainly serious and causes life-threatening condition for the patient
It is also categorized under “major heart attack” but it occurs due to the partial blockage of the coronary artery, and therefore doesn’t lead to any abnormal elevations to the ST segment on an electrocardiogram.
Coronary artery blockage is detected by coronary angiography that indicates the location as well as the extent of blockage.
Treatment for myocardial infarction
Myocardial Infarction can be treated by the following methods:
For all types of MI The same medications are prescribed and recommended. For immediate bases your doctor may prescribe the following classes of medications:
- Blood thinners
- Pain killers
- Antihypertensive agents
- Anti cholesterolemia
- Oxygen therapy
Warning: Don’t take any medication without consulting a doctor.
By surgical process
The stent is a small, flexible mesh-work that is inserted in the blocked artery. It removes the blockage by pressing plaque to the side of the vessel wall and maintains the smooth flow of blood.
2. Coronary grafting
It is most commonly known as bypass surgery in which blood vessel from somewhere else in the body is grafted over the blocked artery to remove the blockage and allow the normal flow of blood.
4. Septal Infarct
The septal infarct also called septal infarction is a patch of dead tissues on septum i.e the wall that separates the right ventricle of heart from the left ventricle of the heart.
Its main reason is myocardial infarction and in the majority of cases, it causes permanent damage to the heart. Its symptoms are almost the same as myocardial infarction.
Septal infarct ECG
It is suggested by the source that finding of pathological Q wave in leads V1, B2, and V3 also an electrocardiogram during ECG indicates septal infarct.
The diagnosis of the septal infarct is not as well defined. Usually patient remains unaware of it until he/she is recommended by a doctor to have ECG or discovered during surgery. It is associated with myocardial infarction having the same symptoms so therefore seems difficult to identify and being diagnosed.
Treatment of septal infarct includes medications to lower high blood pressure and cholesterol. Change in lifestyle is mostly recommended by doctors such as:
- Not to take much stress
- Maintaining body weight
- Limit intake of alcohol
- Limit the intake of caffeine
- Limiting sodium intake
- Exercising regularly
- By avoiding tobacco
5. Inferior myocardial infarction
This term refers to the situation when inferior tissues of the heart get damaged by blockage of the right coronary artery due to thrombosis. It is generally called Inferior infarct.
According to a research inferior myocardial infarction accounts for 40 % to 50% of all acute myocardial infarction. It may become more complicated by second and third-degree heart block that can increase the mortality rate of patients. Studies further revealed heart block that is developed during inferior infarction, also mark to increase the size of infarction. Patients with inferior infarction followed by heart block seem to have larger infarction as compared to patients having inferior infarction without heart block.
How to determine infarct size?
Infarct size can be estimated by:
- Enzymes level
- Gated blood pool scan to check ejection from the right and left ventricles.
- Echocardiography to analyze wall motion of right & left ventricles.
Management & treatment
Initial treatment involves
- Reperfusion therapy to stabilizing patients and reducing the symptoms of ischemia including chest pain.
- Percutaneous coronary intervention ( PCI). It is recommended when a patient has a high risk of bleeding.
- Fibrinolytic therapy
While treatment by medications involves:
- Blood thinner
- Platelet aggregation inhibitors
Complications of inferior infarct
Inferior infarct may or may not be followed by some complications that can make this situation more worse like:
6. Anterior infarct
It is also known as anterior ST-segment elevated myocardial infarction (STEMI) or anterior wall myocardial infarction (AWMI).
It occurs when the anterior myocardial tissue suffers from a lack of blood supply due to injury. Anterior descending coronary artery supplies the blood to anterior myocardial tissue. It can also extend to septal and lateral regions and is termed as extensive anterior myocardial infarction.
The major cause of Anterior infarct is coronary artery disease.
ECG findings for acute anterior infarct
The ECG demonstrates that:
- The ST-segment elevation in V3 & V4 at J point or in septal or lateral lead is concave downward that swamps T wave. This is called tombstoning due to its shape similar to a tombstone.
- Reverse or reciprocal St segment depression inferior leads (II, III, and aVF).
Before you leave!
A myocardial infarction which is generally known as a heart attack has also many types and sub-types and is treated & managed accordingly. A brief and deep knowledge is required by medical personnel to do diagnosis and treatment of cardiac disease.
A student of Pharm D from University of Karachi. She has keen interest in all the attributes towards pharmacy especially community pharmacy and hospital pharmacy with an objective to make medications sound and safe. She loves to provide information about Pharmaceutical Analysis and Pharmacology in a best way so people with no medical background can understand.