[ Physical Illness ]

* Illness of Heart & Vein *
Myocardial Infarction

Angina is a condition in which the coronary arteries that supply blood to the heart itself become narrowed or clogged, causing insufficient blood to flow to the muscles and heart muscles that work the heart.

Myocardial infarction is a condition in which this condition of angina is exacerbated and the flow of blood that sends oxygen and nutrients to the heart muscle is completely stopped. Due to the lack of oxygen and nutrients, the cells become necrotic and cause very intense paroxysmal pain.

The direct cause of myocardial infarction is that significant arteriosclerosis of the coronary arteries and blood clots (thrombus) completely block the coronary arteries.

The cause of arteriosclerosis is certainly the effect of aging, but the most important cause is improper lifestyle.

According to 2020 US death statistics, heart disease was the most deadly and cancer was the second. In addition, the death toll from the new coronavirus infection is the third highest. Unfortunately, the ranking of the number of deaths by disease name among heart diseases is unknown.

  Cause of death / number of deaths
1. Heart disease / 690882
2. Cancer / 598932
3. COVID-19 infection / 345323
4. Injured in an accident /192176
5. Stroke / 159050
6. Chronic respiratory disease / 151637
7. Alzheimer's disease /133382
8. Diabetes / 101106

[ A disease called Myocardial Infarction ]

What kind of illness is it?

Since the heart itself is an important organ, it needs oxygen and nutrients like other organs. The heart muscle that functions the heart has blood vessels that supply oxygen and nutrients, which are called coronary arteries.

Diseases that have problems with the coronary arteries and do not provide enough oxygen and nutrients are called ischemic heart disease. If the condition of insufficient blood flow is not severe and it is performing its minimum function, It is called angina.

However, when ischemic heart disease becomes severe, blood vessels and myocardium become necrotic, and this condition is called myocardial infarction.

An angina pectoris attack, which is a precursor to myocardial infarction, puts a sudden or excessive burden on the heart when a person with arteriosclerosis in the coronary arteries receives sudden exercise, strong stress, or bathing in a hot bath. It happens when you do.

It starts with a mild pain in the heart, then becomes a tightening pain, and you may feel a strong sense of oppression. The pain and oppression disappear within 10 seconds if it is mild, and within 15 minutes at the longest. It does not exceed 30 minutes even in the worst of times.

An angina attack alone is not directly life-threatening, but repeated angina symptoms can lead to myocardial infarction, necrosis of cells and an extremely dangerous condition.

[ Symptom of Myocardial Infarction ]

Typical symptoms

Myocardial infarction causes severe pain that causes a seizure in the center of the precordium and the heart. The pain is much stronger than angina, persistent and lasts tens of minutes to hours.

In addition to cold sweat and pallor of the face, symptoms such as arrhythmia, dyspnea, swelling, and fever appear as symptoms of cardiac dysfunction. Once the condition has subsided, it is not uncommon for another seizure to occur within a month or two.

An angina attack, which is a precursor to myocardial infarction, can last up to 15 minutes. However, if the pain persists, the risk of causing myocardial infarction or ventricular fibrillation is extremely high, not just angina.

In particular, if you have symptoms such as severe headache, palpitation or arrhythmia, dyspnea, or vomiting, your life is imminent and you should urgently call an ambulance to go to the hospital.

[ Cause of Myocardial Infarction ]

Typical Causes

The direct cause of myocardial infarction is coronary atherosclerosis, which can be triggered by risk factors such as hyperglycemia, hyperlipidemia, families with such individuals, and special personalities.

A person with a special personality is a type of person who is confident, well-mannered, enthusiastic about work, hates to lose, has a strong desire for success and control, and is easily frustrated and angry. People who are constantly exposed to intense stress and tension, and people who are addicted to alcohol and tobacco are also dangerous.

Arteriosclerosis progresses with aging, but it is more likely to occur when bad lifestyle habits such as an unbalanced diet or lack of exercise continue for a long time. A porridge-like substance called atheroma is deposited in the blood vessels, narrowing the inner wall of the blood vessels and promoting arteriosclerosis.

As arteriosclerosis progresses, the surface membrane of the atheroma breaks and blood clots form there. When this blood clot completely blocks the blood vessels in the heart, it causes a myocardial infarction.

Risk factors that promote arteriosclerosis include hypertension, hyperlipidemia, diabetes, as well as diseases such as obesity, lack of exercise, and renal failure. Also, intense stress and smoking habits can trigger a stroke of myocardial infarction.

[ Diagnosis of Myocardial Infarction ]

How to diagnose Myocardial Infarction

There are two types of heart disease tests: general tests that are performed in daily preventive medical examinations, and urgent tests that are performed due to the occurrence of seizures.

The tests themselves include non-invasive tests that do not pierce the body directly with a needle or insert a tube, and invasive tests that pierce the body with a needle or insert a tube. A non-invasive test is usually performed, and if any abnormality is found, an invasive test is also performed.

When testing for heart disease, a doctor will first ask you a question or auscultate. Blood pressure is measured because high blood pressure is one of the causes of heart disease.

It is data for knowing the current state of the heart and determining the effect of drugs such as antihypertensive drugs. If any of these are abnormal, proceed to electrocardiography.

In electrocardiography, three waveforms, P wave, QRS complex, and T wave, are measured. The P wave indicates the electrical excitement of the atrium, and the QRS complex indicates the electrical excitement of the ventricle. The T wave is the waveform when the electrical excitement of the ventricles is restored.

When there is something wrong with the heart, a waveform peculiar to the abnormality appears, so a doctor can judge the heart disease and its progress by looking at the electrocardiogram.

For the diagnosis of ischemic heart disease such as angina, a measurement called exercise electrocardiography is performed while exercising the prescribed exercise and putting a burden on the heart. Measure the electrocardiogram while doing a light exercise like walking on a conveyor belt.

Even with angina, which has not led to myocardial infarction, there seems to be no special change in electrocardiogram measurement in a quiet state without chest pain, but in exercise electrocardiogram, a pattern peculiar to angina appears. Therefore, you can make a correct diagnosis of angina.

The heart disease tests that can be performed at ordinary clinics are as described above, but in addition to these, echocardiography (echocardiography), chest X-ray examination, cardiac catheterization, coronary angiography, and cardiovascular medicine There are methods such as inspection, CT, and MRI measurement. Multiple of these tests may be done, such as in the event of a real myocardial infarction attack.

[ Treatment of Myocardial Infarction ]

Treatment policy for myocardial infarction

In the preventive sense of ischemic heart disease (angina, myocardial infarction), try to have a modest daily life, avoid overeating and drinking too much, eat a well-balanced diet, quit, and exercise moderately. Also, it is necessary to get enough rest and sleep.

However, if a stroke or symptom of myocardial infarction occurs, appropriate treatment is urgently needed. Treatment methods include "pharmacotherapy", "catheter treatment" and "surgery" depending on the symptoms and stage.

If you have a stroke that seems to be myocardial infarction or angina, do not hesitate to call an ambulance and have it taken to an emergency hospital with a CCU (equipment equipped with centralized monitoring and treatment of coronary artery disease) for treatment is important. The sooner the lifesaving rate increases.

Drug therapy

As drug therapy, the following drugs are used according to the symptoms.

• Vasodilators that dilate blood vessels to improve blood flow
• Antihypertensive drug that lowers blood pressure and reduces the burden on the heart
• Antiplatelet agent that lowers blood viscosity and makes blood smooth
• A diuretic that reduces the burden on the heart by producing a large amount of urine
• Cardiac stimulant that strengthens the work of the heart itself
• Antiarrhythmic agent that normalizes pulse disorder

Treatment with catheter

The treatment method using a catheter is to insert a small balloon with a diameter of 2 to 4 mm and a length of about 20 mm inside the lesion of the damaged and narrowed coronary artery, which is the direct cause of angina pectoris and myocardial infarction, and inflate the coronary artery. It is a method of expanding from the inside.

This catheter method is applicable to relatively mildly ill patients. After expanding the blood vessels, the balloons are contracted and removed. Another method is to insert a small tubular wire mesh called a stent inside the blood vessel to inflate it and leave it as it is.

Surgery

More severely ill patients require extensive surgical treatment called coronary bypass surgery. In this method, another blood vessel is connected to the end of a narrowed blood vessel or an occluded lesion to create a blood bypass path that improves blood flow.

Previously, this surgery was performed with a heart-lung machine that completely stopped the heart, but recent advances in medicine have made it possible to perform surgery without stopping the heart. However, in any case, there is no difference in surgery that requires extremely advanced equipment and techniques.