MYOCARDIAL INFARCTION

death of a section of the myocardium, the muscle of the heart, caused by an interruption of the blood flow to the area. Commonly referred to as a heart attack, a myocardial infarction results from constriction or obstruction in the coronary arteries. The most common cause is a blood clot (thrombotic occlusion) that lodges in an area of an atherosclerotic coronary artery, thickened with cholesterol-containing plaque. Factors that contribute to the risk of myocardial infarction include high blood pressure, diabetes mellitus, hypercholesterolemia (i.e., increased concentrations of low-density lipoprotein cholesterol or decreased concentrations of high-density lipoprotein cholesterol in the blood), cigarette smoking, and a history of coronary artery disease. Typically a person experiencing a myocardial infarction has severe chest pain, described as crushing, squeezing, or heavy, that is unremitting for 30 to 60 minutes and sometimes is experienced for longer periods. It often radiates to the arms, neck, and back. The pain is similar to that of angina pectoris (q.v.), but it is of longer duration and cannot be relieved by nitroglycerin. Other common symptoms include shortness of breath; sweating; nausea; rapid heartbeat, often complicated by one or more arrhythmias (irregular heartbeats); reduced blood pressure; and a sense of impending doom. The intensity of the symptoms depends on the size of the area of muscle affected by the infarction. A minority of individuals do not experience pain; in these cases myocardial infarction may be diagnosed from a routine electrocardiogram (ECG). The focus of treatment is to limit the size of the area of tissue lost from lack of blood (the infarct) and to prevent and treat complications. As many as 20 percent of individuals with myocardial infarction die before they reach the hospital; most of these deaths are attributed to ventricular arrhythmia, also called fibrillation. Thus, the sooner the heart rate can be monitored by the ECG and the more promptly the arrhythmia is reversed by defibrillation with either antiarrhythmic drugs or electrical shock, the greater is the chance of survival. Pain is treated with narcotics such as morphine, and rest and sedation are required. New therapies such as beta-adrenergic blockers help alleviate pain and lower the heart rate. Coronary thrombolysis therapy is widely used; it involves the administration of drugs such as streptokinase or tissue plasminogen activator to prevent further blood clots from forming. Angioplasty or coronary artery bypass grafting are additional measures for patients requiring further treatment. The prognosis for patients who survive the first month is good; most are gradually able to resume normal activity.