Heart attack

Heart attack : Myocardial Infarction

Dato’Dr.G.SelvarajuDIMP; JSD; AMP;

MBBS; ,MRCP(UK); AM (Mal); FIAMISConsultant Physician in Internal Medicine & Gastroenterologist

Clinical Specialist Geriatric Medicine

11/04/2023 2

What is Heart attack?

Heart attack -- a sudden interruption in the heart's blood supply. This happens when there is a blockage in the coronary arteries, the vessels that carry blood to the heart muscle. When blood flow is blocked, heart muscle can be damaged very quickly and die. Prompt emergency treatments have reduced the number of deaths from heart attacks in recent years

Dato'Dr G.Selvaraju

11/04/2023 Dato'Dr G.Selvaraju 3

Heart attack symptoms

A heart attack is an emergency even when symptoms are mild. Warning signs include:-Pain or pressure in the chest-Discomfort spreading to the back, jaw, throat, or arm-Nausea, indigestion, or heartburn-Weakness, anxiety, or shortness of breath-Rapid or irregular heartbeats


Heart attack symptoms in women

Women don't always feel chest pain with a heart attack. Women are more likely than men to have heartburn, loss of appetite, tiredness or weakness, coughing, and heart flutters. These symptoms should not be ignored. The longer you postpone treatment, the more damage the heart may sustain.


What happens in a Heart attack ?

In more than 90% of the patients with acute MI an acute thrombus often associated with plaque rupture occludes the artery (previously partially obstructed by an atherosclerotic plaque) that supplies the damaged area


Coronary Arteries


Coronary Atherosclerosis

Dato'Dr G.Selvaraju 8

Coronary Artery Disease

11/04/2023


Signs of Coronary Artery Disease

A precursor to a heart attack, coronary artery disease or CAD occurs when sticky plaque builds up inside the coronary arteries. This narrows the arteries, making it more difficult for blood to flow through. Many people don't know they have CAD until a heart attack strikes. But there are warning signs, such as recurring chest pain caused by the restricted blood flow. This pain is known as angina.


Inside a heart attack

The plaque deposited in your arteries is hard on the outside and soft and mushy on the inside. Sometimes the hard outer shell cracks. When this happens, a blood clot forms around the plaque. If the clot completely blocks the artery, it cuts off the blood supply to a portion of the heart. Without immediate treatment, that part of the heart muscle could be damaged or destroyed.


Don’t wait to be sure ….

The best time to treat a heart attack is as soon as symptoms begin. Waiting to be sure can result in permanent heart damage or even death. If you think you may be having a heart attack, call for an ambulance. And don't try driving yourself to the hospital.


Tests for Coronary Heart Disease


Test to detect Coronary block


What is CT Angiogram? • A computerized tomography (CT) coronary angiogram is an

imaging test to look at the arteries that supply your heart muscle with blood.

• Unlike a traditional coronary angiogram, CT angiograms don't use a catheter threaded through your blood vessels to your heart. Instead, a coronary CT angiogram relies on a powerful X-ray machine to produce images of your heart and heart vessels.

• CT angiograms don't require the recovery time needed with traditional angiograms.

• Coronary CT angiograms are becoming a common option for people with a variety of heart conditions.

• CT angiograms will expose you to a small amount of radiation


Who should get CT Coronary Angiogram?

• In patients at high risk for developing coronary disease (cigarette smokers, those with genetic risk, high cholesterol levels, hypertension, or diabetes),

• who have unclear results with treadmill or other testing, or who have symptoms suspicious of coronary disease,

• CT angiography is an excellent next step in the diagnosis. If the CT scan is normal or only mildly abnormal, it makes the likelihood of a severe blockage of the coronary arteries extraordinarily small.

• Conversely, if the CT scan is significantly abnormal, cardiac catheterization and angiography are then indicated, to see if angioplasty, stenting, or coronary bypass surgery may be indicated.

• In people who have had bypass surgery, CT angiography is very effective at evaluating the patency of the bypass grafts.

• In people who have had coronary stents , it is sometimes difficult to image the inside of the stent to see if it is narrowed.

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How is it done?

• This procedure use intravenous dye which contains iodine and CT scanning to image the coronary arteries. While the use of catheters is not necessary (thus the term "noninvasive" test applies to this procedure), there are still some risks involved




What are the risks? • In people allergic to iodine, pre-treatment with medications is

necessary to prevent allergic reactions to the dye.• In people with abnormal kidney function and/or diabetes, the

dye may worsen kidney function. • Finally, there is radiation exposure which is similar to, if not

greater than, that received with a conventional coronary angiogram.

• Nonetheless, this is generally a very safe test for most people, but should only be undergone when ordered by a physician familiar with the patient and their underlying medical condition.

• Special care is needed for people with history of Bronchial Asthma



To see positive as positive is easy;To see negative as positive is Coronary CT Angiogram


Normal Heart

External appearance Angiogram


CT images -1


CT images -2


CT images -3


CT images -4


Risk Factors – age & sex

Men have a higher risk of having a heart attack than women, and at an earlier age. But it's important to note that heart disease is the No. 1 killer of women, too. People with a family history of heart ailments also have a higher risk of heart trouble.


Risk Factors –high BP & cholesterol

High cholesterol and high blood pressure are major risk factors for heart disease. Being overweight, obese, or physically inactive all increase your risk. So does diabetes, especially if your glucose levels are not well controlled. Discuss your risks with your doctor and develop a strategy for managing them. There are many steps you can take to protect your heart.


Risk Factors – Smoking

If you smoke, your risk of heart disease is 2 to 4 times greater than a non-smoker's. And if you smoke around loved ones, you're increasing their risk with second hand smoke.. But it's never too late to quit. Within 24 hours of quitting, your heart attack risk begins to fall.


Major Reversible Risk Factors

• Abnormal serum lipid levels – High LDL ; low HDL

• HTN • Cigarette smoking including passive smoking• DM ( Tri)• Obesity ( Tri)• Physical inactivity


Prevention of heart diseases – the ABCs• Attitude • Blood Pressure control• Cholesterol control• Diabetes control : Self Care • Exercise• Food : healthy food • Games : for body & mind• Healthy Life style &• Quit smoking


Heart disease prevention- Fitness

The key to preventing heart disease is a healthy lifestyle. This includes a nutritious diet, at least 30 minutes of exercise most days of the week, not smoking, and controlling high blood pressure, cholesterol, and diabetes. If you drink alcohol, do so in moderation -- no more than one drink a day for women, two drinks a day for men. Ask your friends and family for help in making these changes. They'll benefit, too.


Heart disease prevention – diet

What you eat makes a difference. Be sure you get plenty of whole grains, vegetables, legumes, and fruits to help keep your heart healthy. Plant oils, walnuts, other nuts, and seeds can also help improve cholesterol levels. And don't forget to eat fish at least a couple of times each week for a good source of heart-healthy protein.


Health & Medicine

Heart attack