Transcript Group 50_Myocardial infarction_Pecha kuchax

MYOCARDIAL
INFARCTION
Byron Rudman
14019991
Brandon Wright
14015570
Brenton Lotz
14008442
Emilio Guerro
13140346
Kyle Rorke
13415591
MYOCARDIAL
INFARCTION
Definition: Myocardial Infarction occurs when
the heart is subject to prolonged exposure to
ischemia, resulting in irreversible necrosis of the
myocardium.1
FIXED RISK FACTORS 2
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Age
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Gender
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Family history
MODIFIABLE RISK FACTORS 2
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Hypertension
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Smoking
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Abnormal lipids
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Diabetes
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Lack of physical exercise
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Obesity (especially central obesity)
EMERGING RISK FACTORS 2
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Chronic kidney disease
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Depression/stress
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Constant low-grade systemic inflammation2
DIAGNOSIS 2
Diagnosis requirements:
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Elevated or depressed troponin levels (and one of the following)
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ECG changes
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Signs and symptoms of Myocardial Infarction
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Imagery evidence (eg. Angiogram, CT)
SIGNS 2
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Angina – typical chest pain. Either at rest or with effort.
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Dyspnoea
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Nausea
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Levine's sign – constricting chest pain
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Dizziness
TREATMENT 2
1.
Mortality reduction therapy:
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Aspirin 325mg
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P2Y12 Inhibitor: clopidogrel or ticagrelor
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Low molecular weight heparin
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High dose statins
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Beta-blockers/ACE-I
TREATMENT 2
2.
Symptomatic Relief
3.
Open Artery Policy
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Thrombolytic drug
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Percutaneous coronary intervention (PCI) (eg. Stent)
4.
Treat Cardiovascular Disease Risk Factors
PATHOLOGICAL TYPES 2,3
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Transmural Myocardial Infarction
Associated with atherosclerosis involving a major coronary artery. This
extends through the thickness of the entire heart muscle.
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Subendocardial Myocardial Infarction
Involves a small area in the sub endocardial wall
CLASSIFICATION 2
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Type 1: Spontaneous MI due to a primary coronary event. Eg.
Plaque.
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Type 2: MI secondary to ischemia caused by increased 02
demand or decreased supply.
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Type 3: Sudden, unexpected cardiac death.
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Type 4: Associated with coronary angioplasty or stents
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Type 5: Associated with Coronary Artery Bypass Graft
MORTALITY 4
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130 heart attacks occur every day in South Africa.
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Of these people 33 die a day.
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5 people have a heart attack in South Africa every hour.
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For every woman that dies of a heart attack 2 men die.
MORBIDITY 1
Short Term
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Cardiac arrest – this accounts for the majority of acute deaths and is
caused primarily by ventricular fibrillation.
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Congestive heart failure – this is due to a large MI involving more than
25% of the cardiac muscle.
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Cardiogenic shock – this occurs when more than 40% of myocardium is
damaged.
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Rupture – an opening formed in the myocardium which leads to
tamponade and death.
MORBIDITY 1
Long Term
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Heart failure – coronary artery disease is the most common cause of
congestive heart failure.
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Sudden cardiac death – due to ventricular arrhythmias.
WHO? 5,6
According to the American Heart Association
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Globally males generally have a higher prevalence than
females.
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The prevalence of myocardial infarction in black people is the
highest.
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The prevalence in black males higher than black females.
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The prevalence in black females is even higher than the
prevalence in males of other races.
WHO? 5,6
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65,2% of all men that suffer from Myocardial Infarctions are
between the ages of 55 and 75.
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51,1% of all women that suffer from Myocardial Infarctions are
between the ages of 55 and 75.
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75% of cardiovascular events occur in 5-10% of people that have
had previous events.
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Individuals who have had a heart attack are 55% more likely to
be suffering from depression than those who have not.
WHEN? 1,6
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Between the ages of 20 and 39 the risk is the same for males and
females.
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After the age of 40 males have roughly double the risk
compared to females.
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After the age of 40 the prevalence of myocardial infarction in
females more than doubles every 20 years.
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After the age of 40 the prevalence in males continues to
increase rapidly every 20 years.
WHERE? 3
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Myocardial Infarctions are one of the leading causes of disease
in developing countries.
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Three quarters of deaths due to CHD, for example MI’s, occurred
in low and middle income countries
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The cardiovascular disease burden in developing countries is
due to the increase in the prevalence of risk factors and the lack
of access to certain interventions.
CONCLUSION
Based on the extremely high number of cases of myocardial
infarctions and deaths related to myocardial infarctions seen daily
in South Africa, we can conclude that MI’s pose a significant threat
to the general health of all South Africans. In order to confront this
problem, steps need to be taken to both increase public
awareness as well as decrease the prevalence of risk factors within
our country.
REFERENCES
1.
AM Zafari [Internet]. Myocardial Infarction. New York. Medscape; [updated 2015 Sep 15; cited
2016 Jan 26]. Available from: http://emedicine.medscape.com/article/155919-overview
2.
Prof Kerr. Cardiology [unpublished lecture notes]. University of Pretoria; notes provided at lectures
2016 January.
3.
Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing Epidemic of Coronary
Heart Disease in Low- and Middle-Income Countries. Curr Probl Cardiol. 2010 Feb; 35(2): 72–115.
4.
The Heart and Stroke Foundation South Africa [Internet]. Global action needs to be taken on the
‘silent killer’. The Heart and Stroke Foundation South Africa. South Africa. [updated 2015; cited 2016
Jan 26]. Available from: http://www.heartfoundation.co.za/media-releases/global-action-needsbe-taken-%E2%80%98silent-killer%E2%80%99#sthash.7zYNoWc1.dpuf
5.
Stringhini S1, Sinon F, Didon J, Gedeon J, Paccaud F, Bovet P. Declining Stroke and Myocardial
Infarction Mortality Between 1989 and 2010 in the African Region. Stroke. 2012 Sep;43(9):2283-8
6.
Steyn K. Heart Disease in South Africa Media Data Document. MRC South Africa. 2007 July.