Myocardial infarction

A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops in the coronary artery of the heart, causing damage to the heart muscle.[1] The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw.[1] Often it occurs in the center or left side of the chest and lasts for more than a few minutes.[1] The discomfort may occasionally feel like heartburn.[1] Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat or feeling tired.[1] About 30% of people have atypical symptoms.[8] Women more often present without chest pain and instead have neck pain, arm pain or feel tired.[11] Among those over 75 years old, about 5% have had an MI with little or no history of symptoms.[12] An MI may cause heart failure, an irregular heartbeat, cardiogenic shock or cardiac arrest.[3][4]

Myocardial infarction
Other namesAcute myocardial infarction (AMI), heart attack
A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, causing catastrophic thrombus formation, totally occluding the artery and preventing blood flow downstream.
SpecialtyCardiology, emergency medicine
SymptomsChest pain, shortness of breath, nausea, feeling faint, cold sweat, feeling tired; arm, neck, back, jaw, or stomach pain[1][2]
ComplicationsHeart failure, irregular heartbeat, cardiogenic shock, cardiac arrest[3][4]
CausesUsually coronary artery disease[3]
Risk factorsHigh blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol[5][6]
Diagnostic methodElectrocardiograms (ECGs), blood tests, coronary angiography[7]
TreatmentPercutaneous coronary intervention, thrombolysis[8]
Medication[[]], nitroglycerin, heparin[8][9]
PrognosisSTEMI 10% risk of death (developed world)[8]
Frequency15.9 million (2015)[10]

Most MIs occur due to coronary artery disease.[3] Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet and excessive alcohol intake.[5][6] The complete blockage of a coronary artery caused by a rupture of an atherosclerotic plaque is usually the underlying mechanism of an MI.[3] MIs are less commonly caused by coronary artery spasms, which may be due to cocaine, significant emotional stress (commonly known as Takotsubo syndrome or broken heart syndrome) and extreme cold, among others.[13][14] A number of tests are useful to help with diagnosis, including electrocardiograms (ECGs), blood tests and coronary angiography.[7] An ECG, which is a recording of the heart's electrical activity, may confirm an ST elevation MI (STEMI), if ST elevation is present.[8][15] Commonly used blood tests include troponin and less often creatine kinase MB.[7]

Treatment of an MI is time-critical.[16] Aspirin is an appropriate immediate treatment for a suspected MI.[9] Nitroglycerin or opioids may be used to help with chest pain; however, they do not improve overall outcomes.[8][9] Supplemental oxygen is recommended in those with low oxygen levels or shortness of breath.[9] In a STEMI, treatments attempt to restore blood flow to the heart and include percutaneous coronary intervention (PCI), where the arteries are pushed open and may be stented, or thrombolysis, where the blockage is removed using medications.[8] People who have a non-ST elevation myocardial infarction (NSTEMI) are often managed with the blood thinner heparin, with the additional use of PCI in those at high risk.[9] In people with blockages of multiple coronary arteries and diabetes, coronary artery bypass surgery (CABG) may be recommended rather than angioplasty.[17] After an MI, lifestyle modifications, along with long-term treatment with aspirin, beta blockers and statins, are typically recommended.[8]

Worldwide, about 15.9 million myocardial infarctions occurred in 2015.[10] More than 3 million people had an ST elevation MI, and more than 4 million had an NSTEMI.[18] STEMIs occur about twice as often in men as women.[19] About one million people have an MI each year in the United States.[3] In the developed world, the risk of death in those who have had an STEMI is about 10%.[8] Rates of MI for a given age have decreased globally between 1990 and 2010.[20] In 2011, an MI was one of the top five most expensive conditions during inpatient hospitalizations in the US, with a cost of about $11.5 billion for 612,000 hospital stays.[21]

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