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Friday, August 21, 2020

Diagnosis and treatment for myocardial infarction


Diagnosis of myocardial infarction

The diagnosis are made by EKG findings physical examination, and biochemical parameters. New regional wall motion abnormalities on an echocardiogram are 'also the cause of an acute myocardial infarction. 


A cardiac stress test (to check the blood flow to the heart muscle) may give an evidence of an old myocardial infarction. It can be avoided in the first 24 hours after an acute myocardial infarction due to the increased arrhythmic risk in the peri-infarct period. 


The general appearance of the patients may vary according to the symptoms; the patient may be uncomfortable, or restless and with an increased respiratory rate. A cool and pale skin is common at a points of vasoconstriction. Some patients have low-grade fever (38-39°C). Blood pressure may be elevated or decreased, and the pulse can be irregular. 


If heart failure increases the jugular venous pressure and hepatojugular reflux causes swelling of the legs due to peripheral edema may be found on inspection. Various abnormalities can be found in third and fourth heart sound, systolic murmurs, paradoxical splitting of the second heart sound.


Treatment-of-a-myocardial-infarction
Myocardial-infarction


 Electrocardiogram:

Electrocardiogram (ECG or EKG) shows elevations of the ST segment and changes in the T waye, In addition, the presence of a new left bundle branch block is also indicative of an acute myocardial infarction. After a myocardial infarction, changes can be seen in Q waves of ECG indicates ischemic heart tissue. 

 

Angiography : 

A catheter is inserted into an coronary artery (usually the femoral artery) and is pushed to the vessels supplying the heart. Obstructed or narrowed arteries can be identified. 


Treatment for myocardial infarction: 

A heart attack due to cardiac arrhythmias, is often a life-threatening. First line treatment is : oxygen, aspirin, glyceryl trinitrate (nitroglycerin) and analgesia (usually morphine) are administered as soon as possible.


Reperfusion :

 In the acute phase of the disease it is necessary to salvage as much myocardium as possible to restore contractile function of heart chambers. This is achieved with thrombolytic drugs, such as streptokinase, urokinase, alteplase (recombinant tissue plasminogen activator, rtPA) and or reteplase. Heparin alone as an anticoagulant is ineffective. Aspirin is a standard therapy for all reperfusion regimens. Emergency coronary artery bypass surgery is another option. 


Monitoring for arrhythmias :

 Is to prevent life-threatening arrhythmias or conduction disturbances. This requires monitoring by antiarrhythmic agents which are given to individuals with life-threatening arrhythmias after a myocardial infarction and not to suppress the ventricular ectopy that is often seen after a myocardial infarction.


 Antiplatelet drug therapy :

 Such as aspirin or clopidogrel should be continued to reduce the risk of thrombus formation. This combination may further reduce risk of cardiovascular events, however the risk of hemorrhage is increased. 

 

Beta blocker therapy :

 such as metoprolol or carvedilol are given.B -Blockers decrease mortality and morbidity. They also improve symptoms of cardiac ischemia. 


ACE inhibitor therapy :

 are given with in 24-48 hours post-MI in hemodynamically-stable patients with a history of MI, diabetes mellitus, hypertension, anterior location of infarct, tachycardia, and evidence of left ventricular dysfunction. ACE inhibitors reduce mortality. development of heart failure, and decrease ventricular arrhythemia during post-MI.


 Statin therapy :

Statin therapy has been shown to reduce mortality and morbidity during post-MI, irrespective of the patient's cholesterol level.

 

 The aldosterone antagonist agent : 

Eplerenone has been shown to further reduce the risk of cardiovascular death during post-MI in patients with heart failure and left ventricular dysfunction, when used in conjunction with standard therapies.


Myocardial-infarction definition and pathophysiology

4 comments:

Neelesh garhewal said...

Sir plz provide us jurisprudence subject notes thankyou

Neelesh garhewal said...

Plz sir provide me jurisprudence subject notes. Thankyou

manoj sahu said...

Ok

manoj sahu said...

Pharmaceutical jurisprudence
https://www.srupharma.online/2020/08/Jurisprudence.html

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