Myocardial Infarction – Early recognition for effective treatment

The article was professionally consulted by Prof. TS.BS Vo Thanh Nhan - Director of Cardiovascular Center, Vinmec Central Park International General Hospital.

Myocardial infarction is a common cardiovascular disease in both developed and developing countries such as in Vietnam. Although the death rate from myocardial infarction has decreased compared to the past thanks to advances in diagnosis and treatment, the consequences and complications after myocardial infarction are still a matter of concern. Let's find out with the doctors what a heart attack is and how to best manage it.

The heart is an organ that pumps blood to the body. The heart is supplied by two main blood vessels, the right coronary artery and the left coronary artery.
Myocardial infarction occurs when there is a sudden complete or partial occlusion of one of these two blood vessels or both. If an area of ​​the heart muscle dies due to ischemia, then the heart's pumping function is no longer as complete as before, causing consequences such as heart failure, cardiogenic shock, sudden cardiac death,...

The most common cause of myocardial infarction is atherosclerosis. This condition occurs because atherosclerotic plaque accumulates over time and adheres to the walls of blood vessels, the composition includes cholesterol, calcium, cell debris.
From about 30 years old, the patient's body begins the process of forming and developing atheroma. This process takes place from several years to several decades.
In subjects with a number of risk factors such as hypertension, smoking, dyslipidemia, diabetes that contribute to vascular damage over time. It is these disorders that make the walls of blood vessels more susceptible to cholesterol molecules to be deposited and adhered to.

Where atherosclerotic plaque attaches to the inflamed vessel wall, at some point this plaque is peeled and broken, promoting the formation of a blood clot that blocks the blood vessel lumen. When the lumen is blocked, the posterior myocardium is not supplied with blood, resulting in necrosis and death of the myocardium, causing myocardial infarction.

Hypertension . Diabetes. Stroke . History of myocardial infarction, family history of premature coronary artery disease (male before 55 years old, female before 65 years old). Chronic kidney disease or a history of autoimmune disease. History of preeclampsia or gestational diabetes. Dyslipidemia: Increased cholesterol, increased blood triglycerides. Elderly, over 40 years old. Overweight, obese BMI ≥23. Smoke. People who are sedentary.

Thrill, palpitations. Chest pain. The degree can range from as little as a heavy, burning sensation in the left chest to as much as a sharp, stabbing, stabbing pain. Pain may radiate to the neck, lower jaw, left shoulder, back, abdomen, or left arm. Pain lasts more than 20 minutes.

Shortness of breath. Sweating. Dizziness. Nausea, vomiting. Low blood pressure or high blood pressure. Cold, wet hands and feet. Excitement, anxiety, panic. Faint. Sudden death. In others, they do not experience the symptoms described above, but feel only mild fatigue or only discomfort in the epigastrium.

When a patient arrives at the hospital with the symptoms described above along with other symptoms noted during the examination, the doctors will conduct a number of specialized tests to assist in the diagnosis of the disease:
Routine electrocardiogram. Stress electrocardiogram. 4D echocardiography. Stress echocardiography. Blood tests look for signs of myocardial necrosis such as Troponin I, Troponin T. CT coronary artery. Coronary angiography using DSA.

Coronary artery disease must be detected early, so when a customer has cardiovascular risk factors and has the above symptoms, they must go to the doctor and have a cardiovascular screening as soon as possible
Supportive treatment If the patient has hypoxia The blood will be assisted with oxygen breathing.
Used chest pain relievers.
Used some drugs to control heart rate, or drugs that contribute to good heart contraction later.
Primary treatment Coronary interventional intervention (PCI): This is a procedure performed by interventional cardiologists. During the procedure the patient remains awake and can watch the procedure progress on the video monitor. The doctor will inject local anesthetic at the patient's thigh or wrist. The catheter system is threaded at the thigh or wrist along the blood vessel toward the heart. Based on the images obtained on the screen, the doctors found the location of the blockage and placed a stent (catheter) into the blocked blood vessel. The stent inflates to help normal blood circulation.

Coronary bypass surgery (CABG): The patient was anesthetized and the surgery was carried out in the operating room at the Department of Cardiac Surgery. Vascular segments taken from other places in the body are used to bridge the anterior and posterior occlusion, allowing blood to follow the graft to feed the underlying heart muscle. The removed blood vessel is only a very small part of the rich vascular system of the body, so it will not affect the functioning of these organs.

Patients should learn more about the cause of the disease to have the best prevention for themselves and their families.
The role of a heart attack diet and exercise in the prevention of atherosclerotic cardiovascular disease has been proven effective. Healthy eating habits and regular exercise will reduce the incidence of many coronary heart disease risk factors. For patients who have had optimal lifestyle changes but still cannot control their risk factors, they should adhere to the treatment prescribed by specialists. Quit smoking. Reduce alcohol. Lose weight, maintain BMI below 23 kg/m2. In short, myocardial infarction is a dangerous disease that can lead to death. If diagnosed early, it will help save the life of the ischemic heart muscle in time, and at the same time limit life-threatening complications and long-term complications later. Therefore, seek the help of a doctor as soon as there are pathological signs to receive the best treatment for a heart attack.