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Myocardial Infarction – Causes, Symptoms & Treatment
A myocardial infarction is a life-threatening event in which heart muscle tissue dies due to a blocked blood supply. Immediate treatment is essential to save lives.
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A myocardial infarction is a life-threatening event in which heart muscle tissue dies due to a blocked blood supply. Immediate treatment is essential to save lives.
What is a Myocardial Infarction?
A myocardial infarction (commonly known as a heart attack) is a medical emergency in which part of the heart muscle (myocardium) is permanently damaged or dies due to an interrupted or severely reduced blood supply. Without oxygen, heart muscle tissue begins to die within minutes. Myocardial infarction is one of the leading causes of death worldwide and remains one of the most dangerous cardiovascular events a person can experience.
Causes
In the vast majority of cases, a myocardial infarction is caused by a complete blockage of one of the coronary arteries that supply the heart with blood. This blockage typically develops through:
- Atherosclerosis: Over many years, fatty deposits, calcium, and inflammatory cells build up inside the coronary arteries, forming plaques that narrow the vessel.
- Plaque rupture and thrombosis: When an atherosclerotic plaque tears or ruptures, a blood clot (thrombus) forms at the site and can completely block the artery.
- Coronary artery spasm: In rare cases, a sudden spasm of a coronary artery can restrict or cut off blood flow.
Key risk factors for myocardial infarction include:
- High blood pressure (hypertension)
- Elevated blood cholesterol (hypercholesterolaemia)
- Diabetes mellitus
- Smoking
- Physical inactivity and obesity
- Family history and genetic predisposition
- Chronic stress and psychosocial factors
Symptoms
Symptoms of a myocardial infarction can vary widely between individuals. Classic warning signs include:
- Severe, persistent chest pain (often described as pressure, tightness, or squeezing) lasting more than 15 minutes
- Pain radiating to the left arm, jaw, back, neck, or upper abdomen
- Shortness of breath and difficulty breathing
- Profuse sweating, dizziness, and nausea
- Feeling of intense anxiety or impending doom
- Pale or grey skin and cold sweats
In women, older adults, and people with diabetes, heart attacks may present atypically, with less pronounced chest pain or even no chest pain at all (a so-called silent heart attack).
Diagnosis
Diagnosis is confirmed through a combination of tests:
- ECG (Electrocardiogram): Detects characteristic changes such as ST-segment elevation (STEMI) or depression (NSTEMI).
- Cardiac biomarkers: Elevated blood levels of Troponin I and T and CK-MB confirm heart muscle damage.
- Echocardiography: Ultrasound imaging of the heart to assess cardiac function and identify areas of impaired wall motion.
- Coronary angiography: Imaging of the coronary arteries to precisely locate the blockage.
Treatment
In myocardial infarction, the principle is: time is muscle. The faster treatment is initiated, the more heart muscle tissue can be saved.
Immediate Measures
- Call emergency services immediately (e.g. 911 or 112)
- Position the patient semi-reclined, keep calm, and loosen tight clothing
- In the event of cardiac arrest: begin cardiopulmonary resuscitation (CPR) immediately
Drug Therapy
- Aspirin (acetylsalicylic acid): Inhibits platelet aggregation and prevents further clot growth.
- Heparin: Anticoagulant therapy to prevent further thrombosis.
- Thrombolytics: Clot-dissolving medications used when catheter-based treatment is not immediately available.
- Nitrates, beta-blockers, ACE inhibitors: To reduce the workload on the heart and limit further damage.
Interventional and Surgical Therapy
- Percutaneous Coronary Intervention (PCI): Catheter-based procedure in which the blocked artery is reopened using a balloon (PTCA) and kept open with a stent. This is the preferred and most effective treatment.
- Coronary Artery Bypass Grafting (CABG): Surgical bypass of the blocked artery segment, typically performed when multiple vessels are severely affected.
Aftercare and Rehabilitation
Comprehensive follow-up care after a myocardial infarction is essential for recovery and prevention of further events. This includes:
- Cardiac rehabilitation (inpatient or outpatient)
- Long-term medication (e.g. antiplatelet agents, statins, beta-blockers)
- Lifestyle changes: smoking cessation, heart-healthy diet, regular physical activity, stress management
- Regular follow-up appointments with a cardiologist
References
- Ibanez B et al. - 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 2018; 39(2):119-177.
- Thygesen K et al. - Fourth Universal Definition of Myocardial Infarction. European Heart Journal, 2019; 40(3):237-269.
- World Health Organization (WHO) - Cardiovascular diseases (CVDs): Key Facts. Geneva, 2023. Available at: www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
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