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Myocardial Infarction

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Description: Myocardial infarction, commonly known as a heart attack, occurs when blood flow to a part of the heart is blocked for a long enough time that part of the heart muscle is damaged or dies.
Type: Myocardial infarction is not classified as a single-gene inherited disorder. Instead, it is a complex multifactorial condition influenced by various genetic and environmental factors. Genetic predisposition to myocardial infarction can be inherited in a polygenic manner, where multiple genes contribute to an individual's risk. Factors like family history, lifestyle, and other health conditions also play significant roles.
Signs And Symptoms: Chest pain that may or may not radiate to other parts of the body is the most typical and significant symptom of myocardial infarction. It might be accompanied by other symptoms such as sweating.
Prognosis: The prognosis after myocardial infarction varies greatly depending on the extent and location of the affected heart muscle, and the development and management of complications. Prognosis is worse with older age and social isolation. Anterior infarcts, persistent ventricular tachycardia or fibrillation, development of heart blocks, and left ventricular impairment are all associated with poorer prognosis. Without treatment, about a quarter of those affected by MI die within minutes and about forty percent within the first month. Morbidity and mortality from myocardial infarction has, however, improved over the years due to earlier and better treatment: in those who have a STEMI in the United States, between 5 and 6 percent die before leaving the hospital and 7 to 18 percent die within a year.It is unusual for babies to experience a myocardial infarction, but when they do, about half die. In the short-term, neonatal survivors seem to have a normal quality of life.
Onset: Myocardial infarction, commonly known as a heart attack, typically has a sudden onset. Symptoms may include chest pain or discomfort (often described as a pressure or squeezing sensation), shortness of breath, sweating, nausea, and lightheadedness. Immediate medical attention is crucial.
Prevalence: Prevalence of myocardial infarction, also known as a heart attack, varies globally and can depend on factors such as age, gender, ethnicity, and geography. In general, the prevalence increases with age and is higher in men than in women. In many developed countries, the lifetime risk of having a myocardial infarction for adults is approximately 20-25% for men and 10-15% for women.
Epidemiology: Myocardial infarction is a common presentation of coronary artery disease. The World Health Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease; with it being the leading cause of death in high- or middle-income countries and second only to lower respiratory infections in lower-income countries. Worldwide, more than 3 million people have STEMIs and 4 million have NSTEMIs a year. STEMIs occur about twice as often in men as women.Rates of death from ischemic heart disease (IHD) have slowed or declined in most high-income countries, although cardiovascular disease still accounted for one in three of all deaths in the US in 2008. For example, rates of death from cardiovascular disease have decreased almost a third between 2001 and 2011 in the United States.In contrast, IHD is becoming a more common cause of death in the developing world. For example, in India, IHD had become the leading cause of death by 2004, accounting for 1.46 million deaths (14% of total deaths) and deaths due to IHD were expected to double during 1985–2015. Globally, disability adjusted life years (DALYs) lost to ischemic heart disease are predicted to account for 5.5% of total DALYs in 2030, making it the second-most-important cause of disability (after unipolar depressive disorder), as well as the leading cause of death by this date.
Intractability: Myocardial infarction, commonly known as a heart attack, is not considered intractable. Advances in medical treatments, lifestyle changes, and timely intervention can significantly improve outcomes. However, it requires prompt medical attention and ongoing management to prevent complications and recurrence.
Disease Severity: Myocardial infarction (MI), commonly known as a heart attack, is considered a severe medical condition. The severity can range from mild to life-threatening, depending on factors such as the extent of heart muscle damage, the location of the blockage in the coronary arteries, how quickly treatment is administered, and the overall health of the individual. Prompt medical attention is critical to minimize damage and improve outcomes.
Healthcare Professionals: Disease Ontology ID - DOID:5844
Pathophysiology: Myocardial infarction, commonly known as a heart attack, occurs when blood flow to a part of the heart muscle becomes blocked for an extended period, resulting in irreversible damage to the heart tissue. This blockage is typically due to a buildup of plaque, a substance composed of fat, cholesterol, and other elements, within the coronary arteries. When a plaque ruptures, a blood clot forms around it, obstructing the blood flow further.

Pathophysiology:
1. **Atherosclerosis Formation**: The process starts with the accumulation of lipid-laden plaques in the coronary arteries.
2. **Plaque Rupture**: The fibrous cap covering the plaque can rupture, exposing the lipid core to the bloodstream.
3. **Thrombus Formation**: Platelets aggregate at the site of rupture, leading to the formation of a thrombus (blood clot).
4. **Obstruction of Blood Flow**: The thrombus can obstruct the artery, severely reducing or cutting off blood flow to the myocardium (heart muscle).
5. **Ischemia and Infarction**: Reduced blood flow leads to ischemia (oxygen deprivation) and, if prolonged, results in infarction (death) of myocardial tissue.

Prompt medical intervention is critical to restore blood flow and minimize damage to the heart muscle.
Carrier Status: Myocardial infarction, commonly known as a heart attack, does not involve a carrier status as it is not a hereditary condition passed through carriers. It primarily results from the blockage of coronary arteries leading to reduced blood flow to the heart muscle. Key risk factors include age, hypertension, high cholesterol, smoking, diabetes, obesity, and a sedentary lifestyle.
Mechanism: Myocardial infarction, commonly known as a heart attack, occurs when blood flow to a part of the heart muscle is blocked for an extended period, resulting in tissue damage or death. The primary mechanism involves the occlusion of coronary arteries due to atherosclerosis, in which lipid-laden plaques build up and can rupture, leading to the formation of a blood clot (thrombus) that obstructs the artery.

On a molecular level, several processes are involved:

1. Endothelial Dysfunction: Initial damage to the endothelial cells lining the coronary arteries can lead to increased permeability and inflammation.
2. Lipid Accumulation: Low-density lipoprotein (LDL) cholesterol infiltrates the arterial wall, where it becomes oxidized and taken up by macrophages, forming foam cells and fatty streaks.
3. Inflammation: The immune response to oxidized LDL and necrotic foam cells leads to chronic inflammation, which further destabilizes the arterial wall.
4. Plaque Rupture: Inflammatory processes weaken the fibrous cap of the atherosclerotic plaque, making it prone to rupture.
5. Thrombosis: Once the plaque ruptures, it exposes the underlying tissue, prompting platelet aggregation and clot formation, which can obstruct blood flow.
6. Ischemia and Cell Death: Oxygen deprivation (ischemia) in the downstream myocardium leads to cell death (necrosis), causing tissue damage.

These molecular mechanisms collectively contribute to the pathogenesis of myocardial infarction.
Treatment: Myocardial infarction (MI), commonly known as a heart attack, requires immediate treatment to restore blood flow to the heart. Treatment options generally include:

1. **Medications:**
- **Aspirin:** Helps prevent further blood clotting.
- **Thrombolytics (clot busters):** Dissolve blood clots in the coronary arteries.
- **Antiplatelet agents:** Prevent new clots from forming.
- **Blood thinners:** Such as heparin, to reduce blood clotting.
- **Pain relievers:** Such as morphine, to manage pain and discomfort.
- **Nitroglycerin:** To improve blood flow by dilating blood vessels.
- **Beta blockers:** To reduce heart rate and blood pressure, decreasing the heart's workload.
- **ACE inhibitors:** To lower blood pressure and reduce strain on the heart.
- **Statins:** To lower blood cholesterol.

2. **Interventional Procedures:**
- **Percutaneous Coronary Intervention (PCI):** Commonly known as angioplasty, often with stenting, to open up blocked coronary arteries.
- **Coronary Artery Bypass Graft (CABG) Surgery:** Surgical procedure to bypass blocked arteries, creating a new route for blood to reach the heart muscle.

Prompt medical attention is essential to minimize heart damage during a myocardial infarction.
Compassionate Use Treatment: Compassionate use treatment for myocardial infarction typically involves providing access to investigational drugs or therapies that are not yet widely available. Examples can include certain experimental medications or advanced medical devices being studied in clinical trials.

Off-label treatments for myocardial infarction refer to the use of approved medications for an unapproved indication or in a manner different from the approved labeling. For example, certain anti-inflammatory drugs, anti-coagulants, or other cardiovascular medications might be used off-label based on emerging evidence or clinical judgment.

Experimental treatments for myocardial infarction are therapies under clinical investigation but not yet approved for general use. These might include novel stem cell therapies, gene therapies, or new classes of medications aimed at reducing myocardial damage and improving recovery outcomes.

It is important to discuss any such treatments with a healthcare provider to understand the potential risks and benefits.
Lifestyle Recommendations: For myocardial infarction, lifestyle recommendations include:

1. **Healthy Diet**: Focus on a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats (such as those found in olive oil and fish). Limit intake of saturated fats, trans fats, cholesterol, salt, and added sugars.

2. **Regular Exercise**: Aim for at least 150 minutes of moderate-intensity aerobic activity, such as brisk walking, every week. Incorporate strength training exercises at least two days a week.

3. **Weight Management**: Achieve and maintain a healthy weight to reduce the strain on your heart.

4. **Smoking Cessation**: If you smoke, seek help to quit. Avoid secondhand smoke as well.

5. **Limit Alcohol**: Drink alcohol in moderation. This generally means up to one drink per day for women and up to two drinks per day for men.

6. **Manage Stress**: Practice stress-reducing techniques such as meditation, deep breathing exercises, yoga, or engaging in hobbies you enjoy.

7. **Regular Medical Check-ups**: Monitor blood pressure, cholesterol levels, and diabetes, and follow your healthcare provider's recommendations for medications if needed.

8. **Take Prescribed Medications**: Adhere to your prescribed medication regimen to manage risk factors such as high blood pressure, cholesterol, and diabetes.

9. **Avoid Illicit Drugs**: Stay away from recreational drugs, particularly stimulants like cocaine, which can increase the risk of a heart attack.
Medication: Following a heart attack, nitrates, when taken for two days, and ACE-inhibitors decrease the risk of death. Other medications include:
Aspirin is continued indefinitely, as well as another antiplatelet agent such as clopidogrel or ticagrelor ("dual antiplatelet therapy" or DAPT) for up to twelve months. If someone has another medical condition that requires anticoagulation (e.g. with warfarin) this may need to be adjusted based on risk of further cardiac events as well as bleeding risk. In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death.Beta blocker therapy such as metoprolol or carvedilol is recommended to be started within 24 hours, provided there is no acute heart failure or heart block. The dose should be increased to the highest tolerated. Contrary to most guidelines, the use of beta blockers does not appear to affect the risk of death, possibly because other treatments for MI have improved. When beta blocker medication is given within the first 24–72 hours of a STEMI no lives are saved. However, 1 in 200 people were prevented from a repeat heart attack, and another 1 in 200 from having an abnormal heart rhythm. Additionally, for 1 in 91 the medication causes a temporary decrease in the heart's ability to pump blood.ACE inhibitor therapy should be started within 24 hours and continued indefinitely at the highest tolerated dose. This is provided there is no evidence of worsening kidney failure, high potassium, low blood pressure, or known narrowing of the renal arteries. Those who cannot tolerate ACE inhibitors may be treated with an angiotensin II receptor antagonist.Statin therapy has been shown to reduce mortality and subsequent cardiac events and should be commenced to lower LDL cholesterol. Other medications, such as ezetimibe, may also be added with this goal in mind.Aldosterone antagonists (spironolactone or eplerenone) may be used if there is evidence of left ventricular dysfunction after an MI, ideally after beginning treatment with an ACE inhibitor.Statins, drugs that act to lower blood cholesterol, decrease the incidence and mortality rates of myocardial infarctions. They are often recommended in those at an elevated risk of cardiovascular diseases.Aspirin has been studied extensively in people considered at increased risk of myocardial infarction. Based on numerous studies in different groups (e.g. people with or without diabetes), there does not appear to be a benefit strong enough to outweigh the risk of excessive bleeding. Nevertheless, many clinical practice guidelines continue to recommend aspirin for primary prevention, and some researchers feel that those with very high cardiovascular risk but low risk of bleeding should continue to receive aspirin.
Repurposable Drugs: Repurposable drugs for myocardial infarction (MI) include:

1. Metformin: Originally an antidiabetic drug, it has potential cardioprotective effects.
2. Colchicine: An anti-inflammatory medication used for gout, showing benefits in reducing cardiac inflammation.
3. Sildenafil: Initially used for erectile dysfunction, it has vasodilatory properties that may benefit MI patients.

These drugs are being investigated for their potential to improve outcomes and reduce damage post-MI. Always consult a healthcare provider for tailored medical advice.
Metabolites: A myocardial infarction, commonly known as a heart attack, results from the blockage of blood flow to a part of the heart muscle, leading to tissue damage or death. Metabolites associated with myocardial infarction can provide diagnostic and prognostic information. Key metabolites include:

1. **Troponins (T and I)**: Proteins released when heart muscle is damaged; highly specific biomarkers for myocardial infarction.
2. **Creatine kinase-MB (CK-MB)**: An enzyme elevated in the blood following heart muscle damage.
3. **Myoglobin**: An early marker of muscle injury, including heart muscle.
4. **Lactate dehydrogenase (LDH)**: An enzyme that rises with tissue breakdown, including after a heart attack.
5. **Brain Natriuretic Peptide (BNP) and N-terminal pro-BNP (NT-proBNP)**: Peptides that may increase due to the heart's response to stress or injury.

These metabolites help in the diagnosis, management, and monitoring of myocardial infarction.
Nutraceuticals: For myocardial infarction, nutraceuticals such as omega-3 fatty acids, antioxidants (e.g., vitamins C and E), coenzyme Q10, and polyphenols (e.g., resveratrol) may provide cardiovascular benefits, potentially supporting heart health. However, these should not replace conventional treatments and should be used under medical supervision. The term "nan" appears to be unclear or incomplete in this context. If you are referring to nanotechnology, it is an emerging field with potential applications in drug delivery and tissue repair for myocardial infarction, but it is still largely in the research phase.
Peptides: Myocardial infarction (MI), commonly known as a heart attack, is a condition where blood flow to a part of the heart is blocked for a long enough time that part of the heart muscle is damaged or dies. Peptides and nanoparticles (nanomedicine) are emerging fields that show promise in the diagnosis, treatment, and management of myocardial infarction.

Peptides:
1. **Therapeutic Peptides**: Certain peptides can help reduce inflammation, limit cell death, and promote healing after a myocardial infarction. For example, B-type natriuretic peptide (BNP) has been used to help manage MI by reducing the heart's workload and dilating blood vessels.
2. **Diagnostic Biomarkers**: Peptides released during myocardial infarction, such as troponins and natriuretic peptides, are critical biomarkers used in the diagnosis and assessment of heart damage.

Nanoparticles (Nanomedicine):
1. **Drug Delivery**: Nanoparticles can be engineered to deliver drugs specifically to the site of myocardial infarction, minimizing side effects and improving the efficacy of treatments. For example, nanoparticles can deliver anti-inflammatory drugs or growth factors to the damaged heart tissue.
2. **Imaging and Diagnosis**: Nanoparticles can enhance imaging techniques like MRI and PET scans, allowing for more accurate and early detection of myocardial infarction and assessment of the extent of heart damage.
3. **Regenerative Medicine**: Nanoparticles can be used to deliver stem cells or genes to promote the regeneration of damaged heart tissue, a promising area of research in treating the aftermath of a myocardial infarction.

Overall, peptides and nanomedicine represent advanced approaches that could significantly improve the outcomes for patients suffering from myocardial infarction through better targeted therapies and more precise diagnostic tools.