Myocardial Infarction

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Jessica King & Melissa Tuemler  from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Prevalence

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Characteristics/Clinical Presentation

According the American Heart Association (AHA), heart attacks can occur in a variety of fashions. Some begin suddenly with severe pain or other symptoms, while others have a slower onset with only mild pain or discomfort. Pain toward the center of the chest is the most common symptom experienced by patients. This pain is typically uncomfortable and resembles the feeling of squeezing or a pressure on the anterior chest. Patient's experiencing a MI may also experience pain in the jaw, shoulder, arms, stomach, neck, or back. The other common signs and symptoms of heart attack are listed below.

Signs and symptoms of MI include:

• Chest pain lasting longer than a few minutes
• Anxiety
• Cough
• Fainting
• Lightheadedness/ Dizziness
• Nausea/ Vomiting
• Heart palpitations
• Shortness of air (SOA) 
• Sweating

 MI can also be "silent" in which there are no symptoms.

Signs and symptoms vary based on gender. The most common symptom experienced by both genders is chest pain or discomfort. Women typically experience other symptoms such as SOA, nausea and vomiting, and nack or jaw pain.

 

Associated Co-morbidities

Associated Co-morbidities for Myocardial Infarction include:

Hypertension

Coronary Artery Disease (CAD)

Medications

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Diagnostic Tests/Lab Tests/Lab Values

The diagnosis of a heart attack can be completed with the following assessment tools:

     1. Complete patient medical history
     2. Physical exam
     3. EKG
     4. Blood testing to be sure there are no abnormal levels of enzymes in the blood

Diagnostic tests for determining if a patient has had an MI can be invasive or non-invasive.

Non-invasive tests:
1. EKG: records the electrical activity of the heart.
2. Ambulatory EKG and Holter Monitoring: records electrical activity of the heart during ADL’s.
3. Chest X-ray: photograph of the heart and lungs that helps determine if the heart is enlarged or if fluid is accumulating in the lungs.
4. Echocardiogram: hand held device placed over the chest that uses ultrasound to produce images of the heart.
5. CT or MRI

6. Exercise Stress Test: monitor with electrodes that are attached to chest and monitor the heart response while an individual walks on a treadmill.

Invasive tests:

1. Blood Tests: may include cardiac enzymes such as troponin and creatine kinase, C-reactive protein, fibrinogen, lipoproteins, triglycerides, BNP, and prothrombin

2. Cardiac Catheterization: examines the inside of the heart and blood vessels using an angiogram and dye. This can measure the blood      pressure in side the heart, detect where a narrowing in the vessel is located, and evaluates overall heart function.
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 NonNononononono

 Diagnositic D

Etiology/Causes

Heart disease has many risk factors, some that can be changed and others that cannot.

Risk factors that cannot be changed include:

• Age (Increased risk after age 65)
• Gender (Males at increased risk)
• Race/ethnicity (African Americans, Mexican Americans, American Indians, Hawaiians and Asian Americans at increased risk)
• Genetics/ Family History

 

Risk factors that can be changed:

• Smoking
• High cholesterol (diet, exercise, and medication)
• High blood pressure (diet, exercise, and medication)
• DM management
• Exercising at least 30 min/day
• Eating a healthy, nutritious diet
• Stress management
• Limiting alcohol consumption to 1 drink/day for women and 2 drinks/day for men

Systemic Involvement

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Medical Management (current best evidence)

Tests	Surgeries	Implanted Medical Devices
	Angioplasty	Left Ventricular Assist Device
	Artificial Heart Valve Surgery	Pacemaker
	Atheroectomy	Implantable Cardioverter Defibrillator
	Bypass Surgery
	Crdiomyoplasty
	Heart Transplant
	Radiofrequency Ablation
	Stent Placement
	Transmyocardial Revascularization

Tests

Surgeries

Implanted Medical Devices

1. Left Ventricular Assist Device: battery operated, mechanical pump device that is surgerically implanted into the heart and is used to maintain the pumping ability of a heart that can't effectively work on its own. This device is typically implanted in patients who are on the waiting list for a heart transplant or suffering from end-stage heart failure.
   
2. Pacemaker: device implanted into heart tissue that sends electrical impulses to help maintain a regular heart beat. This device is typically used when the hearts "natural pacemaker" becomes defective and causes the heart to beat at an irregular beat.
3. Implantable Cardioverter Defibrillator:

Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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