CARDIOVASCULAR DISEASE

CARDIOVASCULAR DISEASE – ACUTE MYOCARDIAL INFARCTION

Cardiovascular disease is one of the deadly diseases in the world. Acute Myocardial Infarction is acute coronary syndrome that causes dead, especially in the first hours after the appearance of symptoms. By knowing the symptoms earlier, we can diagnose immediately so we don’t waste the time to save the heart muscle as much as possible and avoid the complication and fatality.Acute Coronary Syndrome characterized by an imbalance myocardial oxygen supply. It causes Acute Myocardial Infarction and chest pain.

Acute Myocardial Infarction Symptoms.

The chest pain of Acute Myocardial Infarction Symptoms usually lasted more than 20 minutes. Retrosternal spread to the jaw, back and left arm. The pain can be described as burning sensation, on top of heavy objects, such as crumpled and like tingling. Sometimes the pain is felt in epigastric area that is often interpreted as dyspepsia. Symptoms of chest pain is often followed by a cold sweat, nausea, vomiting, feeling faint, dizziness, feeling of floating and fainting ( syncope ). If the symptoms of heart disease was caused by sudden and in high intensity, it may be Acute Myocardial Infarction. Instead, the complaint can be very unclear, especially in people with diabetes mellitus and old age.

Acute Myocardial Infarction Complication.

Complications linked to heart disease causes a triad of death in hospital, ie ischemic, arrhythmias, heart failure.

Medical complications:

Arrhytmias.

Complications often occur within a few hours to 48 hours since the attacks of heart disease. Patients with acute myocardial ischemia that can not be reached in the hospital to get help, most died of malignant arrhythmias. Malignant arrhythmias are life-threatening arrhytmias causing hemodynamic deterioration. These arrhythmias can be divided into 2 major parts: Bradiaritmia and Takiaritmia.

• Bradiaritmia. Imbalance can be caused by sympathetic - parasympathetic, heart disease, especially in the inferior wall IMA. This disorder is temporary, but if the cause hemodynamic obstraction, it necessary to treat. Medical sulfas tested given atropine 0.5 mg IV, repeated every 5 minutes until a total dose of 2 mg. When the pulse response does not increase, the installation of temporary pacemaker (temporary) is the primary choice. If bradiaritmia is permanent, especially in the anterior wall of Acute Myocardial Infarction, may require a permanent pacemaker.


• Takiaritmia. Can be derived from supraventrikuler or ventricular. Takiaritmia ventricular happened to Acute Myocardial Infarction categorized malignant arrhytmias. Ventricular Takiaritmia most responsive to therapy Lidocaine IV. Recurrent small part can be given Amiodraone IV. In the event of ventricular fibrillation conducted according to standart protocol defibrilasi. Prophylactic lidocaine on the Acute Myocardial Infarction routinely is not recommended.

Heart Failure.

Complications of heart disease is the second commonest, especially in anterior wall myocardial, large anterior because contractile elements damaged. In the anterior Acute Myocardial Infarction to watch, a sign :

• Tachycardia is not clear why (> 110 x / min).


• Tend hypotension


• Patient anxiety, decreased tissue perfusion


• Breathing frequency increased


• Decreased urine production


• Physical examination found bilateral ronki wet, Gallop, noisy mitral regurgitation

All the above signs is a sign of left heart failure.

Heart disease mortality Acute Myocardial Infarction with cardiogenic shock 80 %. The principle of treatment is to increase coronary flow, reduced cardiac work and improve the flow of systemic. Besides the general resuscitation measures on heart disease remain to be done that is oxygen - ventilation, correction of electrolyte, acid base, eliminate pain and maintain sinus rhythm. Dopamine and dobutamin used to improve contractility and to maintain blood pressure.