PRIYA MISHRA

01 MAY 2023
BPT FINAL YEAR
MYOCARDIAL INFARCTION
Introduction

 Myocardial infarction (MI) (colloquially known

as a heart attack) results from interruption of
myocardial blood flow and resultant ischaemia
and is a leading cause of death worldwide[1].
 MI is mainly due to underlying
coronary artery disease. When the
coronary artery is occluded, the myocardium
is deprived of oxygen. Prolonged deprivation
of oxygen supply to the myocardium can lead
to myocardial cell death and necrosis.
Etiology

 Risk factors
 Male > Female
 Age
◦ >45 years for males
◦ >55 years for females
 Cardiovascular risk factors: smoking, hypertension, low
density lipoprotein (LDL) cholesterol, hyperlipidaemia,
diabetes, obesity, physical inactivity, air pollution
 Positive family history: a history of first-degree male
relative (i.e. brother, father, son) with MI <55 years of
age or first-degree female relative (i.e. mother, sister,
daughter) with MI <65 years of age[1]
The Causes of Myocardial Infarction

 In most cases, heart attacks occur due to a blockage in an

artery supplying blood to the heart. The blockage happens
due to plaque – a sticky buildup in the arteries known as
atherosclerosis.
 Myocardial infarction can occur without a blockage as well.
Such cases may occur due to the following:
 Coronary artery spasm
 Trauma causing rupture in the coronary arteries
 Obstruction of the arteries due to an air bubble or blood clot
originating somewhere else in the body
 Eating disorders
 Rare medical conditions that cause narrowing of the blood
vessels
 Anomalous coronary arteries or a congenital heart defect
 Stress cardiomyopathy
The Symptoms of Myocardial Infarction

 Symptoms of myocardial infarction can vary from one person to the

other. Some people experience mild symptoms, whereas others
have severe symptoms. Some people may even experience no
symptoms at all.
 The most common symptoms of a heart attack include the
following:
 Chest pain feels like tightness, pressure, aching, squeezing, or pain.
 Cold sweat
 Discomfort or pain spreads to the arm, shoulder, back, jaw, neck,
teeth, or upper belly.
 Fatigue
 Nausea
 Sudden dizziness or lightheadedness
 Indigestion or heartburn
 Shortness of breath
Epidemiology

 The most common cause of death and disability in

the western world and worldwide is coronary
artery disease[2].
 There are 32.4 million myocardial infarctions and
strokes worldwide every year.
 Patients with previous myocardial infarction (MI)
are the highest risk group for further coronary
events.
 Survivors of MI are at increased risk of recurrent
infarctions and have an annual death rate of 5% -
six times that in people of the same age who do
not have coronary heart disease.[3]
Myocardial Infarctions are the leading
cause of death in the industrialized
nations of the world. In the United States,
there are about 450,000 deaths due to
MIs each year. Now 95% of patients
hospitalized with an MI will survive due to
improvements in emergency response
time, and treatment techniques. The risk
of having an MI increases with age, but
50% of MIs in the United States occur in
people under the age of 65 years old.[4]
Characteristics/Clinical Presentation

 Characteristics/Clinical Presentation
 Myocardial ischemia can present as
 Chest pain/tightness, which may radiate down
the left arm or into the jaw [1]
 Dramatic manifestations, such as cardiac arrest.
[2]

 Silent" ischaemia can occur in those with poor

visceral sensation (diabetics, post-cardiothoracic
surgery) and may manifest with other symptoms
of myocardial compromise, e.g. breathlessness [1]
 Signs and symptoms vary based on gender.
 Pathology

Coronary artery disease with rupture of an

atherosclerotic plaque resulting in occlusion (local
thrombosis/dissection) is the major cause of
myocardial infarctions. Other causes include:
Ischaemic imbalance (i.e. myocardial oxygen
supply/demand imbalance)
In critically-ill patients or in the setting of major (non-
cardiac) surgery
Vasospasm Iatrogenic, e.g. during revascularisation
procedures[1]
Treatment

 The diagnosis and management of patients with MI is best

done with an interprofessional team. In most hospitals,
there are cardiology teams that are dedicated to the
management of these patients.
 For patients who present with chest pain, the key to the
management of MI is time to treatment.
 A cardiology consult should be made immediately to
ensure that the patient gets treated within the time frame
recommendations.
 As MI can be associated with several serious
complications, these patients are best managed in an ICU
setting.
 Long term management
There is no cure for ischemic heart disease, and
all treatments are symptom-oriented.
The key to improving outcomes is to prevent
coronary artery disease.
The primary care provider, physiotherapist and
nurse practitioner should educate the patient on
the benefits of a healthy diet, the importance of
controlling blood pressure and diabetes,
exercising regularly, discontinuing smoking,
maintaining healthy body weight, and remaining
compliant with medications.
The pharmacist should educate the patient on
types of medication used to treat ischemic heart
disease, their benefits, and potential adverse
effects.
MEDICAL MANAGEMENT
Myocardial infarction treatment involves restoring
blood flow to the heart muscles at the earliest. This
can be done in several ways – using medication and
surgery. Standard treatment options include:
Supplementary Oxygen: People with low levels of
blood oxygen or those facing problem breathing are
provided supplementary oxygen along with other
treatments. This oxygen is provided through a tube
attached just before the nose or using a mask
covering your mouth and nose. This is the easiest
way to increase blood glucose levels and reduce
strain on the heart.
Medications: Several different medications may be
given to a heart attack patient, including:
Anti-clotting medications: These medications include
aspirin and other medicines used for blood thinning.
Thrombolytic medications: These medications work to
break down clots and are usually given within the first
twelve hours following a heart attack.
Nitroglycerin: This medication is given to dilate the
blood vessels to allow blood to pass through easily. It
also helps in relieving chest pain.
Pain medications: Morphine is often given during a
heart attack to alleviate chest pain.
Anti-arrhythmia medications: These medications are
given in case of a heart attack resulting from
arrhythmias or the heart beating out of rhythm.
Percutaneous Coronary Intervention: This
myocardial infarction treatment is used to restore
circulation of your heart muscle. It involves using
a catheter-based device inserted into one of your
major blood vessels (often near the wrist or upper
thigh). This tool helps in restoring blood flow and
relieves the symptoms of a heart attack. It
involves placing a stent at the blockage site to
keep the artery open and avoid another blockage.
Coronary Artery Bypass Grafting:

People with severe blockages in their coronary

arteries may be advised to undergo a coronary
artery bypass grafting procedure. Commonly
known as open-heart surgery, CABG, or bypass
surgery, it involves using another blood vessel
harvested from another part of your body to
construct a detour for the blood to pass through.
This technique helps reroute the blood around
the blocked parts of the artery to allow blood to
reach the heart safely.
Physical Therapy Management

 Physical Therapy Management

 Cardiac Rehab is beneficial to patients of all

ages who have had a heart attack, CAD,

angina, or CHF. Other individuals who may
gain benefits from this include post-surgical
CABG, percutaneous intervention (PCI), or
coronary angioplasty patients.
Indications for Cardiac Rehab

A medical examination is completed at the initial

consultation to determine the needs and
limitations of the patient.
The results of the exam are interpreted, the team
creates a rehab program and sets goals for
treatment.
Treatment typically consists of a physical activity
program in a group setting where vital signs can
consistently be monitored. As the program
progresses, the patient is taught how to monitor
their own vitals and progresses to more
challenging aerobic activities.
Cycle Ergometer Use in the post-operative period
following cardiac surgery is a safe choice for patient
rehabilitation[7].
Along with physical activity, patient education is also a
very important part of cardiac rehab. Patients may work
with a dietician or be given advice on how to stop
smoking if necessary.
According to the American Heart Association, the benefits
of cardiac rehab include:
Regular physical activity helps your heart and the rest of
your body get stronger and work better. Physical activity
improves your energy level and lifts your spirits. It also
reduces your chances of future heart problems, including
heart attack.
Counseling and education can help
you quit smoking, eat right, lose
weight, and lower your blood
pressure and cholesterol levels.
Counseling may also help you learn
to manage stress and to feel better
about your health
Physiotherapy role in myocardial infarction treatment programme:

 1.complete bed rest-up to 2 days.

 2.partial bed rest-up to 4 days.
 3.up and about-in hospital from third or fourth day for up to 2
weeks.
 4.after discharge from hospital: 3 weeks to 12 weeks.
 5.outpatient rehab.-3-9 months.
 Complete bed rest:
 Aims of physiotherapy :
1.to prevent accumulation of secretion in the lungs.

 2.to prevent deep vein thrombosis.

 3.to prevent pressure sores.

 4.to teach and encourage relaxation.

 5.to explain the purpose of an active rehabilitation programme.

Techniques used in myocardial infarction treatment programme:

 1.relaxation: lying or half-lying, conscious

relaxation 10 min approx. Modified physiological
relaxation may be indicated. If the patient can
learn to relax, the heart rate is reduced and this
aids recovery by easing the load on the heart.
 2.breathing exercises: bilateral basal breathing-
three times. There must be no forceful breathing.
This will improve oxygenation of the blood and
therefore reduces the demand on the heart.
3.free active exercises: lying or half-lying
a. ankle pumps

b. foot turning in and out

c. fingers bending and stretching

d. wrists bending and stretching

4.breathing exercises: anterior basal expansion within

patients normal pattern- 3 times.
5.passive movements
6.breathing exercises: posterior basal exercises- 3
times.
7.passive movements- repeat again
8.relaxation- repeat again
Aims of physiotherapy:

1.to maintain clear lung fields.

2.to increase the load on the heart such that there

is hypertrophy of the myocardium.

3.to educate the patient to recognize signs and

symptoms of excess exercise.

4.to begin rebuilding the patients confidence.

5.to train postural awareness.

6.to strengthen leg and trunk exercises.

Myocardial infarction treatment Home
Programme : General exercises
1.half yard grasp standing-one leg swinging forward
and backwards then repeat with other leg.
2.half yard grasp standing: knees and hip bending and
stretching.
3.yard standing: arms circling backwards.
4.yard standing: trunk bending and turning to touch left
knee.
5.lying:alternate hip and knee bending and stretching.
6.sitting:throwing and catching ball.
7.standing:arms bending and stretching.
8.wing stride standing, trunk bending side to side.
9.standing:stepping up and down.
10.sitting ,standing up and sitting down.
11.stride standing: bouncing ball.
12.stride standing: throwing ball.
13.sitting:trunk turning side to side.
Progression:

1.increase no. of repetitions.

2.increase the length of time for each

exercise.

3.increase speed.

4.add weights.

5.alter range.