Myocardial infarction is a result of the necrosis of the heart muscle due to prolonged ischemia (decreased oxygen supply to the myocardium).
Depending on the size of the vessel and the damaged area vary the severity of the condition and the presence of possible complications – pulmonary edema, acute heart failure, heart blocks or atrial fibrillation.
It was estimated that those who experienced a heart attack in the past are at increased risk of future infarctions and the death rate for these individuals is about 5% – this is six times more than for healthy people of the same age.
Primary prevention of the myocardial infarction should be administered when there is no information about the heart attack in the past. This kind of prevention is actually a treatment of atherosclerosis, coronary artery disease, dyslipidemia and arterial hypertension.
Primary prevention of myocardial infarction should include non-pharmacological (lifestyle changes),
pharmacological and if necessary invasive means. Coronary stent implantation helps to restore blood supply to the heart muscle and avoid further necrosis of the myocardium.
- Smoking is considered to be the major risk factor for cardiovascular disease. Every person should be strongly recommended to quit smoking;
- Atherosclerosis/coronary artery disease is caused by the abnormal accumulation of the lipids of the lining of the blood vessels. It is important to maintain cholesterol levels in the blood below the upper threshold. Diet and statins administration are required to control blood cholesterol.
- Controlling body weight and if possible reaching normal ranges of body-mass index (which are 18.5-25 kg/m2) – overweight and obesity is associated with up to 80% increase in risk of developing acute myocardial infarction.
- Blood glucose control is significant as well since diabetes mellitus/hyperglycemia contributes to the formation of the plaques and increases the risk of heart attack. According to several studies mortality due to coronary heart disease is 2-3 times higher among males with diabetes and 3-7 times higher among diabetic females than among people who do not suffer from diabetes.
- Low-dose administration of aspirin is considered to be effective as a prevention of the heart attack since it reduces the formation of the thrombus .
Secondary prevention is a prevention of the heart attack in the future and the death.
1) Lifestyle changes may significantly influence the mortality rate and prevent heart attacks in the future:
- Quit smoking – researches suggest that stopping smoking decreases the death risk following the myocardial infarction more than twice;
- Ceasing alcohol consumption;
- Mediterranean-style diet – individuals should be recommended to eat more bread, fruit, vegetables and fish; less meat; replace butter and cheese with products based on plant oils)
- Physical activity for 20–30 minutes pro day. Activity should be increased gradually in a step-by-step manner.
2) Individuals who experienced an acute myocardial infarction should take some medicines to prevent further complications:
- Dual antiplatelet therapy (aspirin (75-325 mg/day) + clopidogrel) and anticoagulants (warfarin);
- ACE (angiotensin-converting enzyme) inhibitor (enalapril capoten);
- Beta-blockers (propranolol, metoprolol) are known to reduce mortality rate by 25%;
- Calcium channel blockers (diltiazem – 300 mg/day) when beta-blockers are contraindicated;
- Statins (simvastatin, pravastatin, atorvastatin) are known to reduce mortality rate and the need for invasive treatment in the future;