Myocardial_infarction

qas: question: What is the scientific name for blood flow?
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question: What percentage of women have had a heart attack?
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question: What percentage of people have chest pain when experiencing an MI?
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question: What is heartburn a commonly known as?
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question: How long does heartburn last?
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context: Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, occurs when blood flow stops to a part of the heart causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it is in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired. About 30% of people have atypical symptoms, with women more likely than men to present atypically. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause heart failure, an irregular heartbeat, or cardiac arrest.

qas: question: What is used to confirm a artery spasm?
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question: What test includes cocaine?
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question: What type of rupture helps prevent MI?
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question: What causes extreme cold?
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question: What does a coronary angiography look for?
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context: Most MIs occur due to coronary artery disease. Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol intake, among others. The mechanism of an MI often involves the complete blockage of a coronary artery caused by a rupture of an atherosclerotic plaque. MIs are less commonly caused by coronary artery spasms, which may be due to cocaine, significant emotional stress, and extreme cold, among others. A number of tests are useful to help with diagnosis, including electrocardiograms (ECGs), blood tests, and coronary angiography. An ECG may confirm an ST elevation MI if ST elevation is present. Commonly used blood tests include troponin and less often creatine kinase MB.

qas: question: What drugstore item is a poor treatment for MI?
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question: Supplemental oxygen does not improve what?
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question: What medicine is used to remove blockages?
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question: What surgery is designed to slow blood flow?
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question: What blood thinner is used in ST elevation treatments?
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context: Aspirin is an appropriate immediate treatment for a suspected MI. Nitroglycerin or opioids may be used to help with chest pain; however, they do not improve overall outcomes. Supplemental oxygen should be used in those with low oxygen levels or shortness of breath. In ST elevation MIs treatments which attempt to restore blood flow to the heart are typically recommended and include angioplasty, where the arteries are pushed open, or thrombolysis, where the blockage is removed using medications. People who have a non-ST elevation myocardial infarction (NSTEMI) are often managed with the blood thinner heparin, with the additional use angioplasty in those at high risk. In people with blockages of multiple coronary arteries and diabetes, bypass surgery (CABG) may be recommended rather than angioplasty. After an MI, lifestyle modifications, along with long term treatment with aspirin, beta blockers, and statins, are typically recommended.

qas: question: What type of heart problem has a typically instantaneous onset?
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question: How is pain in the left arm often described?
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question: What is a good way to predict a heart attack?
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question: What is the term for pain in the left arm?
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question: What does a lack of oxygen supply cause?
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context: The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and rarely instantaneous. Chest pain is the most common symptom of acute MI and is often described as a sensation of tightness, pressure, or squeezing. Chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle is termed angina pectoris. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper abdomen, where it may mimic heartburn. Levine's sign, in which a person localizes the chest pain by clenching their fists over their sternum, has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed it had a poor positive predictive value.

qas: question: What is excessive weakness called?
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question: Diaphoresis causes a massive surge of what hormones?
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question: Which nervous system is responsible for shortness of breath?
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question: What is left ventricular failure called?
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question: What kind of shock can cause sudden death?
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context: Shortness of breath occurs when the damage to the heart limits the output of the left ventricle, causing left ventricular failure and consequent pulmonary edema. Other symptoms include diaphoresis (an excessive form of sweating), weakness, light-headedness, nausea, vomiting, and palpitations. These symptoms are likely induced by a massive surge of catecholamines from the sympathetic nervous system, which occurs in response to pain and the blood flow abnormalities that result from dysfunction of the heart muscle. Loss of consciousness (due to inadequate blood flow to the brain and cardiogenic shock) and sudden death (frequently due to the development of ventricular fibrillation) can occur in MIs.

qas: question: How many symptoms do people with diabetes typically report?
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question: What are the most common symptoms for men?
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question: How long after the ischemic event do symptoms manifest?
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question: What is more predictive of coronary ischemia for women?
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context: Atypical symptoms are more frequently reported by women, the elderly, and those with diabetes when compared to their male and younger counterparts. Women also report more numerous symptoms compared with men (2.6 on average vs. 1.8 symptoms in men). The most common symptoms of MI in women include dyspnea, weakness, and fatigue. Fatigue, sleep disturbances, and dyspnea have been reported as frequently occurring symptoms that may manifest as long as one month before the actual clinically manifested ischemic event. In women, chest pain may be less predictive of coronary ischemia than in men. Women may also experience back or jaw pain during an episode.

qas: question: What percentage of silent cases are later discovered on electrocardiograms?
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question: People with what disease are least likely to experience a silent MI?
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question: Why is a donor heart more sensitive to pain from MIs?
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question: What have been ruled out as possible explanations for silent MIs in diabetics?
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question: What fraction of MIs are discovered with blood enzyme tests?
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context: At least one quarter of all MIs are silent, without chest pain or other symptoms. These cases can be discovered later on electrocardiograms, using blood enzyme tests, or at autopsy without a prior history of related complaints. Estimates of the prevalence of silent MIs vary between 22 and 64%. A silent course is more common in the elderly, in people with diabetes mellitus and after heart transplantation, probably because the donor heart is not fully innervated by the nervous system of the recipient. In people with diabetes, differences in pain threshold, autonomic neuropathy, and psychological factors have been cited as possible explanations for the lack of symptoms.

qas: question: What forms of air pollution does smoking tobacco cause?
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question: How many cigarettes per day increase the risk of a heart attack?
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question: Increased physical activity is bad for what?
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question: Short term exposure to 3-4 servings of what is dangerous?
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context: Tobacco smoking (including secondhand smoke) and short-term exposure to air pollution such as carbon monoxide, nitrogen dioxide, and sulfur dioxide (but not ozone) have been associated with MI. Other factors that increase the risk of MI and are associated with worse outcomes after an MI include lack of physical activity and psychosocial factors including low socioeconomic status, social isolation, and negative emotions. Shift work is also associated with a higher risk of MI. Acute and prolonged intake of high quantities of alcoholic drinks (3-4 or more) increase the risk of a heart attack.

qas: question: Evidence for what product has proven to be unequivocally dangerous?
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question: Study show you should replace polyunsaturated fat with what?
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question: Blood cholesterol has a significant impact on what?
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question: What type of cholesterol requires careful limitations?
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question: Trans what decreases risk?
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context: The evidence for saturated fat is unclear. Some state there is evidence of benefit from reducing saturated fat, specifically a benefit from eating polyunsaturated fat instead of saturated fat. While others state there is little evidence that reducing dietary saturated fat or increasing polyunsaturated fat intake affects heart attack risk. Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed. Trans fats do appear to increase risk.

qas: question: How many genetic variants are shown to decrease risk of an MI?
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question: PCSK9 is found in what locus?
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question: How many genetic variants are in the 9p21 genomic locus?
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question: What was implicated in the coding region of 9p21?
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question: SORT1 is associated with decreasing risk of what?
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context: Genome-wide association studies have found 27 genetic variants that are associated with an increased risk of myocardial infarction. Strongest association of MI has been found with the 9p21 genomic locus, which contains genes CDKN2A & 2B, although the single nucleotide polymorphisms that are implicated are within a non-coding region. The majority of these variants are in regions that have not been previously implicated in coronary artery disease. The following genes have an association with MI: PCSK9, SORT1, MIA3, WDR12, MRAS, PHACTR1, LPA, TCF21, MTHFDSL, ZC3HC1, CDKN2A, 2B, ABO, PDGF0, APOA5, MNF1ASM283, COL4A1, HHIPC1, SMAD3, ADAMTS7, RAS1, SMG6, SNF8, LDLR, SLC5A3, MRPS6, KCNE2.

qas: question: How many subtypes does ST-elevated MI have?
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question: What are always a manifestation of artery disease?
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question: How long does an MI take?
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question: How many plaques become unstable in a typical MI?
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question: How long does an angiography take?
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context: Acute myocardial infarction refers to two subtypes of acute coronary syndrome, namely non-ST-elevated and ST-elevated MIs, which are most frequently (but not always) a manifestation of coronary artery disease. The most common triggering event is the disruption of an atherosclerotic plaque in an epicardial coronary artery, which leads to a clotting cascade, sometimes resulting in total occlusion of the artery. Atherosclerosis is the gradual buildup of cholesterol and fibrous tissue in plaques in the wall of arteries (in this case, the coronary arteries), typically over decades. Bloodstream column irregularities visible on angiography reflect artery lumen narrowing as a result of decades of advancing atherosclerosis. Plaques can become unstable, rupture, and additionally promote the formation of a blood clot that occludes the artery; this can occur in minutes. When a severe enough plaque rupture occurs in the coronary arteries, it leads to MI (necrosis of downstream myocardium). It is estimated that one billion cardiac cells are lost in a typical MI.

qas: question: What does necrosis trigger?
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question: What is a collagen scar called?
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question: What is another name for a ventricular aneurysm?
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question: apoptosis is the death of what artery?
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question: What is impaired blood flow called?
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context: If impaired blood flow to the heart lasts long enough, it triggers a process called the ischemic cascade; the heart cells in the territory of the occluded coronary artery die (chiefly through necrosis) and do not grow back. A collagen scar forms in their place. Recent studies indicate that another form of cell death, apoptosis, also plays a role in the process of tissue damage following an MI. As a result, the person's heart will be permanently damaged. This myocardial scarring also puts the person at risk for potentially life-threatening abnormal heart rhythms (arrhythmias), and may result in the formation of a ventricular aneurysm that can rupture with catastrophic consequences.

qas: question: Normal heart tissue is slower than what?
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question: What is the name of the arrhythmia that is slower than normal?
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question: V-tach is the leading cause of what?
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question: Electrical impulses trigger what?
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question: A rising blood pressure can cause additional what?
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context: Injured heart tissue conducts electrical impulses more slowly than normal heart tissue. The difference in conduction velocity between injured and uninjured tissue can trigger re-entry or a feedback loop that is believed to be the cause of many lethal arrhythmias. The most serious of these arrhythmias is ventricular fibrillation (V-Fib/VF), an extremely fast and chaotic heart rhythm that is the leading cause of sudden cardiac death. Another life-threatening arrhythmia is ventricular tachycardia (V-tach/VT), which can cause sudden cardiac death. However, VT usually results in rapid heart rates that prevent the heart from pumping blood effectively. Cardiac output and blood pressure may fall to dangerous levels, which can lead to further coronary ischemia and extension of the infarct.

qas: question: The setting of plaque is called what?
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question: CRP is known to play a direct role in what?
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question: What specific marker indicates inflammation?
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question: Drugs for MI tend to raise what?
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question: What type of screening is generally recommended?
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context: Myocardial infarction in the setting of plaque results from underlying atherosclerosis. Inflammation is known to be an important step in the process of atherosclerotic plaque formation. C-reactive protein (CRP) is a sensitive but nonspecific marker for inflammation. Elevated CRP blood levels, especially measured with high-sensitivity assays, can predict the risk of MI, as well as stroke and development of diabetes. Moreover, some drugs for MI might also reduce CRP levels. The use of high-sensitivity CRP assays as a means of screening the general population is advised against, but it may be used optionally at the physician's discretion in those who already present with other risk factors or known coronary artery disease. Whether CRP plays a direct role in atherosclerosis remains uncertain.

qas: question: How many anginas must a person report to have a STEMI?
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question: ST elevation can develop into what?
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question: The ECG must show less than how many mV for a male to be considered a STEMI?
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question: What has recently been added as a qualification for a STEMI?
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question: Which two named leads only have to be above 1 mm to be counted?
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context: For a person to qualify as having a STEMI, in addition to reported angina, the ECG must show new ST elevation in two or more adjacent ECG leads. This must be greater than 2 mm (0.2 mV) for males and greater than 1.5 mm (0.15 mV) in females if in leads V2 and V3 or greater than 1 mm (0.1 mV) if it is in other ECG leads. A left bundle branch block that is believed to be new used to be considered the same as ST elevation; however, this is no longer the case. In early STEMIs there may just be peaked T waves with ST elevation developing later.

qas: question: What is used to examine blood flood in unstable patients?
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question: What is another name for thallium-201?
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question: What purpose does technetium serve in terms of identifying tissue?
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question: What must be determined after taking an imaging test?
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question: A patient does not need routine imaging when they have what kind of biomarker?
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context: In stable patients whose symptoms have resolved by the time of evaluation, technetium (99mTc) sestamibi (i.e. a "MIBI scan") or thallium-201 chloride can be used in nuclear medicine to visualize areas of reduced blood flow in conjunction with physiological or pharmacological stress. Thallium may also be used to determine viability of tissue, distinguishing whether nonfunctional myocardium is actually dead or merely in a state of hibernation or of being stunned. Medical societies and professional guidelines recommend that the physician confirm a person is at high risk for myocardial infarction before conducting imaging tests to make a diagnosis. Patients who have a normal ECG and who are able to exercise, for example, do not merit routine imaging. Imaging tests such as stress radionuclide myocardial perfusion imaging or stress echocardiography can confirm a diagnosis when a patient's history, physical exam, ECG, and cardiac biomarkers suggest the likelihood of a problem.

qas: question: How many mg of fat is suggested for a healthy person's diet?
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question: What percentage of mono-polyunsaturated fat should make up a person's daily energy requirements?
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question: What is a good replacement for olive oil?
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question: Nutritionists recommend an intake of more than 30% of what in one's diet?
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question: What controversy have dieticians largely settled?
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context: There is some controversy surrounding the effect of dietary fat on the development of cardiovascular disease. People are often advised to keep a diet where less than 30% of the energy intake derives from fat, a diet that contains less than 7% of the energy intake in the form of saturated fat, and a diet that contains less than 300 mg/day of cholesterol. Replacing saturated with mono- polyunsaturated fat is also recommended, as the consumption of polyunsaturated fat instead of saturated fat may decrease coronary heart disease. Olive oil, rapeseed oil and related products are to be used instead of saturated fat.

qas: question: What drug has been shown to have significant benefits for people at risk of an MI?
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question: Most studies tend to focus on people with what disease?
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question: People with diabetes have an increased likelihood of what side effect?
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question: Based on the lack of benefits, what has largely stopped recommending asprin?
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question: Aspirin is recommended for people with a high risk both cardiovascular disease and what?
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context: 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.

qas: question: What is the shortened way of referring to thrombolysis?
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question: PCI and what treatment must be performed within 90 to 120 minutes?
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question: How long does the PCI procedure take?
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question: What treatment is recommended after 24 hours?
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question: When must ECG evidence be taken?
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context: The main treatment for MI with ECG evidence of ST elevation (STEMI) include thrombolysis and percutaneous coronary intervention. Primary percutaneous coronary intervention (PCI) is the treatment of choice for STEMI if it can be performed in a timely manner. If PCI cannot be performed within 90 to 120 minutes then thrombolysis, preferably within 30 minutes of arrival to hospital, is recommended. If a person has had symptoms for 12 to 24 hours evidence for thrombolysis is less and if they have had symptoms for more than 24 hours it is not recommended.

qas: question: What enzymes in the body typically destroy blood clots?
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question: What is an example of a contraindication that must be present for thrombolysis?
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question: Thrombolytic drugs are given to how many people?
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question: If thrombolytic drugs are given after 6 hours of onset, what are the odds of bleeding?
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question: How many hours must pass after onset of symptoms before administering thrombolysis?
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context: Thrombolysis involves the administration of medication that activates the enzymes that normally destroy blood clots. Thrombolysis agents include streptokinase, reteplase, alteplase, and tenecteplase. If no contraindications are present (such as a high risk of bleeding), thrombolysis can be given in the pre-hospital or in-hospital setting. When given to people suspected of having a STEMI within 6 hours of the onset of symptoms, thrombolytic drugs save the life of 1 in 43 who received them. The risks were major bleeding (1 in 143) and brain bleeding (1 in 250). It is unclear whether pre-hospital thrombolysis reduces death in people with STEMI compared to in-hospital thrombolysis. Pre-hospital thrombolysis reduces time to thrombolytic treatment, based on studies conducted in higher income countries.

qas: question: When is clopidogrel removed?
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question: What is NSTEACS an abbreviation for?
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question: Clopidogrel is a form of what inhibitor?
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question: What inhibitors are used in low-risk scenarios?
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question: Eptifibatide has what kind of molecular weight?
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context: People with an acute coronary syndrome where no ST elevation is demonstrated (non-ST elevation ACS or NSTEACS) are treated with aspirin. Clopidogrel is added in many cases, particularly if the risk of cardiovascular events is felt to be high and early PCI is being considered. Depending on whether early PCI is planned, a factor Xa inhibitor or a potentiator of antithrombin (fondaparinux or low molecular weight heparin respectively) may be added. In very high-risk scenarios, inhibitors of the platelet glycoprotein αIIbβ3a receptor such as eptifibatide or tirofiban may be used.

qas: question: Cardiac rehabilitation is not an option under what circumstances?
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question: Cardiac rehabilitation often recommends ceasing what activities?
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question: What should start immediately upon registering at the hospital?
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question: When are other medical conditions address?
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context: Cardiac rehabilitation benefits many who have experienced myocardial infarction, even if there has been substantial heart damage and resultant left ventricular failure; ideally other medical conditions that could interfere with participation should be managed optimally. It should start soon after discharge from hospital. The program may include lifestyle advice, exercise, social support, as well as recommendations about driving, flying, sport participation, stress management, and sexual intercourse.

qas: question: How many classes of ST-segmentation are there?
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question: Prognosis improves after what complication?
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question: What has decreased over the years?
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question: What are some examples of ST-segment deviation?
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question: What are risk factors called?
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context: Some risk factors for death include age, hemodynamic parameters (such as heart failure, cardiac arrest on admission, systolic blood pressure, or Killip class of two or greater), ST-segment deviation, diabetes, serum creatinine, peripheral vascular disease, and elevation of cardiac markers. Assessment of left ventricular ejection fraction may increase the predictive power. Prognosis is worse if a mechanical complication such as papillary muscle or myocardial free wall rupture occurs. Morbidity and mortality from myocardial infarction has improved over the years due to better treatment.

qas: question: What is Dressler's syndrome?
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question: What does an aneurysm of the left ventricle lead to?
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question: What does mitral regurgitation cause?
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question: Atrial fibrillation can only be what kind of problem?
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context: Complications may occur immediately following the heart attack (in the acute phase), or may need time to develop (a chronic problem). Acute complications may include heart failure if the damaged heart is no longer able to pump blood adequately around the body; aneurysm of the left ventricle myocardium; ventricular septal rupture or free wall rupture; mitral regurgitation, in particular if the infarction causes dysfunction of the papillary muscle; Dressler's syndrome; and abnormal heart rhythms, such as ventricular fibrillation, ventricular tachycardia, atrial fibrillation, and heart block. Longer-term complications include heart failure, atrial fibrillation, and an increased risk of a second MI.

qas: question: What percentage of deaths does unipolar depressive disorder cause?
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question: How many people died from IHD from 1985-2015?
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question: What is the worldwide leading cause of death?
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question: What percentage of deaths will IHD be responsible for in 2030?
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question: When did IHD begin to be a bigger problem in the developing word?
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context: 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.

qas: question: What is a myocardial infarction is always considered to be?
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question: What occupation cannot have a heart attack classified as work-related?
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question: What typically covers an MI?
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question: When is an MI not considered a work-related injury?
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question: What generally treats MI as an injury?
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context: At common law, in general, a myocardial infarction is a disease, but may sometimes be an injury. This can create coverage issues in administration of no-fault insurance schemes such as workers' compensation. In general, a heart attack is not covered; however, it may be a work-related injury if it results, for example, from unusual emotional stress or unusual exertion. In addition, in some jurisdictions, heart attacks suffered by persons in particular occupations such as police officers may be classified as line-of-duty injuries by statute or policy. In some countries or states, a person having suffered from an MI may be prevented from participating in activity that puts other people's lives at risk, for example driving a car or flying an airplane.