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 (including serious types), cardiogenic shock, or cardiac arrest.
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.
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 of 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.
Worldwide, about 8.6 million myocardial infarctions occurred in 2013. More than 3 million people had an ST elevation MI and more than 4 million had an NSTEMI. STEMIs occur about twice as often in men as women. About one million people have an MI each year in the United States. In the developed world the risk of death in those who have had an STEMI is about 10%. Rates of MI for a given age have decreased globally between 1990 and 2010., A disease is a particular abnormal condition, a disorder of a structure or function, that affects part or all of an organism. The study of disease is called pathology which includes the causal study of etiology. Disease is often construed as a medical condition associated with specific symptoms and signs. It may be caused by external factors such as pathogens, or it may be caused by internal dysfunctions particularly of the immune system such as an immunodeficiency, or a hypersensitivity including allergies and autoimmunity., Stroke is when poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. They result in part of the brain not functioning properly. Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, feeling like the world is spinning, or loss of vision to one side. Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than one or two hours it is known as a transient ischemic attack (TIA) or mini-stroke. A hemorrhagic stroke may also be associated with a severe headache. The symptoms of a stroke can be permanent. Long-term complications may include pneumonia or loss of bladder control.
The main risk factor for stroke is high blood pressure. Other risk factors include tobacco smoking, obesity, high blood cholesterol, diabetes mellitus, previous TIA, and atrial fibrillation. An ischemic stroke is typically caused by blockage of a blood vessel, though there are also less common causes. A hemorrhagic stroke is caused by either bleeding directly into the brain or into the space between the brain's membranes. Bleeding may occur due to a ruptured brain aneurysm. Diagnosis is typically with medical imaging such as a CT scan or magnetic resonance imaging (MRI) scan along with a physical exam. Other tests such as an electrocardiogram (ECG) and blood tests are done to determine risk factors and rule out other possible causes. Low blood sugar may cause similar symptoms.
Prevention includes decreasing risk factors, as well as possibly aspirin, statins, surgery to open up the arteries to the brain in those with problematic narrowing, and warfarin in those with atrial fibrillation. A stroke or TIA often requires emergency care. An ischemic stroke, if detected within three to four and half hours, may be treatable with a medication that can break down the clot. Aspirin should be used. Some hemorrhagic strokes benefit from surgery. Treatment to try recover lost function is called stroke rehabilitation and ideally takes place in a stroke unit; however, these are not available in much of the world.
In 2013 approximately 6.9 million people had an ischemic stroke and 3.4 million people had a hemorrhagic stroke. In 2010 there were about 33 million people who had previously had a stroke and were still alive. Between 1990 and 2010 the number of strokes which occurred each year decreased by approximately 10% in the developed world and increased by 10% in the developing world. In 2013, stroke was the second most frequent cause of death after coronary artery disease, accounting for 6.4 million deaths (12% of the total). About 3.3 million deaths resulted from ischemic stroke while 3.2 million deaths resulted from hemorrhagic stroke. About half of people who have had a stroke live less than one year. Overall, two thirds of strokes occurred in those over 65 years old., Substituted amphetamines are a class of compounds based upon the amphetamine structure; it includes all derivative compounds which are formed by replacing, or substituting, one or more hydrogen atoms in the amphetamine core structure with substituents. The compounds in this class span a variety of pharmacological subclasses, including stimulants, empathogens, and hallucinogens, among others. Examples of substituted amphetamines are amphetamine (itself), methamphetamine, ephedrine, cathinone, phentermine, mephentermine, bupropion, methoxyphenamine, selegiline, amfepramone, pyrovalerone, MDMA (ecstasy), and DOM (STP)., A muscle relaxant is a drug that affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics. Neuromuscular blockers act by interfering with transmission at the neuromuscular end plate and have no central nervous system (CNS) activity. They are often used during surgical procedures and in intensive care and emergency medicine to cause temporary paralysis. Spasmolytics, also known as "centrally acting" muscle relaxants, are used to alleviate musculoskeletal pain and spasms and to reduce spasticity in a variety of neurological conditions. While both neuromuscular blockers and spasmolytics are often grouped together as muscle relaxants, the term is commonly used to refer to spasmolytics only., Mephentermine is a cardiac stimulant. It was formerly used in Wyamine nasal decongestant inhalers and before that as a stimulant in psychiatry., A pandemic (from Greek  "pan" "all" and  "demos" "people") is an epidemic of infectious disease that has spread through human populations across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic. Further, flu pandemics generally exclude recurrences of seasonal flu. Throughout history, there have been a number of pandemics, such as smallpox and tuberculosis. One of the most devastating pandemics was the Black Death, killing over 75 million people in 1350. The most recent pandemics include the HIV pandemic as well as the 1918 and 2009 H1N1 pandemics., Substance abuse , also known as drug abuse , is a patterned use of a drug in which the user consumes the substance in amounts or with methods which are harmful to themselves or others , and is a form of substance - related disorder . Widely differing definitions of drug abuse are used in public health , medical and criminal justice contexts . The exact cause of substance abuse is not clear , with theories including : a genetic disposition ; learned from others - or a habit which if addiction develops , manifests as a chronic debilitating disease . Drugs most often associated with this term include : alcohol , substituted amphetamines , barbiturates , benzodiazepines ( particularly alprazolam , lorazepam , diazepam and clonazepam ) , cocaine , methaqualone , cannabis and opioids . In some cases criminal or anti-social behavior occurs when the person is under the influence of a drug , and long term personality changes in individuals may occur as well . In addition to possible physical , social , and psychological harm , use of some drugs may also lead to criminal penalties , although these vary widely depending on the local jurisdiction . Substance abuse is widespread with an estimated 120 million users of hard drugs such as cocaine , heroin , and other synthetic drugs . In 2013 drug use disorders resulted in 127,000 deaths up from 53,000 in 1990 . The highest number of deaths are from opioid use disorders at 51,000 . Cocaine use disorder resulted in 4,300 deaths and amphetamine use disorder resulted in 3,800 deaths . Alcohol use disorders resulted in an additional 139,000 deaths ., Methaqualone, sold under the brand name Quaalude (\kw-lüd\) in the US and Mandrax in the UK and South Africa, is a sedative and hypnotic medication. It is a member of the quinazolinone class.
The sedativehypnotic activity of methaqualone was first noted by researchers in the 1950s. In 1962, methaqualone was patented in the US by Wallace and Tiernan. Its use peaked in the early 1970s as a hypnotic, for the treatment of insomnia, and as a sedative and muscle relaxant., Public health refers to "the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals." It is concerned with threats to health based on population health analysis. The population in question can be as small as a handful of people, or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). The dimensions of health can encompass "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity," as defined by the United Nations' World Health Organization. Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics and health services. Environmental health, community health, behavioral health, health economics, public policy, insurance medicine, mental health and occupational safety and health are other important subfields., Cocaine, also known as coke, is a strong stimulant mostly used as a recreational drug. It is commonly snorted, inhaled, or injected into the veins. Mental effects may include loss of contact with reality, an intense feeling of happiness, or agitation. Physical symptoms may include a fast heart rate, sweating, and large pupils. High doses can result in very high blood pressure or body temperature. Effects begin within seconds to minutes of use and last between five and ninety minutes. Cocaine has a small number of accepted medical uses such as numbing and decreasing bleeding during nasal surgery.
Cocaine is addictive due to its effect on the reward pathway in the brain. After a short period of use, there is a high risk that dependence will occur. Its use also increases the risk of stroke, myocardial infarction, lung problems in those who smoke it, blood infections, and sudden cardiac death. Cocaine sold on the street is commonly mixed with local anesthetics, cornstarch, quinine, or sugar which can result in additional toxicity. Following repeated doses a person may have decreased ability to feel pleasure and be very physically tired.
Cocaine acts by inhibiting the reuptake of serotonin, norepinephrine, and dopamine. This results in greater concentrations of these three neurotransmitters in the brain. It can easily cross the bloodbrain barrier and may lead to the breakdown of the barrier. Cocaine is made from the leaves of the "coca" plant which are mostly grown in South America. In 2013, 419 kilograms were produced legally. It is estimated that the illegal market for cocaine is 100 to 500 billion USD each year. With further processing crack cocaine can be produced from cocaine.
After cannabis, cocaine is the most frequently used illegal drug globally. Between 14 and 21 million people use the drug each year. Use is highest in North America followed by Europe and South America. Between one and three percent of people in the developed world have used cocaine at some point in their life. In 2013 cocaine use directly resulted in 4,300 deaths, up from 2,400 in 1990. The leaves of the "coca" plant have been used by Peruvians since ancient times. Cocaine was first isolated from the leaves in 1860. Since 1961 the international Single Convention on Narcotic Drugs has required countries to make recreational use of cocaine a crime., Subject: substance abuse, Relation: medical_specialty, Options: (A) emergency medicine (B) infectious disease (C) pathology (D) psychiatry (E) surgery
Output: psychiatry