(Warning: This is a poem, not written as any medical advice, but for entertainment, awareness and general informational purposes only. Also please keep in mind that medicine is constantly changing.)

Myocardial infarction

Is the medical jargon

For heart attack.

What it usually implies

Is that the blood supply

In some part of the heart

Has been impaired or lost

And as a cost

That part of the heart muscle

Has suffered a struggle

And was damaged

And because it was not timely managed

Now it is dead,

Soon to be replaced

By scar tissue

Which cannot function as heart

And may raise other issues

On top of the pump failure –

Such as disturbances of electrical signals

In and around such tissues

Causing rhythm abnormalities.

For a damaged heart

That is already compromised

These things in the worst case

May cause the ultimate demise.

Because when the rhythm is too bad

The situation become even more sad

As the failing muscle is already struggling

Pumping gets even more inefficient –

Time for filling the heart

With blood

May not be sufficient,

Squeezing may be weak and deficient.

In such critical moments

Beating in the appropriate rhythm and rate

May become so important

That unless things are brought under control

Sudden death may be the ultimate toll.

 

Blockages or plaques

And blood clot formation

Are the most common reasons

For arterial obstructions

Limiting or halting their circulation

In any tissue or organ.

 

Heart’s function

Is its pumping action.

This is achieved

Through the contraction

Of millions of its muscle cells

In unison.

Each muscle cell to contract

It needs electrical stimulation

To start

The sequence of events.

This stimulation is generated

By the pacemaker cells,

That are situated

At a specific location of the heart

Known as the Sinoatrial (SA) node.

Then this impulse has to spread out

Through an elaborate network

Of electrical grid,

All of these have to function properly

In order for the heart to succeed.

The rhythmic beats

That we feel

Is the result

Of the pacemaker impulses

Causing the heart to squeeze and relax

Resulting in the ejection of the blood

And then refilling,

So that the cycle can continue

And life is able to do its dealings.

When things are normal

SA node should be driving the heart

And normal sinus rhythm should be showing

In the EKG chart.

Pacemaking coming from any other location

Gives abnormal rhythm, arrhythmia, not a normal condition.

Some kind of trouble this may imply

Further tests may be needed

In order to get some reply.

 

Heart attack

When someone has been struck –

It is a very serious matter

As the heart may lose its ability

To pump blood throughout the body

Adequately,

That can cause death or disability,

Can affect their ability

To enjoy their life

The same way again

Even if they survive.

 

The symptom usually

Can start with a pain

Usually in the mid or left side

Or may be felt in the entire chest,

Pain may be hard to localize

To any particular point,

It is usually not like a pain

That can be felt in any other joint.

Can happen while they are doing something

Or when they are at rest,

Pain may feel like pressure or heaviness,

Some people felt

As if an elephant has been

Sitting on their chest.

Many other sensations and descriptions –

Tightness, burning and chest discomfort

Fullness, constricting or crushing

Squeezing, heart burn or lump in the throat.

 

Pain may radiate

To the arm, shoulder, hand and back

And sometimes to the neck and jaw

May feel like

As if being attacked

By some kind of a viscous claw.

Shortness of breath, nausea and vomiting

Palpitations, irregular rhythm and sweating

Fatigue, dizziness or fainting

A feeling of doom and restlessness

Unable to feel at ease

In any particular position or place.

List of symptoms is quite large

As human beings are so different and so diverse.

Symptoms can be typical or atypical,

Sometimes can be silent

But often time sudden,

Drastic

And dramatic.

Also can mimic

Many other conditions

That is described

In medical books and publications.

Careful history, exams, tests and expertise

Are usually needed

To make the correct diagnosis.

Treatments need to be started without delay

So that the worst scenarios have no chance to replay.

Time is of the essence

To be able to save the muscles

And to be able to lessen

Their pains and their struggles.

Coronary arteries

With plaques and blood clots

Are where the roots

Of this problem sit.

For this reason

Coronary Artery Disease

Is mentioned

In the patient’s diagnosis and prognosis.

 

To survive

All cells need nutrients and oxygen

Which the body send

Through blood flow – the circulation.

And when this is reduced or absent

The affected cells then

Get damaged

And with the prolongation

Of this damaging condition

The unfortunate cells have nothing

But death as their only option.

For life’s continuation

Body is unable to take any break or pause

From its circulation.

 

Two terms – ischemia and infarction

Are used to describe this situation.

When blood flow is inadequate

Creating a low oxygen state

The phenomenon is called ischemia.

And ischemic cells and tissues start to suffer

Damages from which they cannot recover

Unless proper circulation is restored.

When ischemia is severe and persistent

Damages are irreversible

And death comes at the end,

This is infarction –

The cells and tissues are dead by definition

To be exact,

And what has been created

Is called an infarct.

 

Even with blockages in arteries

Ischemia may not be apparent

As long as the tissue’s demand for oxygen

Is being met

Through the circulation that is present.

But when the demand exceeds supply

Ischemia sets in and its effects start to apply

Damaging the cells initially

And killing them eventually.

 

Chest discomfort and pain

Related to cardiac (heart related) ischemia

Is known as angina.

 

Muscles of the heart

Are called myocardium

Whose oxygen demand

Depends on various factors

Such as activity level, heart rate and blood pressure.

 

Plaques or blockages

May remain silent without symptoms

In some cases,

Until due to their erosion or rupture

Blood clot forms and make the picture

Suddenly worse

Causing a heart attack out of the blue,

Prior to this patient might not have

Any clue.

 

So

With plaques and blockages

Symptoms may not appear

Until oxygen demands of the tissue

Are high enough

To cause the issue

Of ischemia.

Or until there is a sudden complete block

That may result from

Some kind of blood clot.

 

Chronic blockages

Can trigger formation

Of collateral circulation

Which are small blood vessels

That sprout out,

The blocked artery may also try

To broaden its rout

By arterial dilatation.

These are compensatory mechanisms

Helping the tissues to cope and survive

But also may be playing a role

To hide

The symptoms and the underlying conditions.

 

Blood

Starts at the heart

Flowing out

Through the biggest vessel

Which we call

The Aorta

Which then starts sending branches

To tissues and organs as it advances.

 

Left and right coronary arteries

Are the 2 vessels that goes into

The heart’s own territories.

They go inside its muscles

Branching out like trees

Supplying blood to these cells

And also to the network of electrical system

Whose job is to generate and maintain

The rhythm

So that the heart can do its beating

Acting as a pump

And thus creating and sustaining

The survivability

Of all of the cells of the entire body,

As without the adequate continuity

Of this blood flow

Cells suffer the blow

Of lacking oxygen and nutrients

And also their toxic byproducts

Start to build up,

So the cells are damaged

And then they start to die

Infarction is the medical term

That happens right in front of our eyes.

 

For example

Strangulation

Of a finger

With a tight rope or a string –

It turns blue quickly

That can be easily seen.

If the flow of blood

Is not allowed to restart

Soon

The finger will start to die

In front of our very eyes,

Its color turning black

Telling us that due to the lack

Of oxygen

The finger now has

Turned into an infarct

Which now is impossible to revert.

Amputation is the only solution,

Many diabetics and smokers

Suffer from this condition,

As due to blockages in the limb arteries

Limbs or toes may suffer infarction,

And when this happens

Then they must be removed

Through surgeries.

 

Same exact thing goes on

In any tissue or organ,

Constant blood flow needs to be maintained

For them to remain alive

And carry out the functions of life.

 

Reduction in blood flow

When happens

In the entire brain

It causes you to slow down

May be even faint.

Severe obstruction,

Usually from plaques and blood clots,

In a limited area but persistent

Ends up causing

Cerebrovascular Accident,

Also known as stroke

Where that part of the brain

Is now dead

And has turned into an infarct,

It has lost all of its abilities

And all of its arts.

 

When plaques build up

In the arteries of our gut,

Or it could be blood clot

Coming from the heart,

Causing obstruction

In the circulation

Of our intestines –

This condition

Is known

As mesenteric ischemia,

Which can cause

Symptoms of abdominal pain after eating,

And patients may feel like

Taking a pause

From food

Because of fear of pain,

And thus they may start to lose

Their weight.

They may have other symptoms including

Nausea and vomiting

Constipation, diarrhea and rectal bleeding.

May lead to complications –

Such as

Bowel infarction, perforation

Severe infection, low blood pressure or hypotension

Shock and death.

 

Plaques in leg arteries

Can cause ischemia during walking.

Patients feel pain in the muscles

Claudication is the name of this thing.

Left untreated and when it gets worse

Their legs they may end up losing.

For this disease a major cause

Is known to be smoking.

 

Over time for various reasons

Arteries in their walls

Can build up

Atherosclerotic plaques

Which are sticky substances

That causes

Narrowing in the diameter

Of their internal lumen

Which causes the reduction

In the flow of blood.

During normal activities

This flow may remain adequate

For their oxygen need.

But when oxygen demands are high

Then this supply

May not be enough.

This is how ischemia will usually start

And unless steps are taken to revert

Symptoms usually will begin to appear

Sooner or later,

Such as pain and other discomfort,

The tissue or organ

May not be able to carry out

Its normal functions.

As the plaque gets larger

The lumen gets narrower,

As ischemia gets worse

Symptoms tend to get more severe

And sharper.

 

When this happens in the heart

Chest symptoms as described earlier

May start,

Depending on the amount

And the territory of muscles affected

In the Severity of symptoms this will be reflected.

Or if the cells controlling the electrical network

Are damaged or disturbed

Rhythm abnormalities may start

And on EKGs this can be observed.

 

Plaque development

Is a slow process

Does not happen in a moment.

Patients may not notice anything initially

But with the progression of severity

Symptoms may come slowly,

Limiting exercise tolerance

Such as –

Going up on the stairs

Or  heavy activity

Or even vigorous romance –

That may trigger

Chest discomfort, shortness of breath

And other symptoms

By which

Patents may notice

That something is wrong.

Symptoms usually stops

Soon after the exertion is dropped.

Such symptoms

If suspected to be coming from

Cardiac ischemia

Then they are called

Stable angina,

For which the underlying usual cause

Is some kind of plaque or plaques

Causing partial loss

Of circulation

In some coronary arteries.

This then in order to confirm

Further tests will have to be done.

 

To figure this out –

Stress test, echocardiogram and coronary angiogram

CT scan, MRI or some other imaging program,

Are some of the possible routs –

That their physicians may decide to take,

These and other tests they may want to run

So that the correct diagnosis

They are able to make.

 

When cells are in distress or dead

They may break

And or release their products and contents,

These are what blood tests

Usually try to detect.

 

Stress tests

Try to stress the heart

To see if any ischemia can be induced,

And if symptoms can be reproduced.

With EKG tracings

In conjunction with special imaging

Effects of any plaques or blockages

Can be indirectly seen.

 

Coronary angiogram

Tries to do a more direct visualization

Of the coronary circulation.

A special type of dye is injected

Which flows through the arteries,

Then special beams of X-rays are directed

Casting a shadow of the arterial trees.

Blockages or plaques appear as filling defects

Inside the lumen of the blood vessels.

And this effect

Helps estimate

The size and the location

Of the blockage in this circulation.

 

Echocardiogram

Shows the structure and the function

Of the heart.

Ischemic muscles will usually start

To show abnormal motion

And if this is seen

Then it will be an indication

Of some sort of blockage

In this circulation.

Location

Of this abnormal motion

Can help estimate

The arteries that are affected.

After a heart attack

The affected muscle is dead, becomes an infarct,

Which does not move or contract.

This is one way of confirmation

That there was a myocardial infarction.

 

Just by seeing a plaque or blockage

In any imaging or test

It may not be always possible to sense

What would be its clinical significance.

Symptoms and other clinical information is necessary

To have an idea about any chance of any future misery.

When blockages become flow limiting 

Ischemic symptoms patient will start exhibiting –

Such as during

A heart attack or acute myocardial infarction

Or during a stress test when

Ischemia sets in

As a result of myocardial (heart muscle) oxygen demand increasing.

 

Heart attack

Usually is a sudden phenomenon,

And the underlying reason

Is the sudden formation

Of a blood clot,

Which is usually due to

A plaque rupture or plaque erosion,

Where a previously vulnerable plaque

Was causing only partial disruption

In the heart’s own circulation,

Suddenly a rupture appears

Causing blood clot to form

Inside the lumen

Of the coronary artery

Where this happens,

And thus setting off the storm

Of

More severe or complete blockage,

And heart attack becomes the resulting case.

 

Even without rupturing

Some plaques may be vulnerable

In producing

Blood clots,

Due to their erosion,

Leading to loss of flow

And inducing

A myocardial infarction.

 

Acute coronary syndrome

Is the collective term

Used to include conditions

Such as

Myocardial infarctions

And another related diagnosis

Called unstable angina,

Underlying all of which

In most of the cases

Is the acute phenomenon

Of sudden formation

Of blood clots

Formed in and around plaques

That are vulnerable or prone

Due to

Rupture or erosion.

 

In the arteries

Plaques are defects

That stress tests or coronary angiogram

Usually are able to detect

Including their effects.

But whether any of them will break

Or if any of them have eroded

This possibility

They are unable to predict or check.

So the vulnerability of plaques

These tests do not reflect.

Because of this limitation

Despite being not so large

In any test, image or calculation

A plaque can rupture or may have erosion

And by forming a clot

Become the cause

For the pause

Of the coronary circulation

In that particular artery

Causing the misery

Of a myocardial infarction.

So sometimes

Plaques may be too small to be detectable

Or their blockage on the flow

May not seem appreciable,

But they still may end up causing

Such big and devastating trouble.

 

Severity of this attack

Depends on how large

Is the infarct

And its location.

Pumping capability

Is affected accordingly

And the electrical system

May suffer similarly

Causing problem

In the rhythm.

A blockage

Which is located

Higher up in the arterial tree

Usually causes

More severe issues

As it is supplying

Larger areas of the tissues.

For instance

Disease in the left main branch

Usually causes the biggest concern

As it supplies the largest territory,

Severe blockage in this one

Has earned itself the category –

Of being the ‘widow maker’

As massive heart attacks

Resulted from its attacks

And many victims unfortunately had

No chance of recovery.

 

Heart attack – the causes

Other than the plaques and the blockages

Are such as –

Drugs and coronary artery spasm.

For example cocaine

Has many deleterious effects

On cardiovascular system

Among them –

As it puts the heart on overdrive

It can quickly raise blood pressure

Known as acute hypertension,

And can also cause coronary arteries to spasm,

Which may result,

In this setting of high oxygen demand,

In a myocardial infarction.

Coronary artery dissection

And coronary microvascular dysfunction

Are 2 other rare reasons.

 

Demand ischemia

May happen

In a heart with normal (or compromised) circulation

Where it was doing OK in normal circumstances.

But under excessive stress

Such as surgery or a severe illness

The limitations may show up

As heart muscles may not be able to keep up

Because the demands for its oxygen may be too high

For its circulation to supply.

In such cases

Even in the absence of any blockages

Heart cells may end up suffering damages

From this demand ischemia as their underlying causes.

 

Heart and its muscles

Can suffer damages

From many other causes

That does not depend

On lack of oxygen.

 

For acute coronary syndromes

Including heart attacks or myocardial infarctions

Some of the treatments

In the hospital

During or around these acute events

May include attempts –

To reduce the cardiac (heart’s) oxygen demand

By lowering heart rate and blood pressure

As needed and if appropriate,

To control the rhythm,

To remove the obstruction

By blood thinners, clot busters, bypass surgery

Angioplasty or stents,

To control symptoms

And other contributing factors

With oxygen and medications.

 

After a heart attack –

If the muscle damage was significant

Deficiency in the pumping

Can become apparent,

Congestive heart failure is the diagnosis

Shortness of breath and leg swelling

Is usually what the patient feels and sees.

If heart failure is bad enough

Maintaining the normal rhythm may become tough.

Some patients may need defibrillators

Which are shocking devices

That tries to shock the heart back to a normal rhythm

From some types of arrhythmia

That the patient may be suffering from.

Symptoms of inadequate pumping

Are managed by dumping

The excess water that these patients tend to retain,

As sensing inadequate flow

More volume body wants to gain

As a normal circulation it wants to maintain.

And there are other medications

To counteract the adverse actions

That the body tends to suffer,

Modern medicine is coming up with

So many good things to offer.

 

Having a heart attack

Increases the chance

Of having another one

Down the track.

 

What causes plaques?

Some of the risks factors

For this violent actors

Are –

Family history – our genes

And the things that we do as our routine

Also known as lifestyle –

Fatty food, smoking and inappropriate drinking

Physical inactivity, obesity, incorrect way of thinking.

Illegal drugs such as cocaine and some others

All of these have been found to have the linking

Towards the clogging of our arteries and towards the sinking

To such a devastating state.

As our genes cannot be replaced

Changing lifestyle and taking the necessary steps

To control other contributing factors

Such as medical conditions –

Diabetes, cholesterol and hypertension,

Can make a significant difference

In reducing the chances

Of getting these plaques

Or lowering their severity

Or slowing down their progression.

 

Aging is another thing

That brings clogging

In our plumbing.

 

Diabetes, high blood pressure and high cholesterol

Are known to cause trouble,

Such as plaques,

To our blood vessels.

They are at the top of the list

Of common conditions that must be addressed

In order to save our plumbing

From this kind of a mess.

Smoking is a serious culprit,

Need to quit

In order to defeat

These plaques and the miseries that they are able to inflict.

Maintaining proper weight, eating healthy and physical activity

Help keep our blood vessels looking nice, clean and pretty.

 

These are some of the modifiable risk factors

Modification of which may keep plaques – the violent actors

Out of our circulation beds,

Or at least they may be able to keep these unwanted guests

In check.

 

There is no sense

In crying over our genes

As currently,

Even with technologies for gene editing

Such as CRISPR,

We don’t have any practical method

To make them ‘cleaner’

Safely,

As too many genes are involved

And trying to ‘edit’ all of them

Will create more issues than can be solved.

By –

Kris Mojag

Written somewhere in California over a few days in October of 2021 when the weather is going through heat and cold.