Myocardial Infarction

Myocardial InfarctionFamily Planning Association

KandunganPengenalanFaktor Risiko dan cara mencegah serangan jantungRawatan

IntroductionMyocardial Infactionresults from the interruption of blood supply to a part of the heart, causing heart cells to die

Myocardial InfarctionMost commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque

ArtherosclerosisGumpalan Kolestrol, lemak dan sel-sel darah putih di dalam dinding salur darah, menyebabkan penyempitan salur darahJika dibiarkan tidak dirawat, akan menyebabkan kematian sel-sel jantung

Myocardial InfarctionTypical symptoms of acute myocardial infarction include sudden chest pain (typically radiating to the left arm or left side of the neck), shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety (often described as a sense of impending doom)Symptoms more then 20 minutes

Myocardial InfarctionWomen may experience fewer typical symptoms than men, most commonly shortness of breath, weakness, a feeling of indigestion, and fatigue.[2]

Myocardial Infarction] A sizeable proportion of myocardial infarctions (2264%)[3] are "silent", that is without chest pain or other symptomsCommon - Elderly, Diabetes Mellitus

Risk Factors

10StressContinuous stress can promote and accelerate the development of high BP

Anxiety and stress:cause narrowing of arteryIncrease BPCause hypertension

Stress:Releases hormones (catecholamines?)Causes increased LDL

AgeDominant influenceDeath rates increase with each passing decadeAs Clinically evident in middle age or laterBetween ages 40 60, MI incidence 5 times

SexMales more prone than femalesAtherosc and sequelae uncommon in pre menopausal femalesAfter menopause incidence increasesDecreased natural estrogen levelsEstrogen improves endothelial function thus playing a protective role

Genetics

HyperlipidaemiaMajor modifiable risk factor Specifically HypercholesterolemiaElevated levels sufficient to stimulate development of AS in absence of other risk factorsLDL transports cholesterol to peripheral tissuesIncreased LDL = increased risk

HDL mobilizes cholesterol from developing and existing atheroma and transports it to liver for excretion in bileincreased HDL = lower risk increased: after exercise, moderate consumption of alcoholdecreased: in obesity & smokingLDL- Bad cholesterolHDL Good cholesterol

16 CholesterolPlants do not contain cholesterol but contain beta-sitosterol, which competes with cholesterol for absorption

Cholesterol is found only in animal food sources, and is associated with animal fat

Review

17

Oxidants vs. Antioxidants: TocotrienolsOxidants promote the oxidation of lipids, proteins and nucleic acids

Antioxidants prevent the oxidation of lipids, proteins and nucleic acidsAntioxidants include vitamins C and E

Vitamin E is grouped as tocotrienols

Tocotrienols prevent breast cancerTocotrienols act as statin

18Palm oil

19Coconut milk (santan)Review

Santan is rich in long chain FA, especially myristic acid (C14:0)

20Breakfast

ReviewPengat pisang is bananas + santan + water + coconut sugar +pandan + clovesLompat tikam is pulut + pandan + coconut + siraNasi lemak is a balanced meal

21TFA in infant milk formulasTFA = trans FA

Trans monoene level in animal fat = 5 8%

Should we reduce trans monoene level in infant milk formulas?Susu ibu adalah susu yang paling baik untuk bayi Manusia!

22FA, hypercholesterolemia & CVD riskMyristic acid (C14:0)Medium chain FAForms medium chain triglycerides (MCT)Found in santan, palm kernel oil

Coconut milk (santan) and palm kernel oil (minyak kelapa sawit) are rich in myristic acid

23Fruits do not contain cholesterol; they contain fibre & antioxidants (vit. C & flavinoids)

Review

24Vegetables do not contain cholesterol; they contain folic acid

ReviewHigh folic acid lowers homocysteine in bloodHigh homocysteine (hyperhomocysteinaemia) is associated with CHD

25Milk, milkshakes and burgers contain high fat and high cholesterol

ReviewBurgers contain 22% fatEgg banjo is fried in chicken fatMilkshake is full cream milk + egg + glucose + cooking oil + waterGoats milk is low fat

Skimmed milk is low fat but fortified with vitamins

26Eggs have high phospholipids and high cholesterol

Review

Maggi mee is egg noodles and high in cholesterolMi kuning is egg noodles and also rich in cholesterol

27Soy- & tofu-based foods have high phospholipids but no cholesterol

ReviewSoy sauce (kicap) is soy bean + Aspergillus niger + artificial sugar + MSG

Artificial sugar has been linked to cancer

28Seafood has high cholesterol

ReviewSeafood with high cholesterol include: cuttlefish, prawn, shrimp, lobster, crabSambal sotong causes hypertension!

29Breakfast food is high fat, high carbohydrate, variable cholesterol

Review

Bread & potatoes are low-fat

Soft margarine is higher in PUFA and lower in trans FA than hard margarine

30Glutinous rice (pulut) is high gluten, high carbohydrate

ReviewPulut hitam has bran left on and is high in riboflavinPulut manis (wajik) is pulut rice + coconut sugar (gula melaka/ gula keret) + sugarNasi dagang rice is pulut rice with bran left on (high in riboflavin) + santanAll pulut rice are rich sources of gluten and carbohydrate, and are fattening

31Frying adds oil to food; fried foods are fattening

ReviewFritters (cucur) are oily as they absorb frying oil

32Meat is high fat, high cholesterol

ReviewMeat is dense, many muscle cells, highly nucleated, source of uric acid from DNA breakdown. High meat intake leads to gout which often accompanies CHD

Beef soup is a rich source of saturated FA and cholesterol

33Chicken has high saturated FA in the fat under the skin and high cholesterol

ReviewChicken is safe if skin is removed and steamed to remove all traces of fatChicken curry is chicken + santan + water + curry powder + chicken cube (chicken fat + MSG + salt)

34Fish has high PUFA and low cholesterol

ReviewSardine curry is sardine + chili + santanSardine sambal is sardine + chiliFish ball is fish + starch +salt

Fried fish is very oily. Pencicah ikan bakar is chili + water + vinegar + salt

Lemak ikan & fish curry is fish + santan + fresh chili or curry powderDried fish causes GI cancer

35Malaysian 1999 Dietary GuidelinesTotal dietary fat20 30%PUFA as LA (18:2, n-6)4 7%n-3 FA (ALA + EPA + DHA)0.4 1.2% kcaln-6:n-3 FA ratio5 10:1MUFA (eg, olive oil)MaximiseTFA (esp. t18-1 in hydrogenated oils)MinimiseMyristic acid (14:0) in santan & palm kernel oilMinimiseHypercholesterolemic patients6 7% LADietary cholesterol