Infarction

• ALSO KNOWN AS: Heart attack, stroke, acute abdomen
• ANATOMY OR SYSTEM AFFECTED: Blood vessels, brain, heart, intestine, kidneys, lungs
• CAUSES: Lack of blood supply from obstruction, blockage, or spasm of the blood vessel supplying affected organ
• SYMPTOMS: Pain, ischemia, necrosis
• DURATION: Acute
• TREATMENTS: Bed rest, oxygen, thrombolytic medications, nitroglycerine, morphine, stool softeners, low-sodium diet, surgery

DEFINITION: A localized area of tissue damage or necrosis caused by the absence of blood supply and oxygen to the part

Causes and Symptoms

“Infarct” is the term used to indicate a localized area of necrosis resulting when the blood supply to an area falls below the level required for cells to survive. Infarction results from the obstruction of an artery at a point that causes the main blood supply to be blocked. It also occurs when the tissue requirements are raised above the capacity of the diseased vessels to deliver blood. Although an infarction may occur in any tissue, those that require a large supply of blood are particularly vulnerable. Organs in which infarctions are commonly found are the brain, heart, intestine, kidney, and lung. The consequences of an infarction depend on its location and extent. If the infarcted area is extensive enough, then the function of the organ is compromised, and death or disability may result. A large infarct in a vital organ such as the heart, lung, or brain may be responsible for sudden death.

Symptoms related to infarction include the development of tissue ischemia. The most marked manifestation of acute ischemia is pain. Fear and anxiety are other symptoms that may be exhibited. Myocardial infarction, commonly called a heart attack, is classically associated with a characteristic diagnostic triad. First, there is a clinical picture consisting of severe, prolonged chest pain, frequently associated with sweating, nausea, vomiting, and a sense of impending doom. Second, serum levels of the cardiac enzymes released by the necrotic myocardial cells are elevated. Finally, electrocardiographic changes are evident.

Treatment and Therapy

Acute myocardial infarction requires immediate admission to a hospital with a coronary care unit. Continuous close monitoring of cardiac rhythms and enzymatic changes is especially important. The first twenty-four hours after the onset of symptoms is the time of highest risk for sudden death. Myocardial infarction caused by intracoronary thrombi (clots) can be relieved by infusion of thrombolytic agents that dissolve the clots and promote vasodilation. The treatment must be performed within three to four hours after the onset of infarction and can reestablish blood flow in approximately three minutes. Angioplasty to open blood vessels that are blocked or narrowed is often the first choice of treatment and should be performed as soon as possible, and no more than twelve hours after a heart attack. A stent may be placed during or after angioplasty to help keep the artery open. Bed rest followed by a gradual return to activities of daily living reduces the myocardial oxygen demands of the compromised heart.

Pain relief is of utmost importance. If sublingual nitroglycerin is ineffective, then small, carefully titrated doses of morphine sulfate may be given for sedation and vasodilation. Supplementary oxygen is administered to increase arterial oxygen content and deliver more oxygen to the ischemic myocardium. Dietary measures are aimed at preventing nausea and vomiting, and consumption of sodium, saturated fats, sugar, and caffeine is limited. In addition to pain relief, pharmacologic intervention is used to limit infarction size, reduce vasoconstriction, prevent thrombus formation, and augment repair. Treatment for infarction of the brain, kidney, and bowel may require surgery to reestablish circulation and remove necrotic tissue.

Into the mid-2020s, guidelines emphasized rapid intervention for infarction, with angioplasty and stenting preferred over thrombolytic drugs whenever possible. Early mobilization after stabilization was encouraged to reduce complications, while supplemental oxygen was reserved for patients with low blood oxygen levels. Additional therapies, such as antiplatelet agents, statins, beta-blockers, and angiotensin-converting-enzyme (ACE) inhibitors, were routinely used to improve outcomes and prevent recurrence. Treatment for infarction in other organs, including stroke, also emphasized prompt reperfusion and organ-specific management.

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