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Understanding Acute Myocardial Infarction in the Wake of Sushmita Sen's illness

Sushmita Sen, a well-known Bollywood actress and former Miss Universe was born on the 19th of November, 1975. After her reign as Miss Universe, Sushmita Sen became an actress and ruled millions of hearts. She has received numerous awards till date including the IIFA award, the Rajiv Gandhi award, and two Filmfare awards.

Sushmita Sen

Sushmita Sen, in her InstaLive, mentioned her heart attack (myocardial infarction) and how she probably survived it because of her active lifestyle and this was reiterated by her cardiologist. She also spoke about the angioplasty that she underwent. Reports say that she was diagnosed with Addison’s disease in 2014 and was taking steroids to manage the illness. It's worth noting that Satish Kaushik, another well-known actor, recently passed away due to a heart attack.

What is myocardial infarction?

Myocardial infarction is a term used for an event that occurs due to the formation of plaques in the interior walls of the arteries resulting in reduced blood flow to the heart and injuring the heart muscles because of a lack of oxygen supply. An MI results in irreversible damage to the heart muscle due to a lack of oxygen. An MI may lead to impairment in diastolic and systolic function. Acute myocardial infarction is a term used to describe a sudden onset of myocardial infarction symptoms

Unhealthy dietary habits and lifestyle lead to the development of fatty deposits or plaques on the walls of the coronary arteries. As the plaque builds up in the heart over time, it can lead to blockage, preventing blood in the arteries from reaching some parts of the heart muscle. This results in cardiac ischemia, a condition where a portion of the heart is deprived of oxygen. If this is not treated in time, the heart tissues begin to die, leading to a heart attack, or myocardial infarction.

Myocardial infarction is one of the most common causes of fatality worldwide. Globally, the prevalence of the disease approaches three million people. In accordance with the World Health Organization, India accounts for one-fifth of the deaths caused by cardiovascular disease worldwide, especially in the younger population [1].

Myocardial infarction can be classified into 5 types based on etiology and circumstances:

  • Type 1: Spontaneous myocardial infarction caused by ischemia due to a primary coronary event (eg, plaque rupture, erosion, or fissuring; coronary dissection). Based on electrocardiogram (ECG) findings, it is further divided into ST‐elevation myocardial infarction (STEMI) and non‐ST‐elevation myocardial infarction (NSTEMI).

  • Type 2: Ischemia due to increased oxygen demand (eg, hypertension), or decreased supply (eg, coronary artery spasm or embolism, arrhythmia, hypotension).

  • Type 3: Related to sudden unexpected cardiac death.

  • Type 4: Associated with percutaneous coronary intervention (signs and symptoms of myocardial infarction with cTn values > 5 × 99th percentile.

  • Type 5: Associated with coronary artery bypass grafting (signs and symptoms of myocardial infarction with cTn values > 10 × 99th percentile [2].

Clinical presentation

The medical history and general physical examination are often inconsistent when evaluating for acute myocardial infarction. The history should focus on the onset, quality, and associated symptoms. Recent studies have found that diaphoresis (abnormal sweating) and bilateral arm radiating pain are most often associated with myocardial infarction.

The most common symptoms of myocardial infarction include:

  • Chest discomfort/pain usually occurs in the center or on the left side. It usually lasts for a few minutes and feels like pressure, squeezing, or pain. It also can feel like heartburn or indigestion.

  • Shortness of breath may sometimes be the only symptom. It may occur while at rest or doing any mild physical activity.

  • Discomfort in the upper part of the body may feel like pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or the upper part of the stomach.

  • The other associated symptoms are nausea, vomiting, dizziness, lightheadedness, sweating, anxiety, fatigue, weakness, stress, cough, choking sensation, diaphoresis, wheezing, and/or irregular heart rate [3], [4].