Myocardial+Infarction+(MI)

Western Diagnosis Ischemic myocardial necrosis due to abrupt decrease in coronary blood flow Greater than 90% have thrombus that occludes artery that supplies affected myocardium C. cocaine users - coronary artery spasm, MI

Pathophysiology
1. mostly L vent involvement 2. ability of pump to work directly related to extent of myo damage 3. death usually have > 50% L vent mass gone

Signs & Symptoms
1. 2/3 experience prodromal sx for days or weeks before MI 2. worsening angina 3. SOB 4. fatigue 5. 1st acute MI sx: deep substernal visceral pain - pressure or aching - often radiating to back, jaw, or L arm 6. 20% acute MI silent 7. restless, anxious, diaphoretic 8. cyanosis with cool skin 9. thready pulse, arrhythmia 10. muffled heart sounds 11. 60% die of VF before reaching hospital

Lab
1. ECG 2. troponins 3. increased ESR & WBC in 12 hours due to tissue necrosis 4. CK-MB inc within 6 hrs: increased for 48 hrs 5. LDH

Diagnosis
1. history 2. ECG 3. troponins 4. serial enzyme changes --CK-MB --LDH 5. consider MI if chest pain in all men over 35 and women over 50 6. differential: pneumonia, pulmonary embolism, pericarditis, rib fx, costochondral separation, esophageal spasm, chest muscle tightness, hiatal hernia, peptic ulcer, GB disease, aortic dissection, renal stone, many GI disorders

Treatment
1. 911 Prevention is paramount Glutathione

Prognosis
1. mortality in 1st yr is 10%: usually in 1st 4 months post MI 2. quiet bed rest for 3 days 3. discharged from hospital in 7 d 4. physical activity gradually inc over 6 wks 5. then N activity and life if good cardiac fcn 6. look at all aspects of lifestyle

Studies: -90% of studies done show that people periodontal dz have a great increase in heart dz [90%-99.9%, also though to increase risk of diabetes -People with most severe form of psoriasis in their 40's were 2x as likely to have an MI -If people had heart dz of any kind that caused them to become depressed there was a 20% increase MI risk

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Definition:
permanent myocardial damage due to myocardial infarction

Etiology:
The most common cause is coronary artery disease, following the many attendant risk factors for atherosclerosis. Occlusion may be gradual or thrombotic, and involve coronary spasm or emboli. Lesions may be transmural or subendocardial. Curiously, Traditional Chinese Medicine considers excessive joy as a potential contributing factor. This contrasts sharply with the emerging Western understanding of suppression of anger and other emotions, or the more familiar implication of 'type A' behavior as etiologic factors.

Somatic Therapies:
• aerobic exercise program: absolute must, should assess cardiac fitness level by submax. stress test • qigong • tai qi chuan

Nutrition:
eating principles: • immediately after infarct, fluid diet/Fasting • progressing to a soft diet with low fiber

slowly progress to the following diet plan: • low fat diet • low sugar • high complex whole carbohydrates • protein 12-15% diet • low cholesterol/cholesterol foods • low Sodium/Sodium-restricted diet • vegetarian cleansing diet or short fasts • Fasting, General Sample Diet, General Guidelines for Eating, Sample Vegetarian Diet

fresh juices: • carrot, beet, celery, asparagus, or red grapes, black currants, rose hips, blueberries (Airola, p. 104)

specific foods: • flax seed oil, okra, hawthorn berries, millet, buckwheat, sunflower seeds, sesame seeds, bananas, potatoes, asparagus, apples, honey in small amounts (Airola, p. 101)

avoid: • meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods

Botanicals
• Aconitum napellus (toxic): acute pain, full bounding pulse, restless, fear of death, sharp cutting pain on left side, suffocating feeling (Harper-Shove, pp. 133, 137) • Adonis vernalis: contraindicated in functional heart disorders with weakness (Ellingwood, p. 234) • Apocynum cannabinum (toxic): feeble heart action, edema (Ellingwood, p. 230) • Capsicum frutescens: will increase circulation; angina pectoris (Felter and Lloyd, p. 436) • Convallaria majalis (toxic): (Ellingwood, p. 224) • Crataegus oxyacantha: cardiotonic; angina pectoris: pain left breast, radiating down left arm, fear of death (Harper-Shove, p. 132) • Digitalis purpurea (toxic): cardiac emergency with cyanosis, pain, tachycardia, irregular pulse, threatened or actual failure (Felter, p. 341; Felter and Lloyd, p. 656; Sherman) • Kalmia latifolia (toxic): cardiac fibrillation, cardiac excitation (Felter and Lloyd, p. 1094; Sherman) • Leonurus cardiaca: cardiotonic • Lobelia inflata (toxic): angina pectoris: pain with tightness and constriction of chest; acute heart failure (injection) (Ellingwood, p. 240) • Lycopus virginicus: anxiety, irritability, irregularity, cardiac palpitation from organic lesions. Caution: powerfully increases contraction of heart muscle fibers (Felter and Lloyd, p. 1215) • Selenicereus grandiflorus (toxic, cactus): cardiac spasm, constrictive pain like a band around the heart or chest, apprehension of danger or death (Felter and Lloyd, pp. 375, 376) • Taraxacum officinale (leaf): diuretic, tonic • Valeriana spp.: nervine in heart conditions (Collins)

Chinese Formulae
• Stephania and Ginseng C. (Hsu, 1980, p. 500) • Kuan Shin Su Ho Wan Styrax Pills for Coronary Heart Disease (Guan Xin Su Ho) (patent) (Fratkin, p. 136) • Cir Q (patent): (Fratkin, p. 276)

Acupuncture
after assessing the person and palpating, consider these patterns: Heart and Kidney Yang Qi Xu (Deficiency); Heart Yang collapse; Qi Stagnation and Xue Yu (Blood Stasis); Heat in the Xue (Blood); dysfunction of the Yin Wei Mai (Yin Linking Vessel)

» therapeutic note: • in initial phase important to stop sweating to prevent further weakening of Heart • dispersing or neutral technique often more appropriate for many points in the initial Shi (Excess) phases • tonification typically emphasized later for recovery and healing

» illustrative combinations: • SI-3 and PC-6 clear Obstruction from the Heart (Finkelstein, p. 34) • GV-15, PC-8, Sp-6, Kd-1, Kd-3, CV-12, GB-30, St-36 and LI-4 are the Nine Needles for Returning the Yang (Li, p. 627-628; Ellis, et al, 1988, p. 66) • GV-14 and GV-15 (D): combined tonify Heart Yang (Eisen) • PC-6 and Ht-7: regulate and harmonize the Heart and Pericardium (Finkelstein, p. 59) • PC-6, Ht-7, UB-15, UB-14 and St-36: treat weak pulse condition, pulseless patterns, and heart failure patterns (Flaws, 1989, p. 98) • PC-3, PC-6 and PC-7 for chest pain (Shanghai, p. 246) • PC-3, UB-23 and UB-17 for chest pain (Shanghai, p. 246) • PC-6, PC-3, PC-4 and PC-5: strengthen the Heart and tranquilize the Soul (Finkelstein, p. 59) • PC-6 and Sp-6: nourish Yin; clear Fire; and strengthen the Heart to activate the Xue (Blood) circulation (Finkelstein, p. 59) • PC-6, Sp-6 and Ht-7: tranquilize the Heart; ease the Mind; calm Heat and emotions (Finkelstein, p. 59) • PC-6, UB-15 and UB-23: descend Heart Fire; communicate Heart and Kidney (Finkelstein, p. 59) • UB-14 and PC-6 (-): regulate the Qi of the Heart and Pericardium channels; reinforce Yang of Heart and Pericardium • Lv-3 and Sp-6 (+): nourish Yin of Liver and Kidney to relieve Shi (Excess) Fire; (-) transform Xue Yu (Blood Stasis) and disperse extravasation of blood in intercostal region due to injury (Finkelstein, p. 73) • Lv-3 and Lv-13: loosen the Liver and scatter effused blood (Finkelstein, p. 73) • PC-6, PC-5 and St-36 for angina pectoris (Shanghai, p. 249-250) • CV-13, PC-6 and Sp-4 for cardiac spasm (Shanghai, p. 178) • CV-13 and CV-12: treat nine types of cardiac pain (Ellis, et al, 1988, p. 356)

Homeopathy
• notes: A, A#, B, C, C#, D, D#, E, F#, G, G#

• chords: dominant 7th, diminished 7th, A Major, A# Major, C Major, G Major, G# Major (Gimbel, p. 116)

cardiovascular: • The Barcarole • The Blue Danube • Chopin's A minor Waltz • Tango music • Humoresque • Cui's Orientale • Song of India • Donna e Mobile • Oley Speak's Sylvia (Heline, p. 18)

Subtle Support
• notes: A, A#, B, C, C#, D, D#, E, F#, G, G#

• chords: dominant 7th, diminished 7th, A Major, A# Major, C Major, G Major, G# Major (Gimbel, p. 116)

cardiovascular: • The Barcarole • The Blue Danube • Chopin's A minor Waltz • Tango music • Humoresque • Cui's Orientale • Song of India • Donna e Mobile • Oley Speak's Sylvia (Heline, p. 18)

Mind/Body
• Unlike neurotics, people with physical illnesses complain little, because this means experiencing emotions and revealing a vulnerable part of themselves. By not complaining, they tend to suppress their inner lives, they adapt themselves to the environment (usually through denial), and their self-assertion is underdeveloped. Cardiac infarction patients often disregard symptoms, and in a self-destructive manner, internalize their depression. Psychosocial therapy calls for strengthening the patient's conscious self. In this process, the doctor cannot be neutral, uninterested, or 'abstinent', but must become involved in a social situation that he, as well as the patient, has to master. (Locke, 1985, p. 113) • There are 3 critical psychological times for the patient: arrival at the hospital, end of acute stage of the illness, and departure from the hospital. (Locke, 1985, p. 114) • Maintenance of defense mechanisms of denial in convalescence leads to non-compliance with medical advice and rejection of rehabilitation efforts, increasing the risk of reinfarction. Recommendations for management include early recognition, supportive psychotherapy, education, and mobilization in the acute phase of coronary care. (Locke, 1985, p. 114) • Associated with excessive stress; people who work hard in order to be accepted by parents, and have no parental permission to slow down and change direction if a job no longer suits them; may be an acceptable way of confirming to oneself and to others that he's had enough. (Harrison, p. 140) • People with hypertension have a good deal of aggression which they repress through exercising self-restraint. It is this blockage of aggressive energy that is released in a heart attack; it literally tears the heart apart. The heart attack is the sum of all the 'attacks' and 'beatings' that the patient has failed to mete out in the past. Only a hard heart can break, as the ego and dominance of the will are overvalued, and the heart is cut off from the flow of life. (Dethlefsen, p. 201) • Need to maintain control, fear of losing it and having responsibilities taken away; inability to acknowledge and process emotional stress; fear and anger related to disappointments and demands of personal relationships, sense of failure. (Shealy, p. 161) • Coronary patient differs from the average population by marked extroversion and by a compulsive and impulsive addiction to hard work. When under stress, there is a regression to aggressive activity, i.e. rapid acceleration, which switches to brooding and a passive masochistic attitude when stress increases. Intensive mental deceleration through narcissistic tendencies may further compromise arterial and coronary circulation. (Locke, 1985, p. 111) • Heart represents center of love and security. Heart problems are associated with longstanding emotional problems; lack of joy; belief in strain and stress; hardening of the heart. Heart attack is squeezing all the joy out of the heart in favor of material possessions or position. (Hay, 1984, p. 168) • Rehabilitation goals should include improving the patient's ability to participate in chosen activities and facilitating return to work, improving psychologic adjustment, preventing or reversing deconditioning, and reducing risk factors. (Locke, 1985, p. 112) • All actions of therapeutic work at coronary units, of both the physicians and nurses, must contain psychotherapeutic messages. It is important to consider the anxiety that appears at the same time with infarction and which may cause the disturbance of rhythm and possibly fatal outcome; the problem of informing the patient about the degree of illness; and the nurse's relationship with the patient. (Locke, 1985, p. 112) • Patients gather strength more quickly and so avoid post-operative shock when there is an affinity between the patient, a doctor, and a particular nurse. There is a reason why patients seem to get better more easily under one nurse than another. (Locke, 1986, p. 215)

• Reduce stress and maintain regular exercise: Stress reduction and regular exercise contribute to higher levels of HDL cholesterol and reduce the risk of heart disease. Individuals over 40 and those who have not been engaged in vigorous activity on a regular basis should consult with their physician and consider starting with less strenuous activities such as walking. (N Engl J Med 1988;318:110-112; Jiang W, et al. JAMA 1996;275:1651-1656; Kawachi I, et al. Circulation 1996.)

• Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. Chronic Yin Xu (Deficiency) predisposes to Empty Fire, acute and chronic. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted. » Mental signs of Heart channel disorders include insomnia, anxiety, and all Shen disturbances. (Seem, p. 28)
 * Chinese psychophysiology:**

• Pericardium ~ Xin Bao is the Minister who protects the Heart, the Emperor, and maintains the order of the Heart energy; and as such may be adversely affected by emotional stresses internally or invasion of Heat externally. The Pericardium is said to be the origin of joy and sadness. » Healthy expressions are joy, happiness, and healthy relationships. » Weakness, dysfunction, and illness are associated with confusion, delirium, nervousness, and psychosis.

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities of the Heart; nourishes the brain to sustain concentration, clear thinking, and memory; carries the constitutional endowment from the parents; and displays the effects of sexual dissipation, overwork, chronic debilitation, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat and/or acute inflammation. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).