Heart Disease: Myocardial Infarction

Myocardial Infarction

At more than 45 years of age, approximately 4% of men and 7% of women who have a first myocardial infarction (MI) will go on to have an stroke within 5 years. The risk of stroke is far greatest in the first months following an MI.

Relationship to stroke pathogenesis

Since atherosclerosis is the underlying pathology for both MI and most ischemic strokes, this relationship should not be a surprise. Furthermore, an MI may produce damage to the heart wall or persistent atrial fibrillation, both of which promote thrombus formation. Bits of thrombus may break off and embolize the brain. Finally, the thrombolytic agents used to treat an MI by breaking up clot in the coronary vessels increase the risk of intracerebral hemorrhagic strokes.

A little about control/treatment

Since many of the risk factors for stroke and MI are the same, preventing a second MI or a stroke will involve many of the same considerations. These may include lifestyle changes such as smoking cessation, increasing fruits/vegetables and reducing fat in the diet, moderation of alcohol consumption, and increasing physical activity. Medical therapies that may be indicated include reducing blood pressure, antiplatelet agents, anticoagulation if cardiac problems that increase the risk of thrombus formation are present, statins or other lipid-lowering agents, and medical treatment of diabetes mellitus if it is present.