Causes

Infarctions may occur for a variety of reasons, but coronary thrombosis of a coronary artery narrowed with plaque is the most common cause. Other causes include spasms of the coronary arteries; blockage of the coronary arteries by embolism of thrombi, fatty plaques, air, or calcium; and disparity between myocardial oxygen demand and coronary arterial supply. Multiple risk factors have been identified for coronary artery disease and MI. Some factors—such as age, family history, and gender—cannot be modified. Aging increases the atherosclerotic process, family history may increase the risk by both genetic and environmental influences, and males are more prone to MIs than are premenopausal women. Premenopausal women have the benefit of protective estrogens and a lower hematocrit, although heart disease is on the rise in this population, possibly because of an increased rate of smoking in women. Once women become post-menopausal, their risk for MI increases, as it also does for men over age 50.

Modifiable risk factors include cigarette smoking, which causes arterial vasoconstriction and increases plaque formation. A diet high in saturated fats, cholesterol, sugar, salt, and total calories increases the risk for MIs. Elevated serum cholesterol and low-density lipoprotein levels increase the chance for atherosclerosis. Hypertension and obesity increase the workload of the heart, and diabetes mellitus decreases the circulation to the heart muscle. Hostility and stress may also increase sympathetic nervous system activity and pose risk. A sedentary lifestyle diminishes collateral circulation and decreases the strength of the cardiac muscle. Medications can also prevent risks. Oral contraceptives may enhance thrombus formation, cocaine use can cause coronary artery spasm, and anabolic steroid use can accelerate atherosclerosis.

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