Genel Yayın KoordinatörüFatih KİRAZ

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Myocardial infarction (MI) or acute myocardial infarction (AMI), is the medical term for an event commonly known as a heart attack. It happens when blood stops flowing properly to part of the heart and the heart muscle is injured due to not getting enough oxygen. Usually this is because one of the coronary arteries that supplies blood to the heart develops a blockage due to an unstable build up of white blood cells, cholesterol and fat. The event is called "acute" if it is sudden and serious.

A person having an acute myocardial infarction usually has sudden chest pain that sometimes travels to the left arm and the left side of the neck. The chest pain is referred to as "retrosternal" because it is felt behind the breastbone, also called the sternum. Additionally, the person often suffers from shortness of breath, sweating, nausea, vomiting, abnormal heartbeats, and anxiety. The anxiety is often described as a "sense of impending doom." Women experience less of these symptoms than men, but usually have shortness of breath, weakness, a feeling of indigestion, and fatigue. In many cases, in some estimates as high as 64 percent, the person does not have chest pain or other symptoms. These are called "silent" myocardial infarctions.

Immediate treatments for a suspected acute myocardial infarction include oxygen to help with breathing, aspirin, which prevents the blood from clotting and forming further blockages, and nitroglycerin to treat chest pain.

There are many ways a doctor can test a person to determine if they have had a myocardial infarction, such as electrocardiograms (ECGs) that trace the electrical signals in the heart, echocardiography that maps the heart by the sounds that it makes, internal images taken by magnetic resonance imaging (MRI), and testing the blood for substances associated with damage to the heart muscle. Common blood tests are for creatine kinase (CK-MB) and troponin, both of which are released by damaged muscles such as the heart.

ECG testing is used to differentiate between two types of myocardial infarctions based on the shape of the tracing. When the ST section of the tracing is higher than the baseline it is called an ST-elevation myocardial infarction (STEMI) which usually requires more aggressive treatment. STEMI is treated by restoring circulation to the heart, called reperfusion therapy, and typical methods are angioplasty where the arteries are pushed opened and thrombolysis where the blockage is removed using medications. Non-ST elevation

myocardial infarction (NSTEMI) may be managed with medication, although angioplasty may be required if the person is considered to be at high risk.[6] People who have multiple blockages of their coronary arteries, particularly if they also have diabetes, may also be treated with bypass surgery.

Ischemic heart disease, which includes myocardial infarction, angina and heart failure when it happens after myocardial infarction, was the leading cause of death for both men and women worldwide in 2011. Important risk factors are previous cardiovascular disease, older age, tobacco smoking, high blood levels of certain lipids (low-density lipoprotein cholesterol, triglycerides) and low levels of high density lipoprotein (HDL) cholesterol, diabetes, high blood pressure, lack of physical activity and obesity, chronic kidney disease, excessive alcohol consumption, the use of illicit drugs (such as cocaine and amphetamines), and chronic high stress levels.

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. People are considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight in kilograms by the square of the person's height in metres, exceeds 30 kg/m2.

Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, andosteoarthritis. Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illness. Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited; on average obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass.

Dieting and physical exercise are the mainstays of treatment for obesity. Diet quality can be improved by reducing the consumption of energy-dense foods such as those high in fat and sugars, and by increasing the intake of dietary fiber. Anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption together with a suitable diet. If diet, exercise and medication are not effective, a gastric balloon may assist with weight loss, or surgery may be performed to reduce stomach volume and/or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food.

Obesity is a leading preventable cause of death worldwide, with increasing prevalence in adults and children, and authorities view it as one of the most serious public health problems of the 21st century. Obesity is stigmatized in much of the modern world (particularly in the Western world), though it was widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts of the world. In 2013, the American Medical Association classified obesity as a disease.

Insomnia, or sleeplessness, is a sleep disorder in which there is an inability to fall asleep or to stay asleep as long as desired. While the term is sometimes used to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often practically defined as a positive response to either of two questions: "Do you experience difficulty sleeping?" or "Do you have difficulty falling or staying asleep?"

Insomnia is most often thought of as both a sign and a symptom that can accompany several sleep, medical, and psychiatric disorders characterized by a persistent difficulty falling asleep and/or staying asleep or sleep of poor quality. Insomnia is typically followed by functional impairment while awake. Insomnia can occur at any age, but it is particularly common in the elderly.

Insomnia can be short term (up to three weeks) or long term (above 3–4 weeks), which can lead to memory problems, depression, irritability and an increased risk of heart disease and automobile related accidents.

Those who are having trouble sleeping sometimes turn to sleeping pills, which can help when used occasionally but may lead to dependence or

addiction if used regularly for an extended period.

Insomnia can be grouped into primary and secondary, or comorbid, insomnia. Primary insomnia is a sleep disorder not attributable to a medical, psychiatric, or environmental cause. It is described as a complaint of prolonged sleep onset latency, disturbance of sleep maintenance, or the experience of non-refreshing sleep.A complete diagnosis will differentiate between:

• insomnia as secondary to another condition,

• primary insomnia co-morbid with one or more conditions, or

• free-standing primary insomnia.

Types of insomnia

Insomnia can be classified as transient, acute, or chronic.

Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences – sleepiness and impaired psychomotor performance – are similar to those of sleep deprivation.

Acute insomnia is the inability to consistently sleep

well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function. Acute insomnia is also known as short term insomnia or stress related insomnia.

Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of cytokines are more likely to have chronic insomnia. Its effects can vary according to its causes. They might include muscular fatigue, hallucinations, and/or mental fatigue. Some people that live with this disorder see things as if they are happening in slow motion, wherein moving objects seem to blend together. Chronic insomnia can cause double vision.