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85-478: Roy Howard, the group's original lead singer, had a heart attack in 1951 and died shortly thereafter. Doyle Wiggins sang lead for about a year. When he left in 1953, he was replaced by Les Beasley . Beasley remained at the lead position through 1999, when he stepped aside and hired Josh Garner to fill the position. Beasley continued to play bass guitar and act as the group's master of ceremonies. Glen Allred joined as baritone in 1952 Glen had started his career with

170-411: A blood test for biomarkers (the cardiac protein troponin ). When there is evidence of an MI, it may be classified as an ST elevation myocardial infarction (STEMI) or Non-ST elevation myocardial infarction (NSTEMI) based on the results of an ECG . The phrase "heart attack" is often used non-specifically to refer to myocardial infarction. An MI is different from—but can cause— cardiac arrest , where

255-658: A cold sweat , feeling tired , and decreased level of consciousness . About 30% of people have atypical symptoms. Women more often present without chest pain and instead have neck pain, arm pain or feel tired. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause heart failure , an irregular heartbeat , cardiogenic shock or cardiac arrest . Most MIs occur due to coronary artery disease . Risk factors include high blood pressure , smoking , diabetes , lack of exercise , obesity , high blood cholesterol , poor diet, and excessive alcohol intake . The complete blockage of

340-475: A coronary artery caused by a rupture of an atherosclerotic plaque is usually the underlying mechanism of an MI. MIs are less commonly caused by coronary artery spasms , which may be due to cocaine , significant emotional stress (often known as Takotsubo syndrome or broken heart syndrome ) and extreme cold, among others. Many tests are helpful to help with diagnosis, including electrocardiograms (ECGs), blood tests and coronary angiography . An ECG, which

425-486: A heart attack , occurs when blood flow decreases or stops in one of the coronary arteries of the heart , causing infarction (tissue death) to the heart muscle . The most common symptom is retrosternal chest pain or discomfort that classically radiates to the left shoulder, arm, or jaw. The pain may occasionally feel like heartburn . This is the dangerous type of Acute coronary syndrome . Other symptoms may include shortness of breath , nausea , feeling faint ,

510-474: A benefit of 15 to 45%. Physical activity can reduce the risk of cardiovascular disease, and people at risk are advised to engage in 150 minutes of moderate or 75 minutes of vigorous intensity aerobic exercise a week. Keeping a healthy weight, drinking alcohol within the recommended limits, and quitting smoking reduce the risk of cardiovascular disease. Substituting unsaturated fats such as olive oil and rapeseed oil instead of saturated fats may reduce

595-428: A common, and sometimes the only symptom, occurring when damage to the heart limits the output of the left ventricle , with breathlessness arising either from low oxygen in the blood or pulmonary edema . Other less common symptoms include weakness, light-headedness , palpitations , and abnormalities in heart rate or blood pressure . These symptoms are likely induced by a massive surge of catecholamines from

680-476: A global registry of 102,341 patients, the GRACE risk score estimates in-hospital, 6 months, 1 year, and 3-year mortality risk after a heart attack. It takes into account clinical (blood pressure, heart rate, EKG findings) and medical history. Nowadays, GRACE risk score is also used within non-ST elevation ACS patients as a high-risk criteria(GRACE score > 140), which may favor early invasive strategy within 24 hours of

765-480: A late consequence of Kawasaki disease . Calcium deposits in the coronary arteries can be detected with CT scans . Calcium seen in coronary arteries can provide predictive information beyond that of classical risk factors. High blood levels of the amino acid homocysteine is associated with premature atherosclerosis; whether elevated homocysteine in the normal range is causal is controversial. In people without evident coronary artery disease , possible causes for

850-431: A myocardial infarction before age 55 years, or a female first-degree relative (mother, sister) less than age 65 increases a person's risk of MI. Genome-wide association studies have found 27 genetic variants that are associated with an increased risk of myocardial infarction. The strongest association of MI has been found with chromosome 9 on the short arm p at locus 21, which contains genes CDKN2A and 2B, although

935-463: A myocardial infarction increases with older age, low physical activity, and low socioeconomic status . Heart attacks appear to occur more commonly in the morning hours, especially between 6AM and noon. Evidence suggests that heart attacks are at least three times more likely to occur in the morning than in the late evening. Shift work is also associated with a higher risk of MI. One analysis has found an increase in heart attacks immediately following

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1020-406: A myocardial infarction. Spasm of coronary arteries, such as Prinzmetal's angina may cause blockage. If impaired blood flow to the heart lasts long enough, it triggers a process called the ischemic cascade ; the heart cells in the territory of the blocked coronary artery die ( infarction ), chiefly through necrosis , and do not grow back. A collagen scar forms in their place. When an artery

1105-543: A myocardial infarction. The flow of blood can be imaged, and contrast dyes may be given to improve image. Other scans using radioactive contrast include SPECT CT-scans using thallium , sestamibi ( MIBI scans ) or tetrofosmin ; or a PET scan using Fludeoxyglucose or rubidium-82 . These nuclear medicine scans can visualize the perfusion of heart muscle. SPECT may also be used to determine viability of tissue, and whether areas of ischemia are inducible. Medical societies and professional guidelines recommend that

1190-422: A new left bundle branch block or a true posterior MI pattern), thrombolytics may be administered or percutaneous coronary intervention may be performed. In the former, medication is injected that stimulates fibrinolysis , destroying blood clots obstructing the coronary arteries . In the latter, a flexible catheter is passed via the femoral or radial artery and advanced to the heart to identify blockages in

1275-538: A number of other conditions. In those who have ACS, atheroma rupture is most commonly found 60% when compared to atheroma erosion (30%), thus causes the formation of thrombus which block the coronary arteries. Plaque rupture is responsible for 60% in ST elevated myocardial infarction (STEMI) while plaque erosion is responsible for 30% of the STEMI and vice versa for Non ST elevated myocardial infarction (NSTEMI). In plaque rupture,

1360-637: A person localizes the chest pain by clenching one or both fists over their sternum , has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed it had a poor positive predictive value . Typically, chest pain because of ischemia, be it unstable angina or myocardial infarction, lessens with the use of nitroglycerin , but nitroglycerin may also relieve chest pain arising from non-cardiac causes. Chest pain may be accompanied by sweating , nausea or vomiting, and fainting , and these symptoms may also occur without any pain at all. Dizziness or lightheadedness

1445-407: A previous heart attack is also suggestive. The pain associated with MI is usually diffuse, does not change with position, and lasts for more than 20 minutes. It might be described as pressure, tightness, knifelike, tearing, burning sensation (all these are also manifested during other diseases). It could be felt as an unexplained anxiety, and pain might be absent altogether. Levine's sign , in which

1530-554: A rise in biomarkers, a rise in the ST segment , changes in the shape or flipping of T waves , new Q waves , or a new left bundle branch block can be used to diagnose an AMI. In addition, ST elevation can be used to diagnose an ST segment myocardial infarction (STEMI). A rise must be new in V2 and V3 ≥2 mm (0,2 mV) for males or ≥1.5 mm (0.15 mV) for females or ≥1 mm (0.1 mV) in two other adjacent chest or limb leads . ST elevation

1615-409: A series of leads placed on a person's chest that measure electrical activity associated with contraction of the heart muscle. The taking of an ECG is an important part of the workup of an AMI, and ECGs are often not just taken once but may be repeated over minutes to hours, or in response to changes in signs or symptoms. ECG readouts produce a waveform with different labeled features. In addition to

1700-406: A significant effect on blood cholesterol and thus recommendations about its consumption may not be needed. Trans fats do appear to increase risk. Acute and prolonged intake of high quantities of alcoholic drinks (3–4 or more daily) increases the risk of a heart attack. Family history of ischemic heart disease or MI, particularly if one has a male first-degree relative (father, brother) who had

1785-452: Is a Southern gospel group. Glen Allred, the former baritone singer for The Florida Boys, is also the baritone singer for The 3 Generations. Randy Allred, the former bass singer for The Dixie Echoes reprises this role. The alto is Cindy Dunn and the soprano is Brandy Allred. Shayne Dunn and Shirley Allred were also featured on the latest album. Discography: Myocardial infarction A myocardial infarction ( MI ), commonly known as

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1870-601: Is a known risk factor, particularly high low-density lipoprotein , low high-density lipoprotein , and high triglycerides . Many risk factors for myocardial infarction are potentially modifiable, with the most important being tobacco smoking (including secondhand smoke ). Smoking appears to be the cause of about 36% and obesity the cause of 20% of coronary artery disease . Lack of physical activity has been linked to 7–12% of cases. Less common causes include stress-related causes such as job stress , which accounts for about 3% of cases, and chronic high stress levels. There

1955-454: Is a recording of the heart's electrical activity, may confirm an ST elevation MI ( STEMI ), if ST elevation is present. Commonly used blood tests include troponin and less often creatine kinase MB . Treatment of an MI is time-critical. Aspirin is an appropriate immediate treatment for a suspected MI. Nitroglycerin or opioids may be used to help with chest pain; however, they do not improve overall outcomes. Supplemental oxygen

2040-795: Is also an important modifiable risk. Short-term exposure to air pollution such as carbon monoxide , nitrogen dioxide , and sulfur dioxide (but not ozone ) has been associated with MI and other acute cardiovascular events. For sudden cardiac deaths, every increment of 30 units in Pollutant Standards Index correlated with an 8% increased risk of out-of-hospital cardiac arrest on the day of exposure. Extremes of temperature are also associated. A number of acute and chronic infections including Chlamydophila pneumoniae , influenza , Helicobacter pylori , and Porphyromonas gingivalis among others have been linked to atherosclerosis and myocardial infarction. Myocardial infarction can also occur as

2125-499: Is associated with infarction, and may be preceded by changes indicating ischemia, such as ST depression or inversion of the T waves. Abnormalities can help differentiate the location of an infarct, based on the leads that are affected by changes. Early STEMIs may be preceded by peaked T waves. Other ECG abnormalities relating to complications of acute myocardial infarctions may also be evident, such as atrial or ventricular fibrillation . Noninvasive imaging plays an important role in

2210-511: Is blocked, cells lack oxygen , needed to produce ATP in mitochondria . ATP is required for the maintenance of electrolyte balance, particularly through the Na/K ATPase . This leads to an ischemic cascade of intracellular changes, necrosis and apoptosis of affected cells. Cells in the area with the worst blood supply, just below the inner surface of the heart ( endocardium ), are most susceptible to damage. Ischemia first affects this region,

2295-433: Is common and occurs due to reduction in oxygen and blood to the brain. In females, the most common symptoms of myocardial infarction include shortness of breath, weakness, and fatigue . Females are more likely to have unusual or unexplained tiredness and nausea or vomiting as symptoms. Females having heart attacks are more likely to have palpitations, back pain, labored breath, vomiting, and left arm pain than males, although

2380-477: Is not the only cause of myocardial infarction, but it may exacerbate or contribute to other causes. A myocardial infarction may result from a heart with a limited blood supply subject to increased oxygen demands, such as in fever, a fast heart rate , hyperthyroidism , too few red blood cells in the bloodstream , or low blood pressure . Damage or failure of procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafts (CABG) may cause

2465-430: Is one of the most common symptoms of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper abdomen . The pain most suggestive of an acute MI, with the highest likelihood ratio , is pain radiating to the right arm and shoulder. Similarly, chest pain similar to

2550-414: Is recommended in those with low oxygen levels or shortness of breath. In a STEMI, treatments attempt to restore blood flow to the heart and include percutaneous coronary intervention (PCI), where the arteries are pushed open and may be stented , or thrombolysis , where the blockage is removed using medications. People who have a non-ST elevation myocardial infarction ( NSTEMI ) are often managed with

2635-412: Is still unable to be distributed to the affected myocardium despite clearing the occlusion—also contributes to myocardial injury. Topical endothelial swelling is one of many factors contributing to this phenomenon. A myocardial infarction, according to current consensus, is defined by elevated cardiac biomarkers with a rising or falling trend and at least one of the following: A myocardial infarction

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2720-411: Is subdivided in three scenarios depending primarily on the presence of electrocardiogram (ECG) changes and blood test results (a change in cardiac biomarkers such as troponin levels ): ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), or unstable angina . STEMI is characterized by complete blockage of a coronary artery resulting in necrosis of part of

2805-448: Is therefore empirical treatment with aspirin, a second platelet inhibitor such as clopidogrel, prasugrel or ticagrelor, and heparin (usually a low-molecular weight heparin ), with intravenous nitroglycerin and opioids if the pain persists. The heparin-like drug known as fondaparinux appears to be better than enoxaparin . If there is no evidence of ST segment elevation on the electrocardiogram , delaying urgent angioplasty until

2890-433: Is usually associated with coronary thrombosis , it can also be associated with cocaine use. Chest pain with features characteristic of cardiac origin (angina) can also be precipitated by profound anemia , brady- or tachycardia (excessively slow or rapid heart rate), low or high blood pressure , severe aortic valve stenosis (narrowing of the valve at the beginning of the aorta ), pulmonary artery hypertension and

2975-457: Is usually clinically classified as an ST-elevation MI (STEMI) or a non-ST elevation MI (NSTEMI). These are based on ST elevation , a portion of a heartbeat graphically recorded on an ECG . STEMIs make up about 25–40% of myocardial infarctions. A more explicit classification system, based on international consensus in 2012, also exists. This classifies myocardial infarctions into five types: There are many different biomarkers used to determine

3060-445: Is varying evidence about the importance of saturated fat in the development of myocardial infarctions. Eating polyunsaturated fat instead of saturated fats has been shown in studies to be associated with a decreased risk of myocardial infarction, while other studies find little evidence that reducing dietary saturated fat or increasing polyunsaturated fat intake affects heart attack risk. Dietary cholesterol does not appear to have

3145-462: The coronary arteries . When occlusions are found, they can be intervened upon mechanically with angioplasty and usually stent deployment if a lesion, termed the culprit lesion, is thought to be causing myocardial damage. Data suggest that rapid triage , transfer and treatment is essential. The time frame for door-to-needle thrombolytic administration according to American College of Cardiology (ACC) guidelines should be within 30 minutes, whereas

3230-661: The elderly , in those with diabetes mellitus and after heart transplantation . In people with diabetes, differences in pain threshold , autonomic neuropathy , and psychological factors have been cited as possible explanations for the lack of symptoms. In heart transplantation, the donor heart is not fully innervated by the nervous system of the recipient. The most prominent risk factors for myocardial infarction are older age, actively smoking , high blood pressure , diabetes mellitus , and total cholesterol and high-density lipoprotein levels. Many risk factors of myocardial infarction are shared with coronary artery disease ,

3315-773: The electrocardiogram (ECG or EKG) is the investigation that most reliably distinguishes between various causes. The ECG should be done as early as practicable, including in the ambulance if possible. ECG changes indicating acute heart damage include: ST elevation , new left bundle branch block and ST depression amongst others. The absence of ECG changes does not immediately distinguish between unstable angina and NSTEMI. Change in levels of cardiac biomarkers , such as troponin I and troponin T , are indicative of myocardial infarction including both STEMI and NSTEMI , however their levels are not affected in unstable angina . A combination of cardiac biomarkers and risk scores, such as HEART score and TIMI score, can help assess

3400-480: The health impact assessment of regional and local plans and policies. Most guidelines recommend combining different preventive strategies. A 2015 Cochrane Review found some evidence that such an approach might help with  blood pressure ,  body mass index  and  waist circumference . However, there was insufficient evidence to show an effect on mortality or actual cardio-vascular events. Statins , drugs that act to lower blood cholesterol, decrease

3485-423: The heart muscle is unable to function properly or dies . The most common symptom is centrally located pressure-like chest pain , often radiating to the left shoulder or angle of the jaw, and associated with nausea and sweating . Many people with acute coronary syndromes present with symptoms other than chest pain, particularly women, older people, and people with diabetes mellitus . Acute coronary syndrome

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3570-522: The single nucleotide polymorphisms that are implicated are within a non-coding region. The majority of these variants are in regions that have not been previously implicated in coronary artery disease. The following genes have an association with MI: PCSK9 , SORT1 , MIA3 , WDR12 , MRAS , PHACTR1 , LPA , TCF21 , MTHFDSL , ZC3HC1 , CDKN2A , 2B , ABO , PDGF0 , APOA5 , MNF1ASM283 , COL4A1 , HHIPC1 , SMAD3 , ADAMTS7 , RAS1 , SMG6 , SNF8 , LDLR , SLC5A3 , MRPS6 , KCNE2 . The risk of having

3655-481: The subendocardial region, and tissue begins to die within 15–30 minutes of loss of blood supply. The dead tissue is surrounded by a zone of potentially reversible ischemia that progresses to become a full-thickness transmural infarct. The initial "wave" of infarction can take place over 3–4 hours. These changes are seen on gross pathology and cannot be predicted by the presence or absence of Q waves on an ECG. The position, size and extent of an infarct depends on

3740-551: The sympathetic nervous system , which occurs in response to pain and, where present, low blood pressure . Loss of consciousness can occur in myocardial infarctions due to inadequate blood flow to the brain and cardiogenic shock , and sudden death , frequently due to the development of ventricular fibrillation . When the brain was without oxygen for too long due to a myocardial infarction, coma and persistent vegetative state can occur. Cardiac arrest, and atypical symptoms such as palpitations , occur more frequently in females,

3825-600: The "farewell concert" on the main stage at the National Quartet Convention , it was announced that, with the blessing of Allred, Beasley, and Stewart, the Florida Boys name would be continuing on and the mantle was passed to Charlie Waller to continue on with the Florida Boys legacy. Waller continued to operate the Florida Boys until 2016. During this event, "The Boys" were joined by tenor Terry Davis and Long time bass singer Buddy Liles. The Florida Boys' cover of

3910-528: The Florida Boys were inducted into the Gospel Music Hall of Fame. The group at this time consisted of Allen Cox, Josh Garner, Glen Allred, Gene McDonald, Les Beasley and Derrell Stewart In 2007, the Florida Boys had two personnel changes at relatively the same time, as long-time bass singer Gene McDonald left to work for a bus company, and tenor Harold Reed left to join the Kingsmen Quartet . McDonald

3995-598: The Oak Ridge Quartet who later became the Oak Ridge Boys. Glen played guitar for the group and also filled in as baritone when Joe Allred (no relation) was not with the group.; Derrell Stewart became the group's pianist in 1956, Derrell had played with the Dixie Rhythm Quartet prior to joining the Florida Boys. Allred, Stewart, and Beasley remained at their respective positions for over four decades and co-owned

4080-527: The United States. In the developed world, the risk of death in those who have had a STEMI is about 10%. Rates of MI for a given age have decreased globally between 1990 and 2010. In 2011, an MI was one of the top five most expensive conditions during inpatient hospitalizations in the US, with a cost of about $ 11.5 billion for 612,000 hospital stays. Myocardial infarction (MI) refers to tissue death ( infarction ) of

4165-432: The acute diagnostic algorithm; however, it can confirm a clinical suspicion of Chronic Coronary Syndrome when the patient's history, physical examination (including cardiac examination ) ECG, and cardiac biomarkers suggest coronary artery disease. Echocardiography , an ultrasound scan of the heart, is able to visualize the heart, its size, shape, and any abnormal motion of the heart walls as they beat that may indicate

4250-409: The affected artery, totality of the blockage, duration of the blockage, the presence of collateral blood vessels , oxygen demand, and success of interventional procedures. Tissue death and myocardial scarring alter the normal conduction pathways of the heart and weaken affected areas. The size and location put a person at risk of abnormal heart rhythms (arrhythmias) or heart block , aneurysm of

4335-647: The blood thinner heparin , with the additional use of PCI in those at high risk. In people with blockages of multiple coronary arteries and diabetes, coronary artery bypass surgery (CABG) may be recommended rather than angioplasty . After an MI, lifestyle modifications, along with long-term treatment with aspirin, beta blockers and statins , are typically recommended. Worldwide, about 15.9 million myocardial infarctions occurred in 2015. More than 3 million people had an ST elevation MI, and more than 4 million had an NSTEMI. STEMIs occur about twice as often in men as women. About one million people have an MI each year in

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4420-416: The body. Investigations is still underway on the role of cyclophilin D in reducing the reperfusion injury. Other, less common, causes of acute coronary syndrome include spontaneous coronary artery dissection, ischemia in the absence of obstructive coronary artery disease (INOCA), and myocardial infarction in the absence of obstructive coronary artery disease (MINOCA). In the setting of acute chest pain,

4505-639: The chest and may radiate or be located to the arm, shoulder, neck, back, upper abdomen, or jaw. This may be associated with sweating , nausea , or shortness of breath . Previously, the word "atypical" was used to describe chest pain not typically heart-related, however, this word is not recommended and has been replaced by "noncardiac" to describe chest pain that indicate a low likelihood of heart-related pain. In unstable angina, symptoms may appear on rest or on minimal exertion. The symptoms can last longer than those in stable angina , can be resistant to rest or medicine, and can get worse over time. Though ACS

4590-482: The chest discomfort persists, morphine . Other analgesics such as nitrous oxide are of unknown benefit. Angiography is recommended in those who have either new ST elevation or a new left or right bundle branch block on their ECG. Unless the person has low oxygen levels additional oxygen does not appear to be useful. If the ECG confirms changes suggestive of myocardial infarction ( ST elevation in specific leads,

4675-475: The content of the plaque is lipid rich, collagen poor, with abundant inflammation which is macrophage predominant, and covered with a thin fibrous cap. Meanwhile, in plaque erosion, the plaque is rich with extracellular matrix , proteoglycan , glycoaminoglycan , but without fibrous caps, no inflammatory cells, and no large lipid core. After the coronary arteries are unblocked, there is a risk of reperfusion injury due spreading inflammatory mediators throughout

4760-405: The diagnosis and characterisation of myocardial infarction. Tests such as chest X-rays can be used to explore and exclude alternate causes of a person's symptoms. Echocardiography may assist in modifying clinical suspicion of ongoing myocardial infarction in patients that can't be ruled out or ruled in following initial ECG and Troponin testing. Myocardial perfusion imaging has no role in

4845-567: The diagnostic accuracy of troponin testing is improving over time. One high-sensitivity cardiac troponin can rule out a heart attack as long as the ECG is normal. Other tests, such as CK-MB or myoglobin , are discouraged. CK-MB is not as specific as troponins for acute myocardial injury, and may be elevated with past cardiac surgery, inflammation or electrical cardioversion; it rises within 4–8 hours and returns to normal within 2–3 days. Copeptin may be useful to rule out MI rapidly when used along with troponin. Electrocardiograms (ECGs) are

4930-561: The door-to-balloon percutaneous coronary intervention (PCI) time should be less than 90 minutes. It was found that thrombolysis is more likely to be delivered within the established ACC guidelines among patients with STEMI as compared to PCI according to a 2009 case control study. If the ECG does not show typical changes consistent with STEMI, the term "non-ST segment elevation ACS" (NSTE-ACS) may be used and encompasses "non-ST elevation MI" (NSTEMI) and unstable angina. The accepted management of unstable angina and acute coronary syndrome

5015-414: The elderly, those with diabetes, in people who have just had surgery, and in critically ill patients. "Silent" myocardial infarctions can happen without any symptoms at all. These cases can be discovered later on electrocardiograms , using blood enzyme tests, or at autopsy after a person has died. Such silent myocardial infarctions represent between 22 and 64% of all infarctions, and are more common in

5100-630: The greatest support is the Mediterranean diet . Vitamins and mineral supplements are of no proven benefit, and neither are plant stanols or sterols . Public health measures may also act at a population level to reduce the risk of myocardial infarction, for example by reducing unhealthy diets (excessive salt, saturated fat, and trans-fat) including food labeling and marketing requirements as well as requirements for catering and restaurants and stimulating physical activity. This may be part of regional cardiovascular disease prevention programs or through

5185-472: The group. During this time, various tenors and basses sang with the group. Billy Todd joined the group as bass singer in the 1958, and stayed with the group until 1972. He was replaced by Buddy Liles , who had sung with The Orrell Quartet, The Rhythm Masters Quartet, The Landmark Quartet, and The Rebels Quartet. Liles stayed with the group for over two decades. The Florida Boys had a nationally syndicated television show, The Gospel Singing Jubilee . In 1999,

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5270-561: The heart attack. Coronary CT angiography combined with troponin levels is also helpful to triage those who are susceptible to ACS. F-fluoride positron emission tomography is also helpful in identifying those with high risk, lipid-rich coronary plaques. Studies have shown that for ACS patients, weekend admission is associated with higher mortality and lower utilization of invasive cardiac procedures, and those who did undergo these interventions had higher rates of mortality and complications than their weekday counterparts. This data leads to

5355-465: The heart is not contracting at all or so poorly that all vital organs cease to function, thus leading to death. It is also distinct from heart failure , in which the pumping action of the heart is impaired. However, an MI may lead to heart failure. Chest pain that may or may not radiate to other parts of the body is the most typical and significant symptom of myocardial infarction. It might be accompanied by other symptoms such as sweating. Chest pain

5440-410: The heart muscle ( myocardium ) caused by ischemia , the lack of oxygen delivery to myocardial tissue. It is a type of acute coronary syndrome , which describes a sudden or short-term change in symptoms related to blood flow to the heart. Unlike the other type of acute coronary syndrome, unstable angina , a myocardial infarction occurs when there is cell death , which can be estimated by measuring by

5525-596: The heart muscle indicated by ST elevation on ECG , NSTEMI is characterized by a partially blocked coronary artery resulting in necrosis of part of the heart muscle that may be indicated by ECG changes, and unstable angina is characterised by ischemia of the heart muscle that does not result in cell injury or necrosis. ACS should be distinguished from stable angina , which develops during physical activity or stress and resolves at rest. In contrast with stable angina, unstable angina occurs suddenly, often at rest or with minimal exertion, or at lesser degrees of exertion than

5610-441: The heart ventricles , inflammation of the heart wall following infarction, and rupture of the heart wall that can have catastrophic consequences. Injury to the myocardium also occurs during re-perfusion. This might manifest as ventricular arrhythmia. The re-perfusion injury is a consequence of the calcium and sodium uptake from the cardiac cells and the release of oxygen radicals during reperfusion. No-reflow phenomenon—when blood

5695-729: The heart, lungs , gastrointestinal tract , aorta , and other muscles, bones and nerves surrounding the chest. In addition to myocardial infarction, other causes include angina , insufficient blood supply ( ischemia ) to the heart muscles without evidence of cell death, gastroesophageal reflux disease ; pulmonary embolism , tumors of the lungs, pneumonia , rib fracture , costochondritis , heart failure and other musculoskeletal injuries. Rarer severe differential diagnoses include aortic dissection , esophageal rupture , tension pneumothorax , and pericardial effusion causing cardiac tamponade . The chest pain in an MI may mimic heartburn . Causes of sudden-onset breathlessness generally involve

5780-402: The incidence and mortality rates of myocardial infarctions. They are often recommended in those at an elevated risk of cardiovascular diseases. Aspirin has been studied extensively in people considered at increased risk of myocardial infarction. Based on numerous studies in different groups (e.g. people with or without diabetes), there does not appear to be a benefit strong enough to outweigh

5865-401: The individual's previous angina ("crescendo angina"). New-onset angina is also considered unstable angina, since it suggests a new problem in a coronary artery. Symptoms of the acute coronary syndromes are similar. The cardinal symptom of critically decreased blood flow to the heart is chest pain , experienced as tightness, pressure, or burning. Localization is most commonly around or over

5950-666: The lungs or heart – including pulmonary edema , pneumonia, allergic reactions and asthma , and pulmonary embolus, acute respiratory distress syndrome and metabolic acidosis . There are many different causes of fatigue, and myocardial infarction is not a common cause. There is a large crossover between the lifestyle and activity recommendations to prevent a myocardial infarction, and those that may be adopted as secondary prevention after an initial myocardial infarction, because of shared risk factors and an aim to reduce atherosclerosis affecting heart vessels. The influenza vaccine also appear to protect against myocardial infarction with

6035-610: The myocardial infarction are coronary spasm or coronary artery dissection . The most common cause of a myocardial infarction is the rupture of an atherosclerotic plaque on an artery supplying heart muscle. Plaques can become unstable, rupture, and additionally promote the formation of a blood clot that blocks the artery; this can occur in minutes. Blockage of an artery can lead to tissue death in tissue being supplied by that artery. Atherosclerotic plaques are often present for decades before they result in symptoms. The gradual buildup of cholesterol and fibrous tissue in plaques in

6120-562: The next morning is not inferior to doing so immediately. Using statins in the first 14 days after ACS reduces the risk of further ACS. Cocaine -associated ACS should be managed in a manner similar to other patients with acute coronary syndrome except beta blockers should not be used and benzodiazepines should be administered early. The TIMI risk score can identify high risk patients in ST-elevation and non-ST segment elevation MI ACS and has been independently validated. Based on

6205-419: The physician confirm a person is at high risk for Chronic Coronary Syndrome before conducting diagnostic non-invasive imaging tests to make a diagnosis, as such tests are unlikely to change management and result in increased costs. Patients who have a normal ECG and who are able to exercise, for example, most likely do not merit routine imaging. There are many causes of chest pain , which can originate from

6290-471: The plaque and act to stabilize it. A stable plaque may have a thick fibrous cap with calcification . If there is ongoing inflammation, the cap may be thin or ulcerate. Exposed to the pressure associated with blood flow, plaques, especially those with a thin lining, may rupture and trigger the formation of a blood clot (thrombus). The cholesterol crystals have been associated with plaque rupture through mechanical injury and inflammation. Atherosclerotic disease

6375-447: The possibility of myocardial infarction in the emergency setting. Acute coronary syndrome often reflects a degree of damage to the coronaries by atherosclerosis . Primary prevention of atherosclerosis is controlling the risk factors: healthy eating, exercise, treatment for hypertension and diabetes , avoiding smoking and controlling cholesterol levels; in patients with significant risk factors, aspirin has been shown to reduce

6460-487: The presence of cardiac muscle damage. Troponins , measured through a blood test, are considered to be the best, and are preferred because they have greater sensitivity and specificity for measuring injury to the heart muscle than other tests. A rise in troponin occurs within 2–3 hours of injury to the heart muscle, and peaks within 1–2 days. The level of the troponin, as well as a change over time, are useful in measuring and diagnosing or excluding myocardial infarctions, and

6545-503: The primary cause of myocardial infarction, with other risk factors including male sex, low levels of physical activity, a past family history , obesity , and alcohol use . Risk factors for myocardial disease are often included in risk factor stratification scores, such as the Framingham Risk Score . At any given age, men are more at risk than women for the development of cardiovascular disease. High levels of blood cholesterol

6630-538: The risk of cardiovascular events. Secondary prevention is discussed in myocardial infarction . After a ban on smoking in all enclosed public places was introduced in Scotland in March 2006, there was a 17% reduction in hospital admissions for acute coronary syndrome. 67% of the decrease occurred in non-smokers. People with presumed ACS are typically treated with aspirin , clopidogrel or ticagrelor , nitroglycerin , and, if

6715-435: The risk of excessive bleeding. Nevertheless, many clinical practice guidelines continue to recommend aspirin for primary prevention, and some researchers feel that those with very high cardiovascular risk but low risk of bleeding should continue to receive aspirin. Acute coronary syndrome Acute coronary syndrome ( ACS ) is a syndrome due to decreased blood flow in the coronary arteries such that part of

6800-486: The risk of myocardial infarction, although there is not universal agreement. Dietary modifications are recommended by some national authorities, with recommendations including increasing the intake of wholegrain starch, reducing sugar intake (particularly of refined sugar), consuming five portions of fruit and vegetables daily, consuming two or more portions of fish per week, and consuming 4–5 portions of unsalted nuts , seeds , or legumes per week. The dietary pattern with

6885-458: The song "Love Lifted Me" was used in Richard Linklater's 2011 Film Bernie and was covered in the soundtrack by actor-musician Jack Black . Les Beasley died in 2018. Derrell Stewart died in 2020. Glen Allred died in 2022. Tenor Lead Baritone Bass Piano Bass guitar Drums Various instruments Glen Allred and 3 Generations Glen Allred & 3 Generations

6970-399: The start of daylight saving time . Women who use combined oral contraceptive pills have a modestly increased risk of myocardial infarction, especially in the presence of other risk factors. The use of non-steroidal anti inflammatory drugs (NSAIDs), even for as short as a week, increases risk. Endometriosis in women under the age of 40 is an identified risk factor. Air pollution

7055-400: The studies showing these differences had high variability. Females are less likely to report chest pain during a heart attack and more likely to report nausea, jaw pain, neck pain, cough, and fatigue, although these findings are inconsistent across studies. Females with heart attacks also had more indigestion, dizziness , loss of appetite , and loss of consciousness. Shortness of breath is

7140-529: The wall of the coronary arteries or other arteries, typically over decades, is termed atherosclerosis . Atherosclerosis is characterized by progressive inflammation of the walls of the arteries. Inflammatory cells, particularly macrophages , move into affected arterial walls. Over time, they become laden with cholesterol products, particularly LDL , and become foam cells . A cholesterol core forms as foam cells die. In response to growth factors secreted by macrophages, smooth muscle and other cells move into

7225-510: Was replaced by Butch Owens , and lead singer Josh Garner moved up to the tenor position, with Les once again singing lead for the group. Then, in June 2007, Les Beasley announced that the legendary quartet would be disbanding the following month. However, he also announced that they would come back together once more for a farewell appearance at the National Quartet Convention in September 2007. At

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