Coordinates	41°52′55″N87°37′40″N
{{infobox disease | name	Cardiac Arrest | Image US Navy 040421-N-8090G-001 Hospital Corpsman 3rd Class Flowers administers chest compressions to a simulated cardiac arrest victim.jpg | Caption CPR being administered during a simulation of cardiac arrest. | DiseasesDB | ICD10 | ICD9 | ICDO | OMIM | MedlinePlus | eMedicineSubj | eMedicineTopic | MeshID D006323 }}

Cardiac arrest, (also known as cardiopulmonary arrest or circulatory arrest) is the cessation of normal circulation of the blood due to failure of the heart to contract effectively. Medical personnel can refer to an unexpected cardiac arrest as a sudden cardiac arrest or SCA.

A cardiac arrest is different from (but may be caused by) a heart attack, where blood flow to the muscle of the heart is impaired.

Arrested blood circulation prevents delivery of oxygen to the body. Lack of oxygen to the brain causes loss of consciousness, which then results in abnormal or absent breathing. Brain injury is likely if cardiac arrest goes untreated for more than five minutes. For the best chance of survival and neurological recovery, immediate and decisive treatment is imperative.

Cardiac arrest is a medical emergency that, in certain situations, is potentially reversible if treated early. When unexpected cardiac arrest leads to death this is called sudden cardiac death (SCD). The treatment for cardiac arrest is cardiopulmonary resuscitation (CPR) to provide circulatory support, followed by defibrillation if a shockable rhythm is present. If a shockable rhythm is not present after CPR and other interventions, clinical death is inevitable.

Classification

Cardiac arrest is classified into "shockable" versus "non–shockable", based upon the ECG rhythm. The two shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia while the two non–shockable rhythms are asystole and pulseless electrical activity. This refers to whether a particular class of disrhythmia is treatable using defibrillation.

Signs and symptoms

Cardiac arrest is an abrupt cessation of pump function in the heart (as evidenced by the absence of a palpable pulse). Prompt intervention can usually reverse a cardiac arrest, but without such intervention it will almost always lead to death. In certain cases, it is an expected outcome to a serious illness.

However, due to inadequate cerebral perfusion, the patient will be unconscious and will have stopped breathing. The main diagnostic criterion to diagnose a cardiac arrest, (as opposed to respiratory arrest which shares many of the same features), is lack of circulation, however there are a number of ways of determining this. Near death experiences are reported by 10-20% of people who survived cardiac arrest.

Causes

Coronary heart disease is the leading cause of sudden cardiac arrest. Many other cardiac and non–cardiac conditions also increase ones risk.

Coronary heart disease

Approximately 60–70% of SCD is related to coronary heart disease. Among adults, ischemic heart disease is the predominant cause of arrest with 30% of people at autopsy showing signs of recent myocardial infarction.

Non ischemic heart disease

A number of other cardiac abnormalities can increase the risk of SCD including: cardiomyopathy, cardiac rhythm disturbances, hypertensive heart disease, congestive heart failure.

In a group of military recruits aged 18–35, cardiac anomalies accounted for 51% of cases of SCD, while in 35% of cases the cause remained unknown. Underlying pathology included: coronary artery abnormalities (61%), myocarditis (20%), and hypertrophic cardiomyopathy (13%). Congestive heart failure increases the risk of SCD by 5 fold.

Many additional conduction abnormalities exist that place one at higher risk for cardiac arrest. For instance, long QT syndrome, a condition often mentioned in young people's deaths, occurs in 1/5000-1/7000 newborns and is estimated to be responsible 3000 deaths each year compared to the approximately 300000 cardiac arrests seen by emergency services . These conditions are a fraction of the overall deaths related to cardiac arrest, but represent conditions which may be detected prior to arrest, which maybe treatable.

Non–cardiac

SCDs is unrelated to heart problems in 35% of cases. The most common non–cardiac causes: trauma, non-trauma related bleeding (such as gastrointestinal bleeding, aortic rupture, and intracranial hemorrhage), overdose, drowning and pulmonary embolism.

Risk factors

The risk factors for SCD are similar to those seen with coronary heart disease including: smoking, lack of physical exercise, obesity, diabetes, and family history.

Hs and Ts

"Hs and Ts" is the name for a mnemonic used to aid in remembering the possible treatable or reversible causes of cardiac arrest. ;Hs

Hypovolemia - A lack of blood volume

Hypoxia - A lack of oxygen

Hydrogen ions (Acidosis) - An abnormal pH in the body

Hyperkalemia or Hypokalemia - Both excess and inadequate potassium can be life-threatening.

Hypothermia - A low core body temperature

Hypoglycemia or Hyperglycemia - Low or high blood glucose

;Ts

Tablets or Toxins

Cardiac Tamponade - Fluid building around the heart

Tension pneumothorax - A collapsed lung

Thrombosis (Myocardial infarction) - Heart attack

Thromboembolism (Pulmonary embolism) - A blood clot in the lung

Trauma

Diagnosis

Cardiac arrest is synonymous with clinical death.

A cardiac arrest is usually diagnosed clinically by the absence of a pulse. In many cases lack of carotid pulse is the gold standard for diagnosing cardiac arrest, but lack of a pulse (particularly in the peripheral pulses) may be a result of other conditions (e.g. shock), or simply an error on the part of the rescuer. Studies have shown that rescuers often make a mistake when checking the carotid pulse in an emergency, whether they are healthcare professionals or lay persons.

Owing to the inaccuracy in this method of diagnosis, some bodies such as the European Resuscitation Council (ERC) have de-emphasised its importance. The Resuscitation Council (UK), in line with the ERC's recommendations and those of the American Heart Association, have suggested that the technique should be used only by healthcare professionals with specific training and expertise, and even then that it should be viewed in conjunction with other indicators such as agonal respiration.

Various other methods for detecting circulation have been proposed. Guidelines following the 2000 International Liaison Committee on Resuscitation (ILCOR) recommendations were for rescuers to look for "signs of circulation", but not specifically the pulse. These signs included coughing, gasping, colour, twitching and movement. However, in face of evidence that these guidelines were ineffective, the current recommendation of ILCOR is that cardiac arrest should be diagnosed in all casualties who are unconscious and not breathing normally.

Prevention

With positive outcomes following cardiac arrest unlikely, an effort has been spent in finding effective strategies to prevent cardiac arrest. With the prime causes of cardiac arrest being ischemic heart disease, efforts to promote a healthy diet, exercise, and smoking cessation are important. For people at risk of heart disease, measures such as blood pressure control, cholesterol lowering, and other medico-therapeutic interventions are used.

Code teams

In medical parlance, cardiac arrest is referred to as a "code" or a "crash". This typically refers to "code blue" on the hospital emergency codes. A dramatic drop in vital sign measurements is referred to as "coding" or "crashing", though coding is usually used when it results in cardiac arrest, while crashing might not. Treatment for cardiac arrest is sometimes referred to as "calling a code".

Extensive research has shown that patients in general wards often deteriorate for several hours or even days before a cardiac arrest occurs. This has been attributed to a lack of knowledge and skill amongst ward based staff, in particular a failure to carry out measurement of the respiratory rate, which is often the major predictor of a deterioration and can often change up to 48 hours prior to a cardiac arrest. In response to this, many hospitals now have increased training for ward based staff. A number of "early warning" systems also exist which aim to quantify the risk which patients are at of deterioration based on their vital signs and thus provide a guide to staff. In addition, specialist staff are being utilised more effectively in order to augment the work already being done at ward level. These include:

Crash teams (or code teams) - These are designated staff members who have particular expertise in resuscitation, who are called to the scene of all arrests within the hospital. This usually involves a specialized cart of equipment (including defibrillator) and drugs called a "crash cart".

Medical emergency teams - These teams respond to all emergencies, with the aim of treating the patient in the acute phase of their illness in order to prevent a cardiac arrest.

Critical care outreach - As well as providing the services of the other two types of team, these teams are also responsible for educating non-specialist staff. In addition, they help to facilitate transfers between intensive care/high dependency units and the general hospital wards. This is particularly important, as many studies have shown that a significant percentage of patients discharged from critical care environments quickly deteriorate and are re-admitted - the outreach team offers support to ward staff to prevent this from happening.

Implantable cardioverter defibrillators

A technologically based intervention to prevent further cardiac arrest episodes is the use of an implantable cardioverter-defibrillator (ICD). This device is implanted in the patient and acts as an instant defibrillator in the event of arrhythmia. Note that standalone ICDs do not have any pacemaker functions, but they can be combined with a pacemaker, and modern versions also have advanced features such as anti-tachycardic pacing as well as synchronized cardioversion. A recent study by Birnie et al. at the University of Ottawa Heart Institute has demonstrated that ICDs are underused in both the United States and Canada. An accompanying editorial by Simpson explores some of the economic, geographic, social and political reasons for this. Patients who are most likely to benefit from the placement of an ICD are those with severe ischemic cardiomyopathy (with systolic ejection fractions less than 30%) as demonstrated by the MADIT-II trial.

Management

Sudden cardiac arrest maybe treated via attempts at resuscitation. This is usually carried out based upon basic life support (BLS) / advanced cardiac life support (ACLS), pediatric advanced life support (PALS) or neonatal resuscitation program (NRP) guidelines.

Cardiopulmonary resuscitation

CPR is a critical part of the management of cardiac arrest. It should be started as soon as possible and interrupted as little as possible. The component of CPR which seems to make the greatest difference is the chest compressions. Tracheal intubation has not been found to improve survival rates in cardiac arrest cases. A 2009 study has found that assisted ventilation may worsen outcomes over placement of an oral airway with passive oxygen delivery. Intubation in the prehospital environment has been found to decrease survival. Correctly performed bystander CPR has been shown to increase survival; it is performed in less than 30% of out of hospital arrests. In addition, it has been shown that those who suffer arrests in remote locations have worse outcomes following cardiac arrest: these areas often have first responders, whereby members of the community receive training in resuscitation and are given a defibrillator, and called by the emergency medical services in the case of a collapse in their local area.

Medications

Medications, while included in guidelines, have been shown not to improve survival to hospital discharge post cardiac arrest. This includes the use of epinephrine, atropine, and amiodarone. The study, however, only refers to the ineffectiveness of these drugs in reference to out-of-hospital cardiac arrests. Though in their 2010 guidelines, the American Heart Association has singled out atropine, indicating that "Available evidence suggests that the routine use of atropine during PEA or asystole is unlikely to have a therapeutic benefit."

Therapeutic hypothermia

Cooling a person after cardiac arrest with return of spontaneous circulation (ROSC) but without return of consciousness improves outcomes. This procedure is called therapeutic hypothermia. The first study conducted in Europe focused on people who were resuscitated 5–15 minutes after collapse. Patients participating in this study experienced spontaneous return of circulation (ROSC) after an average of 105 minutes. Subjects were then cooled over a 24 hour period, with a target temperature of . 55% of the 137 patients in the hypothermia group experienced favorable outcomes, compared with only 39% in the group that received standard care following resuscitation. Death rates in the hypothermia group were 14% lower, meaning that for every 7 patients treated one life was saved. Notably, complications between the two groups did not differ substantially. This data was supported by another similarly run study that took place simultaneously in Australia. In this study 49% of the patients treated with hypothermia following cardiac arrest experienced good outcomes, compared to only 26% of those who received standard care.

ECMO

Sporadic reports of resuscitation with extracorporeal membrane oxygenation devices have appeared in recent years.

Chain of survival

Several organisations promote the idea of a "chain of survival" The links are: Early recognition - If possible, recognition of illness before the patient develops a cardiac arrest will allow the rescuer to prevent its occurrence. Early recognition that a cardiac arrest has occurred is key to survival - for every minute a patient is in cardiac arrest, their chances of survival drop by roughly 10%.

Early CPR - improves blood and oxygen flow to vital organs and an essential component of treating a cardiac arrest. In particular, by keeping the brain supplied with oxygenated blood, chances of neurological damage are decreased.

Early defibrillation - is effective for the management of ventricular fibrillation and pulseless ventricular tachycardia If defibrillation is delayed the rhythm is likely to degenerate into asystole for which outcomes are worse.

Early advanced care - Early Advanced Cardiac Life Support is the final link in the chain of survival.

If one or more links in the chain are missing or delayed, then the chances of survival drop significantly.

These protocols are often initiated by a Code Blue, which usually denotes impending or acute onset of cardiac arrest or respiratory failure, although in practice, Code Blue is often called in less life-threatening situations that require immediate attention from a physician.

Prognosis

Out-of-hospital cardiac arrest (OHCA) has a worse survival rate (2-8% for discharge and 8-22% for admission), than an in-hospital cardiac arrest (15% for discharge). The principal determining factor is the initially documented rhythm. People with ventricular fibrillation or pulseless ventricular tachycardia have 10-15 times greater chance of surviving than those suffering from pulseless electrical activity or asystole.

Since mortality in case of OHCA is high, programs were developed to improve survival rate. Although mortality in case of ventricular fibrillation is high, rapid intervention with a defibrillator increases survival rate.

Survival is mostly related to the cause of the arrest (see above). In particular, patients who have suffered hypothermia have an increased survival rate, possibly because the cold protects the vital organs from the effects of tissue hypoxia. Survival rates following an arrest induced by toxins is very much dependent on identifying the toxin and administering an appropriate antidote. A patient who has suffered a myocardial infarction due to a blood clot in the left coronary artery has a lower chance of survival.

A study of survival rates from out of hospital cardiac arrest found that 14.6% of those who had received resuscitation by ambulance staff survived as far as admission to hospital. Of these, 59% died during admission, half of these within the first 24 hours, while 46% survived until discharge from hospital. This gives us an overall survival following cardiac arrest of 6.8%. Of these 89% had normal brain function or mild neurological disability, 8.5% had moderate impairment, and 2% suffered major neurological disability. Of those who were discharged from hospital, 70% were still alive 4 years later.

A review into prognosis following in-hospital cardiac arrest found a survival to discharge of 14% although the range between different studies was 0-28%.

Epidemiology

Based on death certificates sudden cardiac death accounts for about 15% of all death in Western countries (330,000 per year in the United States). However this gender difference disappeared beyond 85 years of age.

Ethical issues

Some people choose to avoid aggressive measure at the end of life. A do not resuscitate (DNR) in the form of an advance health care directive makes it clear that in the event of cardiac arrest the person does not wish cardiopulmonary resuscitation. Other directive may be made to stipulate the desire for intubation in the event of respiratory failure or if confort measures are all that are desired by stipulating "allow natural death".

References

External links

Sudden Cardiac Arrest Association

Sudden Cardiac Arrest Foundation

New Studies Confirm Chest Compressions Alone are Life-saving for Cardiac Arrest

Cardiac Arrest Videos - Inside Cardiac Arrest

The Center for Resuscitation Science at the Hospital of the University of Pennsylvania

Category:Cardiac dysrhythmia Category:Medical emergencies Category:Causes of death

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Coordinates	41°52′55″N87°37′40″N
background	solo_singer
born	September 26, 1948Cambridge, England
origin	Melbourne, Australia
instrument	Vocals, piano, guitar, recorder
genre	Pop, country, soft rock
occupation	Singer, actress, songwriter, entrepreneur
years active	1963–present
label	MCA, EMI, Pye, Festival
associated acts	Cliff Richard, John Travolta, Electric Light Orchestra, John Farrar, Helen Reddy, Bruce Welch
website	olivianewton-john.com
spouse	Amazon John Easterling (2008–present)Matt Lattanzi (1984–95) (divorced) 1 child }}

Olivia Newton-John AO, OBE (born 26 September 1948) is an English-born, Australian-raised singer and actress. She is a four-time Grammy award winner who has amassed five No. 1 and ten other Top Ten Billboard Hot 100 singles and two No. 1 Billboard 200 solo albums. Eleven of her singles (including two platinum) and 14 of her albums (including two platinum and four double platinum) have been certified gold by the RIAA. Her music has been successful in multiple formats including pop, country and adult contemporary and has sold an estimated over 100 million albums worldwide. She co-starred with John Travolta in the film adaptation of the Broadway musical, ''Grease,'' which featured one of the most successful film soundtracks in Hollywood history.

Newton-John has been a long-time activist for environmental and animal rights issues. Since surviving breast cancer in 1992, she has been an advocate for health awareness becoming involved with various charities, health products and fundraising efforts. Her business interests have included launching several product lines for Koala Blue and co-owning the Gaia Retreat & Spa in Australia.

Newton-John has been married twice. She currently lives with her second husband, John Easterling, in Jupiter Inlet Colony, Florida. She is the mother of one daughter, Chloe Rose Lattanzi, with her first husband, actor Matt Lattanzi.

Life and career

Early life and beginnings

Olivia Newton-John was born in Cambridge, England, to a Welsh father, Brinley ("Bryn") Newton-John, and a German-born mother, Irene Born, the eldest child of the Nobel prize-winning atomic physicist Max Born. Her mother's family had left Germany before World War II to avoid the Nazi regime (Newton-John's maternal grandfather was Jewish, and her maternal grandmother was of paternal Jewish ancestry). Her maternal great-grandfather was jurist Victor Ehrenberg and her matrilineal great-grandmother's father was German jurist Rudolf von Jhering. Newton-John is the youngest of three children, following brother Hugh, a doctor, and sister Rona, an actress who was married to ''Grease'' co-star Jeff Conaway from 1980 until their divorce in 1985. Newton-John's father was an MI.5 officer on the Enigma project at Bletchley Park who took Rudolf Hess into custody during World War II. In 1954 Newton-John's family emigrated to Melbourne, Australia, where her father worked as a professor of German and as Master of Ormond College at the University of Melbourne.

At 14, Newton-John formed a short-lived all-girl band, Sol Four, with three classmates often performing in a coffee shop owned by her brother-in-law. She became a regular on local Australian radio and television shows including HSV-7's ''The Happy Show'' where she performed as "Lovely Livvy." She also appeared on the ''Go Show'' where she met future duet partner, Pat Carroll, and future music producer John Farrar. (Carroll and Farrar would later marry.) She entered and won a talent contest on the television program ''Sing, Sing, Sing,'' hosted by 1960s Australian icon Johnny O'Keefe, performing the songs "Anyone Who Had A Heart" and "Everything's Coming Up Roses." Newton-John was initially reluctant to use the prize she had won, a trip to England, but travelled there nearly a year later after her mother encouraged her to broaden her horizons.

Newton-John recorded her first single, ''Till You Say You'll Be Mine'' b/w ''Forever,'' in England for Decca Records in 1966. Newton-John was homesick in England for her then-boyfriend, Ian Turpie, with whom she had co-starred in the Australian telefilm, ''Funny Things Happen Down Under.'' Newton-John would repeatedly book trips back to Australia that her mother would subsequently cancel. Newton-John's outlook changed when Pat Carroll also moved to England. The two formed a duo called "Pat and Olivia" and toured nightclubs in Europe. (In one incident, they were booked at Paul Raymond's Revue in Soho, London. Dressed primly in frilly, high-collared dresses, they were unaware that this was a strip club until they began to perform onstage.) After Carroll's visa expired forcing her to return to Australia, Newton-John remained in England to pursue solo work until 1975. She became engaged to The Shadows' guitarist Bruce Welch, but they never married.

Newton-John was recruited for the group Toomorrow formed by American producer Don Kirshner who was also the music consultant for the earliest recordings of The Monkees. In 1970, the group starred in a "science fiction musical" film and recorded an accompanying soundtrack album both named after the group. The project bombed and the group disbanded.

Early success

Newton-John released her first solo album, ''If Not For You'' (No. 158 Pop), in 1971. The title track, written by Bob Dylan and previously recorded by Beatle George Harrison for his 1970 album, ''All Things Must Pass,'' was her first international hit (No. 25 Pop, No. 1 AC). Her follow-up single, "Banks of the Ohio," was a Top 10 hit in England and Australia. She was voted Best British Female Vocalist two years in a row by the magazine ''Record Mirror.'' She made frequent appearances on Cliff Richard's weekly show, ''It's Cliff Richard,'' and starred with him in the telefilm, ''The Case.''

In 1974, Newton-John represented the United Kingdom in the Eurovision Song Contest with the song, "Long Live Love". The song was chosen for Newton-John by the British public out of six possible entries. (Newton-John later admitted that she disliked the song.) Newton-John placed fourth at the contest held in Brighton behind ABBA's winning ''Waterloo.'' All six Eurovision contest song candidates were recorded by Newton-John and included on her ''Long Live Love'' album, her first for the EMI Records label.

In the United States, Newton-John's career floundered after ''If Not For You.'' Subsequent singles including "Banks of the Ohio" (No. 94 Pop, No. 34 AC) and remakes of George Harrison's "What Is Life" (No. 34 AC) and John Denver's "Take Me Home, Country Roads" (No. 119 Pop) made minimal chart impact until the release of "Let Me Be There" in 1973. The song reached the American Top 10 on the Pop (No. 6), Country (No. 7), and AC (No. 3) charts and earned her a Grammy for Best Country Female and an Academy of Country Music award for Most Promising Female Vocalist. The album, ''Let Me Be There,'' charted No. 1 on Country Albums for two weeks as well as No. 54 on the Billboard 200.

The ''Long Live Love'' album was released in the United States as ''If You Love Me, Let Me Know'' with the six Eurovision songs dropped for four different, more country-oriented tracks intended to capitalize on the success of "Let Me Be There." The title track was the first single reaching No. 5 Pop, No. 2 Country (her best country placement to date) and No. 2 AC. The next single, "I Honestly Love You," became Newton-John's signature song. Written and composed by Jeff Barry and Peter Allen, the ballad became her first No. 1 Pop (two weeks), second No. 1 AC (three weeks) and third Top 10 Country (No. 6) hit and earned Newton-John two more Grammys for Record of the Year and Best Pop Vocal Performance-Female. The success of both singles helped the album reach No. 1 on both the Pop (one week) and Country (eight weeks) Albums charts.

Newton-John's country success sparked a debate among purists who believed a foreigner singing country-flavored pop music did not belong in country music. In addition to her Grammy for "Let Me Be There," Newton-John was also named the Country Music Association Female Vocalist of the Year in 1974, defeating more established nominees Loretta Lynn, Canadian Anne Murray, Dolly Parton, and Tanya Tucker. This outrage led to the formation of the short-lived Association of Country Entertainers (ACE). Newton-John was eventually supported by the country music community. Stella Parton, Dolly's sister, recorded "Ode To Olivia" and Newton-John recorded her 1976 album, ''Don't Stop Believin','' in Nashville.

Encouraged by expatriate Australian singer Helen Reddy, Newton-John left England and moved to the United States. Newton-John topped the Pop (one week) and Country (six weeks) Albums charts with her next album, ''Have You Never Been Mellow.'' The album generated two singles – the John Farrar penned title track (No. 1 Pop, No. 3 Country, No. 1 AC) and "Please Mr. Please" (No. 3 Pop, No. 5 Country, No. 1 AC). Newton-John's pop career cooled with the release of her next album, ''Clearly Love.'' Her streak of five consecutive gold Top 10 singles on the Billboard Hot 100 ended when the album's first single, "Something Better To Do," stopped at No. 13 (also No. 19 Country and No. 1 AC). Although her albums still achieved gold status, she did not return to the Top 10 on the Hot 100 or Billboard 200 charts again until 1978.

Newton-John's singles continued to easily top the AC chart, where she ultimately amassed ten No. 1 singles including a record seven consecutively:

"I Honestly Love You" (1974) – 3 weeks

"Have You Never Been Mellow" (1975) – 1 week

"Please Mr. Please" (1975) – 3 weeks

"Something Better to Do" (1975) – 3 weeks

"Let It Shine"/"He Ain't Heavy, He's My Brother" (1976) – 2 weeks

"Come on Over" (1976) – 1 week

"Don't Stop Believin'" (1976) – 1 week

She also provided a prominent, but uncredited, vocal on John Denver's "Fly Away" single which was succeeded by her own single, "Let It Shine"/"He Ain't Heavy, He's My Brother," at No. 1 on the AC chart. ("Fly Away" returned to No. 1 after the two week reign of "Let It Shine".) Newton-John also continued to reach the Country Top 10 where she tallied seven Top 10 singles through 1976's "Come on Over" (No. 23 Pop, No. 5 Country, No. 1 AC) and six consecutive (of a career nine total) Top 10 albums through 1976's ''Don't Stop Believin''' (No. 30 Pop, No. 7 Country). She headlined her first U.S. television special, ''A Special Olivia Newton-John,'' in November 1976.

By mid-1977, Newton-John's AC and country success also began to wane. Her ''Making a Good Thing Better'' album (No. 34 Pop, No. 13 Country) failed to be certified gold, and its only single, the title track (No. 87 Pop, No. 20 AC), did not reach even the AC Top 10 or the Country chart. Later that year, ''Olivia Newton-John's Greatest Hits'' (No. 13 Pop, No. 7 Country) became her first platinum album as she prepared to launch a new phase in her career.

''Grease''

Newton-John's career soared after starring in the film adaptation of the Broadway musical, ''Grease,'' in 1978. She was offered the lead role of Sandy after meeting producer Allan Carr at a dinner party at Helen Reddy's home. Burned by her ''Toomorrow'' experience and concerned that she was too old to play a high school senior (she turned 29 during the latter 1977 filming), Newton-John insisted on a screen test with the film's co-star, John Travolta. The film accommodated Newton-John's Australian accent by recasting her character from the play's original American Sandy Dumbrowski to Sandy Olsson, an Australian who vacations and then moves with her family to the United States. Newton-John previewed some of the film's soundtrack during her second American network television special, ''Olivia,'' featuring guests ABBA and Andy Gibb.

''Grease'' became the biggest box-office hit of 1978. The soundtrack album spent 12 non-consecutive weeks at No. 1 and yielded three Top 5 singles for Newton-John: the platinum "You're The One That I Want" (No. 1 Pop, No. 23 AC) with John Travolta, the gold "Hopelessly Devoted To You" (No. 3 Pop, No. 20 Country, No. 7 AC) and the gold "Summer Nights" (No. 5 Pop, No. 21 AC) with John Travolta and the film's cast. The former two songs were written and composed by Newton-John's long-time music producer, John Farrar, specifically for the film. ("Summer Nights" was from the original play written by Jim Jacobs and Warren Casey.) Newton-John became the second female (after Linda Ronstadt in 1977) to have two singles – "Hopelessly Devoted to You" and "Summer Nights" – in the Billboard Top 5 simultaneously. Newton-John's performance earned her a People's Choice award for Favorite Motion Picture Actress. She was also nominated for a Golden Globe as Best Actress in a Musical and performed the Oscar-nominated "Hopelessly Devoted To You" at the 1979 Academy Awards.

The film's popularity has endured through the years. It was re-released for its 20th anniversary in 1998 and ranked as the second highest grossing film behind ''Titanic'' in its opening weekend. It was most recently re-released in July 2010 as a sing-along version in select American theatres. The soundtrack still sells strongly enough to often appear on ''Billboard's'' Top Soundtracks chart.

New image

Newton-John's transformation in ''Grease'' from goody-goody "Sandy 1" to spandex-clad "Sandy 2" emboldened Newton-John to do the same with her music career. In November 1978, she released her next studio album, ''Totally Hot,'' which became her first solo Top 10 (No. 7) album since ''Have You Never Been Mellow.'' Dressed on the cover all in leather, the album's singles "A Little More Love" (No. 3 Pop, No. 94 Country, No. 4 AC), "Deeper Than The Night" (No. 11 Pop, No. 87 Country, No. 4 AC), and the title track (No. 52 Pop) all demonstrated a more aggressive and uptempo sound for Newton-John. Although the album de-emphasized country, it still reached No. 4 on the Country Albums chart. Newton-John released the B-side, "Dancin' 'Round And 'Round," of the "Totally Hot" single to Country radio peaking at No. 29 (as well as No. 82 Pop and No. 25 AC), becoming her last charted solo Country airplay single to date.

Newton-John began 1980 by releasing ''I Can't Help It'' (No. 12 Pop, No. 8 AC), a duet with Andy Gibb from his ''After Dark'' album, and by starring in her third television special, ''Hollywood Nights.'' Later that year, she appeared in her first film since ''Grease'' starring in the musical ''Xanadu'' with Gene Kelly and Michael Beck. Although the movie was a critical failure, its soundtrack (No. 4 Pop) was certified double platinum boasting five Top 20 singles on the Billboard Hot 100. Newton-John charted with ''Magic'' (No. 1 Pop, No. 1 AC), ''Suddenly'' with Cliff Richard (No. 20 Pop, No. 4 AC) and the title song with the Electric Light Orchestra (No. 8 Pop, No. 2 AC). (The Electric Light Orchestra also charted with "I'm Alive" (No. 16 Pop, No. 48 AC) and "All Over The World" (No. 13 Pop, No. 46 AC).) ''Magic'' was Newton-John's biggest Pop hit to that point (four weeks at No. 1) and still ranks as the biggest AC hit of her career (five weeks at No. 1). The film has since become a cult classic and the basis for a well-reviewed Broadway show that ran for more than 500 performances beginning in 2007 and was nominated for four Tony Awards including Best Musical. (A successful international tour of the show followed.)

In 1981, Newton-John released her most successful studio album, the double platinum ''Physical.'' The title track, written by Steve Kipner and Terry Shaddick, spent ten weeks atop the Billboard Hot 100, matching the then record of most weeks spent at No. 1 in the rock era held by Debby Boone's ''You Light Up My Life.'' The single was certified platinum and it ultimately ranked as the biggest song of the decade. (In 2008, Billboard ranked the song No. 6 among all songs that charted in the 50-year history of the Hot 100.) "Physical" even earned Newton-John her only placement ever on the R&B; Singles (No. 28) and Albums (No. 32) chart. The ''Physical'' album spawned two more singles, ''Make a Move on Me'' (No. 5 Pop, No. 6 AC) and ''Landslide'' (No. 52 Pop).

The provocative lyrics of the title track prompted two Utah radio stations to ban the single from their playlists. (In 2010, Billboard magazine ranked this as the most popular single ever about sex.) To counter its overtly suggestive tone, Newton-John filmed an exercise-themed video that turned the song into an aerobics anthem and made headbands a fashion accessory outside the gym. Newton-John became a pioneer in the nascent music video industry by recording a video album for ''Physical'' featuring videos of all the album's tracks and three of her older hits. The video album earned her a fourth Grammy and was aired as an ABC prime time special, ''Let's Get Physical,'' becoming a Top 10 Nielsen hit. The success of ''Physical'' led to an international tour and the release of her second hits collection, the double platinum ''Olivia's Greatest Hits Vol. 2'' (No. 16 Pop), which yielded two more Top 40 singles: ''Heart Attack'' (No. 3 Pop) and ''Tied Up'' (No. 38 Pop). The tour was filmed for her ''Olivia In Concert'' television special which premiered on HBO in January 1983. The special was subsequently released to video earning Newton-John another Grammy nomination.

Newton-John re-teamed with Travolta in 1983 for the critically and commercially unsuccessful ''Two of a Kind,'' redeemed by its platinum soundtrack (No. 26 Pop) featuring ''Twist Of Fate'' (No. 5 Pop), ''Livin' In Desperate Times'' (No. 31 Pop), and a new duet with Travolta, ''Take A Chance'' (No. 3 AC). Newton-John released another video package, the Grammy-nominated ''Twist Of Fate,'' featuring videos of her four songs on the ''Two of a Kind'' soundtrack and the two new singles from ''Olivia's Greatest Hits Vol. 2.''

The same year, Newton-John and Pat Carroll founded ''Koala Blue.'' The store, originally for Australian imports, evolved into a chain of women's clothing boutiques. The chain was initially successful, but it eventually declared bankruptcy and closed in 1992. Newton-John and Farrar would later license the brand name for a line of Australian produced wines, confections, and bed/bath products. Newton-John married her long-time boyfriend, actor Matt Lattanzi, in December 1984. The couple had met four years earlier while filming ''Xanadu.'' Their daughter, Chloe Rose Lattanzi, was born in January 1986. (They divorced in 1995.)

Newton-John's music career cooled again with the release of her next studio album, the gold ''Soul Kiss'' (No. 29 Pop), in 1985. The album's only charted single was the title track (No. 20 Pop, No. 20 AC). Due to her pregnancy, Newton-John limited her publicity for the album. The video album for ''Soul Kiss'' featured only five of the album's ten tracks (concept videos for the album's singles ''Soul Kiss'' and ''Toughen Up'' as well as performance videos of the tracks ''Culture Shock'', ''Emotional Tangle'' and ''The Right Moment'').

Motherhood and advocacy

After a nearly three-year hiatus following the birth of Chloe, Newton-John resumed her recording career with the 1988 album, ''The Rumour.'' The album was promoted by an HBO special, ''Olivia Down Under,'' and its first single, the title track, was written and produced by Elton John. Both the single (No. 62 Pop, No. 33 AC) and the album (No. 67 Pop) fizzled as the nearly 40 year-old Newton-John seemed "old" when compared with the teen queens Debbie Gibson and Tiffany ruling the Pop charts at that time. (Ironically, this album was praised by critics as more mature with Newton-John addressing topics such as AIDS, the environment and single parent households.) The second single, ''Can't We Talk It Over In Bed,'' did not chart, but was released in 1989 by Grayson Hugh, the song's arranger, as ''Talk It Over'' becoming a Top 20 Pop hit. A year later, Newton-John recorded her self-described "self-indulgent" album, ''Warm and Tender.'' Inspired by her daughter, who appeared on the album cover, the album featured lullabies and love songs for parents and their children. This album, the last one produced by John Farrar, also failed to revive her recording career struggling to No. 124 Pop.

Newton-John was primed for another comeback in 1992 when she compiled her third hits collection, ''Back To Basics – The Essential Collection 1971–1992'', and planned her first tour since her ''Physical'' trek ten years earlier. Shortly after the album's release, Newton-John was diagnosed with breast cancer forcing her to cancel all publicity for the album including the tour. (Newton-John received her diagnosis the same weekend her father died.) Newton-John recovered and since became a tireless advocate for breast cancer research and other health issues. She is a product spokesperson for the Liv-Kit, a breast self-examination product. She is also partial owner of the Gaia Retreat and Spa in Byron Bay, Australia advertised as "the ideal place to renew, refresh, and restore your mind, body and soul."

Newton-John's advocacy for health issues was presaged by her prior involvement with many humanitarian causes. Newton-John cancelled a 1978 concert tour of Japan to protest the slaughter of dolphins caught in tuna fishing nets. (She subsequently rescheduled the tour when the Japanese government assured her the matter was being addressed.) She was a performer on the 1979 Music for UNICEF Concert for the UN' International Year of the Child televised worldwide. During the concert, artists performed songs for which they donated their royalties, some in perpetuity, to benefit the cause. She was appointed a Goodwill Ambassador to the United Nations Environment Programme. In 1991, she became the National Spokesperson for the Colette Chuda Environmental Fund/CHEC (Children’s Health Environmental Coalition) following the death of four year old Colette Chuda, a family friend, from cancer. (Chuda was featured along with Newton-John and daughter Chloe on the cover of Newton-John's ''Warm and Tender'' album.)

Newton-John's cancer diagnosis also affected the type of music she recorded. In 1994, she released ''Gaia: One Woman's Journey'' which chronicled her ordeal. This was the first album on which Newton-John wrote all of the songs encouraging her to become more active as a songwriter thereafter. In 2005, she released ''Stronger Than Before,'' sold exclusively in the United States by Hallmark. Proceeds from the album's sales benefited breast cancer research. The album featured the song ''Phenomenal Woman'' based on the poem by Maya Angelou that featured guest vocals from Diahann Carroll, Beth Nielsen Chapman, Delta Goodrem, Amy Holland, Patti LaBelle, and Mindy Smith – all survivors of or affected by cancer.

The following year, Newton-John released a healing CD, ''Grace And Gratitude.'' The album was sold exclusively by Walgreens also benefitting various charities including Y-ME National Breast Cancer Organization. The CD was the "heart" of their "Body – Heart – Spirit" Wellness Collection which also featured a re-branded Liv-Kit and breast-health dietary supplements. Newton-John re-recorded some tracks from ''Grace And Gratitude'' in 2010 and re-released the album as ''Grace And Gratitude Renewed'' on the Green Hill music label. The ''Renewed'' CD includes a new track, "Help Me To Heal," not featured on the original album. The ''Renewed'' CD yielded Newton-John's first appearances on the Billboard Christian Albums (No. 36), Christian & Gospel Albums (No. 54) and New Age Albums (No. 2) charts.

In 2008, Newton-John raised funds to help build the Olivia Newton-John Cancer and Wellness Centre in Melbourne, Australia. She led a three-week, 228 km. walk along the Great Wall of China during April joined by various celebrities and cancer survivors throughout her trek. The walk symbolized the steps cancer patients must take on their road to recovery. Newton-John released a companion CD, ''A Celebration In Song,'' the following month in Australia and later worldwide featuring new and previously recorded duets by "Olivia Newton-John & Friends." Her "Friends" included Jann Arden, Jimmy Barnes, John Farrar, Barry Gibb, Delta Goodrem, Sun Ho, Richard Marx, Cliff Richard, Melinda Schneider, Amy Sky and Keith Urban. (The album was re-released by Green Hill Records with different artwork in 2011.) In October, Newton-John helped launch the www.liv.com website and teamed with fitness franchise Curves to distribute one million Liv-Aid breast self-examination aids for Breast Cancer Awareness Month.

Newton-John collaborated with producer David Foster to record ''Hope Is Always Here'' for the November 2009 television special, ''Kaleidoscope.'' The song was written and composed for the show's performance by another breast cancer survivor, figure skater Dorothy Hamill. The song was released as a digital single after the show aired.

Newton-John was featured in UniGlobe Entertainment's breast cancer docu-drama, ''1 a Minute,'' released in October 2010. The documentary was made by actress Namrata Singh Gujral and featured other celebrities who survived breast cancer or were affected by the disease. During the same month, Bluewater Productions released a comic book featuring Newton-John to coincide with Breast Cancer Awareness Month.

Later career

Newton-John continued to record and perform pop-oriented music as well. In 1998, she returned to Nashville to record ''Back With A Heart'' (No. 59 Pop). The album returned her to the Top 10 (No. 9) on the Country Albums chart. Its first single was a re-recording of ''I Honestly Love You'' produced by David Foster and featuring Kenneth "Babyface" Edmonds on background vocals that charted Pop (No. 67) and AC (No. 18). Country radio dismissed the song, though it did peak at No. 16 on the Country Sales chart. The album track, ''Love Is A Gift,'' won Newton-John a 1999 Daytime Emmy Award for Outstanding Original Song after being featured on the daytime serial, ''As The World Turns.''

Newton-John's subsequent secular albums were released primarily in Australia. Newton-John, John Farnham and Anthony Warlow toured Australia as ''The Main Event.'' The live album won an ARIA Award for Highest Selling Australian CD and was also nominated for Best Adult Contemporary Album. She and Farnham performed ''Dare To Dream'' at the Opening Ceremony of the 2000 Sydney Olympics. In 2002, Newton-John released ''(2),'' a duets album featuring mostly Australian artists (Tina Arena, Darren Hayes, Jimmy Little, Johnny O'Keefe, Billy Thorpe, Keith Urban) as well as a heartfelt "duet" with the deceased Peter Allen. The same year, Newton-John was inducted into Australia's ARIA Hall of Fame. ''Indigo: Women of Song,'' a tribute album covering songs by female artists such as Joan Baez, The Carpenters, Doris Day, Nina Simone, Minnie Riperton and others, was released in 2004. Newton-John dedicated the album to her mother, who had died the previous year.

Newton-John also released several Christmas albums. In 2000, she teamed with Vince Gill and the London Symphony Orchestra for '''Tis The Season'' sold exclusively through Hallmark. The following year, she released ''The Christmas Collection'' which compiled seasonal music previously recorded for her Hallmark Christmas album, her appearance on Kenny Loggins' 1999 TNN Christmas special and her contributions to the ''Mother And Child'' and ''Spirit Of Christmas'' multi-artist collections. (Green Hill Records re-released this album with different artwork in 2010.) In 2007, she re-teamed with her ''Grace And Gratitude'' producer, Amy Sky, for ''Christmas Wish'' (No. 187 Pop) which was sold exclusively by Target in its first year of release.

Newton-John acted occasionally since ''Two of a Kind''. She appeared in a supporting role in the 1996 AIDS drama, ''It's My Party''. In 2000, she appeared in a dramatically different role as Bitsy Mae Harling, a lesbian ex-con country singer, in Del Shores' ''Sordid Lives.'' Newton-John reprised her role for ''Sordid Lives: The Series'' which aired one season on the LOGO television network. The series featured five original songs written and composed by Newton-John specifically for the show. In 2010, Newton-John starred in the film ''Score: A Hockey Musical,'' released in Canada. Newton-John portrayed Hope Gordon, the mother of a home-schooled hockey prodigy. The film opened the 2010 Toronto International Film Festival.

Newton-John's television work included starring in two Christmas movies, ''A Mom For Christmas'' (1990) and ''A Christmas Romance'' (1994) – both Top 10 Nielsen hits. Her daughter, Chloe, starred as one of her children in both ''A Christmas Romance'' and in the 2001 Showtime film ''The Wilde Girls.'' Newton-John guest-starred as herself in the sitcoms ''Ned and Stacey,'' ''Murphy Brown,'' and ''Bette,'' and made two appearances as herself on ''Glee.'' For her first ''Glee'' appearance, Newton-John re-created her "Physical" video with series regular Jane Lynch. The performance was released as a digital single, returning Newton-John to the Billboard Hot 100 (No. 89) for the first time since her 1998 re-release of ''I Honestly Love You.'' In Australia, Newton-John hosted the animal and nature series ''Wild Life'' and guest starred as Joanna on two episodes of the Australian series ''The Man From Snowy River.''

Newton-John met gaffer/cameraman Patrick McDermott a year after her 1995 divorce from Matt Lattanzi. The couple dated on and off for nine years. McDermott disappeared following a 2005 fishing trip off the California coast. Various theories abounded regarding his disappearance ranging from his death by accident or foul play to McDermott staging his disappearance to avoid child support payments to his ex-wife, actress Yvette Nipar. Newton-John, who was in Australia at her Gaia Retreat & Spa at the time of his disappearance, was never a suspect in McDermott's disappearance and has refused to comment on any speculation. A US Coast Guard investigation released in 2008 "suggest[ed] McDermott was lost at sea," although some have claimed contact with McDermott since his disappearance.

Newton-John returned to the tabloid headlines again in 2007 when it was revealed that her daughter Chloe was recovering from anorexia.

Newton-John released another concert DVD, ''Olivia Newton-John and the Sydney Symphony: Live at the Sydney Opera House,'' and a companion CD, ''Olivia's Live Hits,'' in January 2008. An edited version of the DVD premiered on PBS station, WLIW (Garden City, New York), in October 2007 and subsequently aired nationally during the network's fund-raising pledge drives. This was Newton-John's third live album after the 1981 Japanese release, ''Love Performance,'' and her 2000 Australian release, ''One Woman's Live Journey.''

In June 2008, Newton-John secretly wed John ("Amazon John") Easterling, founder and president of natural remedy firm, Amazon Herb Company. The couple had first met 15 years earlier, but they only became romantically involved in 2007. (Like Newton-John, this was Easterling's second marriage.) The couple married alone in a private Incan spiritual ceremony in Cuzco, Peru on June 21 followed nine days later by a legal ceremony on the Jupiter Island beachfront in Florida. There were no guests at either service since the couple preferred to marry simply and privately. Only Newton-John's daughter, Chloe, was aware of the nuptials. The couple did not announce their marriage until a 4 July barbecue at Newton-John's Malibu, California home, where guests were surprised with the news. The wedding was confirmed thereafter by ''HELLO!'' Magazine which published exclusive pictures of both weddings. In June 2009, the Easterlings purchased a new $4.1 million home in Jupiter Inlet, and Newton-John sold her home in Malibu, California.

Current activities

Newton-John still occasionally tours. Most of her recent public performances have been at charitable functions or to promote products such as Zamu, produced by Amazon Herb, a company founded by John Easterling. Her tour schedule can be found at http://olivianewton-john.com/tour.html.

Newton-John joined Judy Brooks and Roy Walkenhorst as co-host of the health and well-being series ''Healing Quest'', currently airing on PBS.

In January 2011, Newton-John began filming "A Few Best Men" in Australia with director Stephan Elliott in the role of mother of the groom played by (Xavier Samuel).

Ten of Newton-John's albums were re-released separately and combined as a box set in October 2010 by Universal Music Japan. The albums include ''Long Live Love,'' ''Clearly Love,'' ''Come On Over,'' ''Don't Stop Believin','' ''Making A Good Thing Better,'' ''Totally Hot,'' ''Physical,'' ''Soul Kiss'', and ''The Rumour''. Each studio album featured two additional bonus tracks not included on the original releases of each album. On the same day, Universal Music Japan also released a "40/40" compilation that included 40 of Newton-John's hits as voted for by her Japanese fans as well as a previously unreleased bonus track, "Come on Home". Newton-John promoted these re-releases with a five-date tour of Japan.

On 12 February 2011, the BBC website reported that Newton-John was keen to join the 'Hetton Thunderer' project, a collaboration between musicians and the Hetton-le-Hole Historical Musical Society to re-invent forgotten musical instruments. Newton-John wished to keep the project under-wraps until demonstrations of the remodelled musical instruments were made public.

Discography and videography

;Studio albums

''Olivia Newton John'' (1971)

''If Not For You'' (1971)

''Olivia'' (1972)

''Music Makes My Day'' (1973)

''Let Me Be There'' (1973) [US compilation]

''Long Live Love'' (1974)

''If You Love Me, Let Me Know'' (1974) [US compilation]

''Have You Never Been Mellow'' (1975)

''Clearly Love'' (1975)

''Come On Over'' (1976)

''Don't Stop Believin''' (1976)

''Making a Good Thing Better'' (1977)

''Totally Hot'' (1978)

''Physical'' (1981)

''Soul Kiss'' (1985)

''The Rumour'' (1988)

''Warm and Tender'' (1989)

''Gaia'' (1994)

''Back With a Heart'' (1998)

'''Tis the Season'' (2000)

''The Christmas Collection (Olivia Newton-John album)'' (2001)

''(2)'' (2002)

''Indigo: Women of Song'' (2004)

''Stronger Than Before'' (2005)

''Grace and Gratitude'' (2006)

''Christmas Wish'' (2007)

''A Celebration in Song'' (2008)

''Grace And Gratitude Renewed'' (2010)

;Main compilation albums

''First Impressions'' (1975) (EMI/Festival compilation)

''Greatest Hits'' (1977)

''Olivia's Greatest Hits Vol. 2'' (1982)

''Back to Basics: The Essential Collection 1971–1992'' (1992)

;Live albums

''Love Performance'' (1981)

''Highlights from The Main Event'' (1998)

''One Woman's Live Journey'' (2000)

''Olivia's Live Hits'' (2008)

;Soundtracks

''Toomorrow'' (1970)

''Grease'' (1978)

''Xanadu'' (1980)

''Two of a Kind'' (1983)

''Sordid Lives'' (2000)

''Sordid Lives: The Series'' (2008)

;DVDs/Laserdisc(12")/VHS/Betamax

''Olivia Physical'' (1982)

''Olivia in Concert'' (1983)

''Twist of Fate'' (1983)

''Soul Kiss'' (1985)

''Olivia Down Under'' (1988)

''Live at the Sydney Opera House'' (2008)

''Video Gold 1'' (2005)

''Video Gold 2'' (2005)

Filmography

''Toomorrow (film) ''The Case'' ''A Special Olivia Newton-John'' ''Only Olivia'' ''Olivia'' ''Xanadu (film) ''Two of a Kind (1983 film) ''She's Having a Baby'' ''Mothers & Others'' ''A Mom for Christmas'' ''A Christmas Romance'' ''It's My Party (film) ''Sordid Lives'' ''The Wilde Girls'' ''A Night with Olivia'' ''Live in Japan '03'' ''Sordid Lives: The Series'' ''Kathy Griffin: My Life On The D-List'' ''1 a Minute'' ''A Few Best Men''

Year !! Title !! Role !! Notes
1965	''Funny Things Happen Down Under''	Olivia
1970	Toomorrow'' ||	Olivia	Lead role
1972	|	Herself	BBC2 TV special w/Cliff Richard & Tim Brooke-Taylor
1976	|	Herself	TV special
1977	|	Herself	TV special
rowspan="2"	1978	|	Herself	TV special
''Grease (film)	Grease''	Sandy Olsson
rowspan="2"	1980	Xanadu'' ||	Terpsichore>Kira	Lead role
''Hollywood Nights''	Herself
1983	Two of a Kind'' ||	Debbie	Lead role
1988	|	Herself	Cameo
1989	|	Herself	TV special
1990	|	Amy Miller	Lead role in television film
rowspan="2"	1991	|	Julia Stonecypher	Lead role in television film
''Madonna: Truth or Dare''	Herself
1996	It's My Party'' ||	Lina Bingham	Supporting role
2000	|	Bitsy Mae Harling	Supporting role
2001	|	Jasmine Wilde	Lead role in television film
2002	|	Herself	TV special
2003	|	Herself	TV special
2008	|	Bitsy Mae Harling	Supporting role in TV Series
2009	|	Herself	Guest appearance
rowspan="3"	2010	|	Herself	Documentary
''Glee (TV series)	Glee''	Herself
''Score: A Hockey Musical''	Hope Gordon
2011	|	Mother-in-Law	Supporting role

Tours

''If Not For You Tour'' (1972)

''Cliff Richard Japan tour w/Pat Carroll'' (1972)

''Clearly Love Tour'' (1975)

''Love Performance Tour'' (1976)

''Totally Hot World Tour'' (1978)

''Physical World Tour'' (1982)

''The Main Event Tour'' (1998)

''Greatest Hits Tour'' (1999)

''One Woman's Live Journey Tour'' (1999)

''Millennium Tour'' (2000)

''30 Musical Years Tour'' (2001)

''Heartstrings World Tour'' (2002)

''Japan 2006 Tour'' (2006)

''Live at the Sydney Opera House Tour'' (2006)

''Grace and Gratitude Tour'' (2006)

''Body Heart & Spirit Tour'' (2007)

''Verona-Canadian 2007 Tour'' (2007)

''United States 2009 Tour'' (2009)

Awards and honours

{| class=wikitable |- style="background:#ccc;" !Year !Category !Genre !Recording !Result |- style="background:#ddd;" | colspan="5" style="text-align:center;"| Grammy Awards |- align=left | style="text-align:left;"|1973 |Best Female Country Vocal Performance |Country |"Let Me Be There" | |- align=left | style="text-align:left;" rowspan="2"|1974 |Record of the Year |General |"I Honestly Love You" | |- align=left |Best Female Pop Vocal Performance |Pop |"I Honestly Love You" | |- align=left | style="text-align:left;"|1975 |Best Female Pop Vocal Performance |Pop |"Have You Never Been Mellow" | |- align=left | style="text-align:left;" rowspan="2"|1978 |Album of the Year |General |"Grease" (Soundtrack) | |- align=left |Best Female Pop Vocal Performance |Pop |"Hopelessly Devoted to You" | |- align=left | style="text-align:left;"|1980 |Best Female Pop Vocal Performance |Pop |"Magic" | |- align=left | style="text-align:left;"|1981 |Best Female Pop Vocal Performance |Pop |"Physical" | |- align=left | style="text-align:left;" rowspan="2"|1982 |Best Female Pop Vocal Performance |Pop |"Heart Attack" | |- align=left |Video of the Year |General |''Olivia Physical'' | |- align=left | style="text-align:left;"|1983 |Best Long Form Music Video |General |''Olivia in Concert'' | |- align=left | style="text-align:left;"|1984 |Best Short Form Music Video |General |''Twist of Fate'' | |}

See also

List of best-selling music artists

List of celebrities who own wineries and vineyards

List of songs by Australian artists which reached number-one on the Hot 100 (USA)

List of songs by British artists which reached number-one on the Hot 100 (USA)

List of artists who reached number one in the United States

List of artists who reached number one on the UK Singles Chart

References

Bibliography

Olivia (The Biography of Olivia Newton-John), Tim Ewbank. (2008). Piatkus books. ISBN 978-0-7499-0983-3.

Wood, Gerry. (1998). "Olivia Newton-John." In ''The Encyclopedia of Country Music.'' Paul Kingsbury, Editor. New York: Oxford University Press. pp. 380–1.

The Story of the Shadows by Mike Read. 1983. Elm Tree books. ISBN 0-241-10861-6.

Rock 'n' Roll, I Gave You The Best Years Of My Life – A Life In The Shadows by Bruce Welch ISBN 0-670-82705-3 (Penguin Books).

External links

Olivia Newton-John

Gaia Retreat

Great Walk To Beijing

ON-J Cancer Centre Appeal

Breast Health

Newton-John, Olivia (1948–) National Library of Australia, ''Trove, People and Organisation'' record for Olivia Newton-John

Category:1948 births Category:20th-century actors Category:21st-century actors Category:Living people Category:Actors from Melbourne Category:ARIA Award winners Category:ARIA Hall of Fame inductees Category:Australian country singers Category:Australian dance musicians Category:Australian expatriate actors in the United States Category:Australian female singers Category:Australian film actors Category:Australian people of English descent Category:Australian people of German descent Category:Australian people of Welsh descent Category:Australian pop singers Category:Australian television actors Category:Breast cancer survivors Category:British Eurovision Song Contest entrants Category:English country singers Category:English dance musicians Category:English expatriates in the United States Category:English female singers Category:English film actors Category:English emigrants to Australia Category:English pop singers Category:English people of German descent Category:English people of Welsh descent Category:English television actors Category:Daytime Emmy Award winners Category:Eurovision Song Contest entrants of 1974 Category:Grammy Award winners Category:Naturalised citizens of Australia Category:Officers of the Order of Australia Category:Officers of the Order of the British Empire Category:People from Cambridge Category:Singers from Melbourne

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Coordinates	41°52′55″N87°37′40″N
name	Myocardial infarction
diseasesdb	8664
icd10	-
icd9
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emedicinesubj	med
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Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and ensuing oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (''infarction'') of heart muscle tissue (''myocardium'').

Classical symptoms of acute myocardial infarction include sudden chest pain (typically radiating to the left arm or left side of the neck), shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety (often described as a sense of impending doom). Women may experience fewer typical symptoms than men, most commonly shortness of breath, weakness, a feeling of indigestion, and fatigue. Approximately one-quarter of all myocardial infarctions are "silent", that is without chest pain or other symptoms.

Among the diagnostic tests available to detect heart muscle damage are an electrocardiogram (ECG), echocardiography, cardiac MRI and various blood tests. The most often used blood markers are the creatine kinase-MB (CK-MB) fraction and the troponin levels. Immediate treatment for suspected acute myocardial infarction includes oxygen, aspirin, and sublingual nitroglycerin.

Most cases of STEMI (ST elevation MI) are treated with thrombolysis or percutaneous coronary intervention (PCI). NSTEMI (non-ST elevation MI) should be managed with medication, although PCI is often performed during hospital admission. In people who have multiple blockages and who are relatively stable, or in a few emergency cases, bypass surgery may be an option, especially in diabetics.

Ischemic heart disease (which includes myocardial infarction, angina pectoris and heart failure when preceded by myocardial infarction) was the leading cause of death for both men and women worldwide in 2004. Important risk factors are previous cardiovascular disease, older age, tobacco smoking, high blood levels of certain lipids (triglycerides, low-density lipoprotein) and low levels of high density lipoprotein (HDL), diabetes, high blood pressure, obesity, chronic kidney disease, heart failure, excessive alcohol consumption, the abuse of certain drugs (such as cocaine and methamphetamine), and chronic high stress levels.

Classification

There are two basic types of acute myocardial infarction: Transmural: associated with atherosclerosis involving major coronary artery. It can be subclassified into anterior, posterior, inferior, lateral or septal. Transmural infarcts extend through the whole thickness of the heart muscle and are usually a result of complete occlusion of the area's blood supply. Subendocardial: involving a small area in the subendocardial wall of the left ventricle, ventricular septum, or papillary muscles. The subendocardial area is particularly susceptible to ischemia.

In the clinical context, a myocardial infarction can be further subclassified into a ST elevation MI (STEMI) versus a non-ST elevation MI (non-STEMI) based on ECG changes.

The phrase ''heart attack'' is sometimes used incorrectly to describe sudden cardiac death, which may or may not be the result of acute myocardial infarction. A heart attack is different from, but can be the cause of cardiac arrest, which is the stopping of the heartbeat, and cardiac arrhythmia, an abnormal heartbeat. It is also distinct from heart failure, in which the pumping action of the heart is impaired; however severe myocardial infarction may lead to heart failure.

A 2007 consensus document classifies myocardial infarction into five main types:

Type 1 – Spontaneous myocardial infarction related to ischaemia due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection

Type 2 – Myocardial infarction secondary to ischaemia due to either increased oxygen demand or decreased supply, e.g. coronary artery spasm, coronary embolism, anaemia, arrhythmias, hypertension, or hypotension

Type 3 – Sudden unexpected cardiac death, including cardiac arrest, often with symptoms suggestive of myocardial ischaemia, accompanied by new ST elevation, or new LBBB, or evidence of fresh thrombus in a coronary artery by angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood

Type 4 – Associated with coronary angioplasty or stents:

* Type 4a – Myocardial infarction associated with PCI

* Type 4b – Myocardial infarction associated with stent thrombosis as documented by angiography or at autopsy

Type 5 – Myocardial infarction associated with CABG

Signs and symptoms

The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and rarely instantaneous. Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle is termed angina pectoris. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and epigastrium, where it may mimic heartburn. Levine's sign, in which the patient localizes the chest pain by clenching their fist over the sternum, has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed that it had a poor positive predictive value.

Shortness of breath (dyspnea) occurs when the damage to the heart limits the output of the left ventricle, causing left ventricular failure and consequent pulmonary edema. Other symptoms include diaphoresis (an excessive form of sweating), weakness, light-headedness, nausea, vomiting, and palpitations. These symptoms are likely induced by a massive surge of catecholamines from the sympathetic nervous system which occurs in response to pain and the hemodynamic abnormalities that result from cardiac dysfunction. Loss of consciousness (due to inadequate cerebral perfusion and cardiogenic shock) and sudden death (frequently due to the development of ventricular fibrillation) can occur in myocardial infarctions.

Women and older patients report atypical symptoms more frequently than their male and younger counterparts. Women also report more numerous symptoms compared with men (2.6 on average vs 1.8 symptoms in men). The most common symptoms of MI in women include dyspnea (shortness of breath), weakness, and fatigue. Fatigue, sleep disturbances, and dyspnea have been reported as frequently occurring symptoms that may manifest as long as one month before the actual clinically manifested ischemic event. In women, chest pain may be less predictive of coronary ischemia than in men.

Approximately one-fourth of all myocardial infarctions are silent, without chest pain or other symptoms. These cases can be discovered later on electrocardiograms, using blood enzyme tests or at autopsy without a prior history of related complaints. A silent course is more common in the elderly, in patients with diabetes mellitus and after heart transplantation, probably because the donor heart is not fully innervated by the nervous system of the recipient. In diabetics, differences in pain threshold, autonomic neuropathy, and psychological factors have been cited as possible explanations for the lack of symptoms.

Any group of symptoms compatible with a sudden interruption of the blood flow to the heart are called an acute coronary syndrome.

The differential diagnosis includes other catastrophic causes of chest pain, such as pulmonary embolism, aortic dissection, pericardial effusion causing cardiac tamponade, tension pneumothorax, and esophageal rupture. Other non-catastrophic differentials include gastroesophageal reflux and Tietze's syndrome.

Causes

Heart attack rates are higher in association with intense exertion, be it psychological stress or physical exertion, especially if the exertion is more intense than the individual usually performs. The period of intense exercise and subsequent recovery is associated with about a 6-fold higher myocardial infarction rate (compared with other more relaxed time frames) for people who are physically very fit. For those in poor physical condition, the rate differential is over 35-fold higher. One observed mechanism for this phenomenon is the increased arterial pulse pressure stretching and relaxation of arteries with each heart beat, which, as has been observed with intravascular ultrasound, increases mechanical "shear stress" on atheromas and the likelihood of plaque rupture.

Acute severe infection, such as pneumonia, can trigger myocardial infarction. A more controversial link is that between ''Chlamydophila pneumoniae'' infection and atherosclerosis. While this intracellular organism has been demonstrated in atherosclerotic plaques, evidence is inconclusive as to whether it can be considered a causative factor. Treatment with antibiotics in patients with proven atherosclerosis has not demonstrated a decreased risk of heart attacks or other coronary vascular diseases.

There is an association of an increased incidence of a heart attack in the morning hours, more specifically around 9 a.m. Some investigators have noticed that the ability of platelets to aggregate varies according to a circadian rhythm, although they have not proven causation.

Risk factors

In general, risk factors for atherosclerosis are risk factors for myocardial infarction:

Age — Men acquire an independent risk factor at age 45, Women acquire an independent risk factor at age 55; in addition, individuals acquire another independent risk factor if they have a first-degree male relative (brother, father) who suffered a coronary vascular event at or before age 55. Another independent risk factor is acquired if one has a first-degree female relative (mother, sister) who suffered a coronary vascular event at age 65 or younger.

Males are more at risk than females.

Diabetes (with or without insulin resistance)

High blood pressure

Dyslipidemia/hypercholesterolemia (abnormal levels of lipoproteins in the blood), particularly high low-density lipoprotein, low high-density lipoprotein and high Triglycerides

Tobacco smoking including secondhand smoke

Air pollution

Family history of ischaemic heart disease (IHD)

Obesity (defined by a body mass index of more than 30 kg/m², or alternatively by waist circumference or waist-hip ratio).

Hyperhomocysteinemia (high homocysteine)

Stress — Occupations with high stress index are known to have susceptibility for atherosclerosis

Alcohol — Studies show that prolonged exposure to high quantities of alcohol can increase the risk of heart attack

Many of these risk factors are modifiable, so many heart attacks can be prevented by maintaining a healthier lifestyle. Physical activity, for example, is associated with a lower risk profile. Non-modifiable risk factors include age, sex, and family history of an early heart attack (before the age of 60), which is thought of as reflecting a genetic predisposition.

Socioeconomic factors such as a shorter education and lower income (particularly in women), and unmarried cohabitation are also correlated with a higher risk of MI. To understand epidemiological study results, it is important to note that many factors associated with MI mediate their risk via other factors. For example, the effect of education is partially based on its effect on income and marital status.

Women who use combined oral contraceptive pills have a modestly increased risk of myocardial infarction, especially in the presence of other risk factors, such as smoking.

Inflammation is known to be an important step in the process of atherosclerotic plaque formation. C-reactive protein (CRP) is a sensitive but non-specific marker for inflammation. Elevated CRP blood levels, especially measured with high-sensitivity assays, can predict the risk of MI, as well as stroke and development of diabetes. Moreover, some drugs for MI might also reduce CRP levels. The use of high-sensitivity CRP assays as a means of screening the general population is advised against, but it may be used optionally at the physician's discretion in patients who already present with other risk factors or known coronary artery disease. Whether CRP plays a direct role in atherosclerosis remains uncertain.

Inflammation in periodontal disease may be linked to coronary heart disease, and, since periodontitis is very common, this could have great consequences for public health. Serological studies measuring antibody levels against typical periodontitis-causing bacteria found that such antibodies were more present in subjects with coronary heart disease. Periodontitis tends to increase blood levels of CRP, fibrinogen and cytokines; thus, periodontitis may mediate its effect on MI risk via other risk factors. Preclinical research suggests that periodontal bacteria can promote aggregation of platelets and promote the formation of foam cells. A role for specific periodontal bacteria has been suggested but remains to be established. There is some evidence that influenza may trigger an acute myocardial infarction.

Baldness, hair greying, a diagonal earlobe crease (Frank's sign) and possibly other skin features have been suggested as independent risk factors for MI. Their role remains controversial; a common denominator of these signs and the risk of MI is supposed, possibly genetic.

Calcium deposition is another part of atherosclerotic plaque formation. Calcium deposits in the coronary arteries can be detected with CT scans. Several studies have shown that coronary calcium can provide predictive information beyond that of classical risk factors.

The European Society of Cardiology and the European Association for Cardiovascular Prevention and Rehabilitation have developed an interactive tool for prediction and managing the risk of heart attack and stroke in Europe. HeartScore is aimed at supporting clinicians in optimising individual cardiovascular risk reduction. The Heartscore Programme is available in 12 languages and offers web-based or PC version.

Pathophysiology

Acute myocardial infarction refers to two subtypes of acute coronary syndrome, namely non-ST-elevated myocardial infarction and ST-elevated myocardial infarction, which are most frequently (but not always) a manifestation of coronary artery disease. The most common triggering event is the disruption of an atherosclerotic plaque in an epicardial coronary artery, which leads to a clotting cascade, sometimes resulting in total occlusion of the artery. Atherosclerosis is the gradual buildup of cholesterol and fibrous tissue in plaques in the wall of arteries (in this case, the coronary arteries), typically over decades. Blood stream column irregularities visible on angiography reflect artery lumen narrowing as a result of decades of advancing atherosclerosis. Plaques can become unstable, rupture, and additionally promote a thrombus (blood clot) that occludes the artery; this can occur in minutes. When a severe enough plaque rupture occurs in the coronary vasculature, it leads to myocardial infarction (necrosis of downstream myocardium).

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 occluded coronary artery die (chiefly through necrosis) and do not grow back. A collagen scar forms in its place. Recent studies indicate that another form of cell death called apoptosis also plays a role in the process of tissue damage subsequent to myocardial infarction. As a result, the patient's heart will be permanently damaged. This myocardial scarring also puts the patient at risk for potentially life threatening arrhythmias, and may result in the formation of a ventricular aneurysm that can rupture with catastrophic consequences.

Injured heart tissue conducts electrical impulses more slowly than normal heart tissue. The difference in conduction velocity between injured and uninjured tissue can trigger re-entry or a feedback loop that is believed to be the cause of many lethal arrhythmias. The most serious of these arrhythmias is ventricular fibrillation (''V-Fib''/VF), an extremely fast and chaotic heart rhythm that is the leading cause of sudden cardiac death. Another life-threatening arrhythmia is ventricular tachycardia (''V-Tach''/VT), which may or may not cause sudden cardiac death. However, ventricular tachycardia usually results in rapid heart rates that prevent the heart from pumping blood effectively. Cardiac output and blood pressure may fall to dangerous levels, which can lead to further coronary ischemia and extension of the infarct.

The cardiac defibrillator is a device that was specifically designed to terminate these potentially fatal arrhythmias. The device works by delivering an electrical shock to the patient in order to depolarize a critical mass of the heart muscle, in effect "rebooting" the heart. This therapy is time dependent, and the odds of successful defibrillation decline rapidly after the onset of cardiopulmonary arrest.

Diagnosis

The diagnosis of myocardial infarction can be made after assessing patient's complaints and physical status. ECG changes, coronary angiogram and levels of cardiac markers help to confirm the diagnosis. ECG gives valuable clues to identify the site of myocardial damage while coronary angiogram allows visualization of narrowing or obstructions in the heart vessels. At autopsy, a pathologist can diagnose a myocardial infarction based on anatomopathological findings.

A chest radiograph and routine blood tests may indicate complications or precipitating causes and are often performed upon arrival to an emergency department. New regional wall motion abnormalities on an echocardiogram are also suggestive of a myocardial infarction. Echo may be performed in equivocal cases by the on-call cardiologist. In stable patients whose symptoms have resolved by the time of evaluation, Technetium (99mTc) sestamibi (i.e. a "MIBI scan") or thallium-201 chloride can be used in nuclear medicine to visualize areas of reduced blood flow in conjunction with physiologic or pharmocologic stress. Thallium may also be used to determine viability of tissue, distinguishing whether non-functional myocardium is actually dead or merely in a state of hibernation or of being stunned.

WHO criteria formulated in 1979 have classically been used to diagnose MI; a patient is diagnosed with myocardial infarction if two (probable) or three (definite) of the following criteria are satisfied: # Clinical history of ischaemic type chest pain lasting for more than 20 minutes # Changes in serial ECG tracings # Rise and fall of serum cardiac biomarkers such as creatine kinase-MB fraction and troponin

The WHO criteria were refined in 2000 to give more prominence to cardiac biomarkers. According to the new guidelines, a cardiac troponin rise accompanied by either typical symptoms, pathological Q waves, ST elevation or depression, or coronary intervention is diagnostic of MI.

Prevention

The risk of a recurrent myocardial infarction decreases with strict blood pressure management and lifestyle changes, chiefly smoking cessation, regular exercise, a sensible diet for those with heart disease, and limitation of alcohol intake. People are usually commenced on several long-term medications post-MI, with the aim of preventing secondary cardiovascular events such as further myocardial infarctions, congestive heart failure or cerebrovascular accident (CVA). Unless contraindicated, such medications may include:

Antiplatelet drug therapy such as aspirin and/or clopidogrel should be continued to reduce the risk of plaque rupture and recurrent myocardial infarction. Aspirin is first-line, owing to its low cost and comparable efficacy, with clopidogrel reserved for patients intolerant of aspirin. The combination of clopidogrel and aspirin may further reduce risk of cardiovascular events, however the risk of hemorrhage is increased. Beta blocker therapy such as metoprolol or carvedilol should be commenced. These have been particularly beneficial in high-risk patients such as those with left ventricular dysfunction and/or continuing cardiac ischaemia. β-Blockers decrease mortality and morbidity. They also improve symptoms of cardiac ischemia in NSTEMI. ACE inhibitor therapy should be commenced 24–48 hours post-MI in hemodynamically-stable patients, particularly in patients with a history of MI, diabetes mellitus, hypertension, anterior location of infarct (as assessed by ECG), and/or evidence of left ventricular dysfunction. ACE inhibitors reduce mortality, the development of heart failure, and decrease ventricular remodelling post-MI. Statin therapy has been shown to reduce mortality and morbidity post-MI. The effects of statins may be more than their LDL lowering effects. The general consensus is that statins have plaque stabilization and multiple other ("pleiotropic") effects that may prevent myocardial infarction in addition to their effects on blood lipids. The aldosterone antagonist agent eplerenone has been shown to further reduce risk of cardiovascular death post-MI in patients with heart failure and left ventricular dysfunction, when used in conjunction with standard therapies above. Spironolactone is another option that is sometimes preferable to eplerenone due to cost. Evidence supports the consumption of polyunsaturated fats instead of saturated fats as a measure of decreasing coronary heart disease. Omega-3 fatty acids, commonly found in fish, have been shown to reduce mortality post-MI. While the mechanism by which these fatty acids decrease mortality is unknown, it has been postulated that the survival benefit is due to electrical stabilization and the prevention of ventricular fibrillation. However, further studies in a high-risk subset have not shown a clear-cut decrease in potentially fatal arrhythmias due to omega-3 fatty acids.

Blood donation may reduce the risk of heart disease for men, but the link has not been firmly established.

A Cochrane review found that giving heparin to people with heart conditions like unstable angina and some forms of heart attacks reduces the risk of having another heart attack. However, heparin also increases the chance of suffering from minor bleeding.

Management

An MI is a medical emergency that requires immediate medical attention. Treatment attempts to salvage as much myocardium as possible and to prevent further complications, hence the phrase "time is muscle". Oxygen, aspirin, and nitroglycerin may be administered. Morphine was classically used if nitroglycerin was not effective; however, it may increase mortality in the setting of NSTEMI. A 2009 and 2010 review of high flow oxygen in myocardial infarction found increased mortality and infarct size, calling into question the recommendation about its routine use. Other analgesics such as nitrous oxide are of unknown benefit. Percutaneous coronary intervention (PCI) or fibrinolysis are recommended in those with an STEMI.

Prognosis

The prognosis post myocardial infarction varies greatly, depending on a person's health, the extent of the heart damage and the treatment given. For the period 2005–2008 in the United States, the median mortality at 30 days was 16.6% with a range from 10.9% to 24.9% depending on the hospital. Using variables available in the emergency room, people with a higher risk of adverse outcome can be identified. One study found that 0.4% of patients with a low-risk profile died after 90 days, whereas in high-risk people it was 21.1%.

Some of the more reproduced risk-stratifying factors include: age, hemodynamic parameters (such as heart failure, cardiac arrest on admission, systolic blood pressure, or Killip class of two or greater), ST-segment deviation, diabetes, serum creatinine, peripheral vascular disease and elevation of cardiac markers. Assessment of left ventricular ejection fraction may increase the predictive power. The prognostic importance of Q-waves is debated. Prognosis is significantly worsened if a mechanical complication such as papillary muscle or myocardial free wall rupture occur. Morbidity and mortality from myocardial infarction has improved over the years due to better treatment.

Complications

Complications may occur immediately following the heart attack (in the acute phase), or may need time to develop (a chronic problem). Acute complications may include heart failure if the damaged heart is no longer able to adequately pump blood around the body; aneurysm or rupture of the myocardium; mitral regurgitation, in particular if the infarction causes dysfunction of the papillary muscle; and arrhythmias, such as ventricular fibrillation, ventricular tachycardia, atrial fibrillation and heart block. Longer-term complications include heart failure, atrial fibrillation, and the increased risk of a second myocardial infarction.

Epidemiology

Myocardial infarction is a common presentation of ischemic heart disease. The WHO estimated in 2002, that 12.6 percent of worldwide deaths were from ischemic heart disease with it the leading cause of death in developed countries, and third to AIDS and lower respiratory infections in developing countries. Worldwide more than 3 million people have STEMIs and 4 million have NSTEMIs a year.

Coronary heart disease is responsible for 1 in 5 deaths in the United States. It is becoming more common in the developing world such that, in India, cardiovascular disease (CVD) is the leading cause of death. The deaths due to CVD in India were 32% of all deaths in 2007 and are expected to rise from 1.17 million in 1990 and 1.59 million in 2000 to 2.03 million in 2010. Although a relatively new epidemic in India, it has quickly become a major health issue with deaths due to CVD expected to double during 1985–2015. Mortality estimates due to CVD vary widely by state, ranging from 10% in Meghalaya to 49% in Punjab (percentage of all deaths). Punjab (49%), Goa (42%), Tamil Nadu (36%) and Andhra Pradesh (31%) have the highest CVD related mortality estimates. State-wise differences are correlated with prevalence of specific dietary risk factors in the states. Moderate physical exercise is associated with reduced incidence of CVD in India (those that exercise have less than half the risk of those that do not).

Legal implications

At common law, in general a myocardial infarction is a disease, but may sometimes be an injury. This has implications for no-fault insurance schemes such as workers' compensation. In general, a heart attack is not covered; however, it may be a work-related injury if it results, for example, from unusual emotional stress or unusual exertion. In addition, in some jurisdictions, heart attacks suffered by persons in particular occupations such as police officers may be classified as line-of-duty injuries by statute or policy. In some countries or states, a person having suffered from a myocardial infarction may be prevented from participating in activity that puts other people's lives at risk, for example driving a car or flying an airplane.

Research

Patients who receive stem cell treatment by coronary artery injections of stem cells derived from their own bone marrow after a myocardial infarction (MI) show improvements in left ventricular ejection fraction and end-diastolic volume not seen with placebo. The larger the initial infarct size, the greater the effect of the infusion. Clinical trials of progenitor cell infusion as a treatment approach to ST elevation MI are proceeding.

There are currently 3 biomaterial and tissue engineering approaches for the treatment of MI, but these are in an even earlier stage of medical research, so many questions and issues must be addressed before they can be applied to patients. The first involves polymeric left ventricular restraints in the prevention of heart failure. The second utilizes ''in vitro'' engineered cardiac tissue, which is subsequently implanted ''in vivo''. The final approach entails injecting cells and/or a scaffold into the myocardium to create ''in situ'' engineered cardiac tissue.

References

External links

American Heart Association's Heart Attack web site – Information and resources for preventing, recognizing and treating heart attack.

Heart Attack – overview of resources from MedlinePlus

Category:Aging-associated diseases Category:Causes of death Category:Ischemic heart diseases Category:Medical emergencies

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