document_title: The Darling Buds of May (TV series)

question_text: who plays victoria in the darling buds of may

text: The Darling Buds of May (TV series)

text: Synopsis[edit]

text: The Larkin family lives on a farm in rural England, in the county of Kent. Sidney ("Pop") and his partner Florence ("Ma") have six children, eldest daughter Mariette, followed by their only son Montgomery, and other daughters Primrose, twins Zinnia and Petunia, and Victoria. Ma is a housewife while Pop supplements his farm income with various other not entirely legitimate enterprises. Tax collector Cedric ("Charlie") visits to audit Pop, but falls in love with Mariette and quits his job to live the rural life. As Ma and Pop raise their other children, Charlie attempts to provide for his now wife Mariette. Ma and Pop soon have a seventh child, Oscar, followed around a year later by Charlie and Mariette's first baby, John Blenheim.

text: Pop and Ma's relationship is depicted as loving and affectionate throughout, although Pop is flirtatious and subject to numerous advances, most of which Ma is aware of and evidently unconcerned by. Proud of all his children, Pop's schemes evidently provide well for the family, enough to fund boarding school for the twins, naval boarding school for Monty, a swimming pool, a fairground, and a holiday to France, although he is just as motivated by doing good and helping others as making a profit. Ma occasionally becomes involved in Pop's schemes, or creates a scheme of her own. Possessing some very close friends, their lifestyle, in particular the fact they have never been married, nonetheless raises eyebrows in the stuffy environs of the local village.

text: Mariette and Charlie's relationship is more torrid, in part due to his insecurity over her attractiveness, and his varying success in providing financially, with their newly acquired hop garden struggling. Mariette's business skills eventual come to bear as they purchase a local brewery. Primrose is depicted as a frustrated romantic, moving to France to live with a boy her own age and attempting to seduce both Charlie and the village minister upon her return. Monty meanwhile contends with bullying, both at home and at naval boarding school. The increasingly mischievous twins gradually grow apart from their younger sibling Victoria, who delights in teasing and embarrassing all her siblings, especially Primrose.

text: Time period[edit]

text: All the episodes are seemingly set during 1958–59 despite the timespan of events across all three series making this a logical impossibility. The first serial is based on the first book, written and set in 1958, during which Florence finds out she is pregnant. In the second serial ("When the green woods laugh") Sidney is accused of committing indecent assault on 23 August 1958. The trial takes place on 7 July, the same day as Charlie's and Mariette's wedding; this would seem to be a continuity error because it cannot be July of the following year as Florence's baby had not yet been born. By the time of the third serial ("A breath of French air") Florence has already given birth to Oscar and the Larkins have a late August holiday in Brittany, during which Charlie and Mariette celebrate their first wedding anniversary. The fourth serial ("Christmas is coming") is set at Christmas and it is established Mariette is five months pregnant; she gives birth in the fifth serial ("Oh! to be in England!"), which would be some time in the spring of 1960 at the earliest according to the dating of the first series and the chronology of events up to that point. However, in the sixth serial ("Stranger at the gates") the twins celebrate their birthday, which a close-up of a wall calendar reveals to be 15 August 1959.

text: In the eighth serial ("Le Grand Weekend") the Larkins' weekend getaway coincides with Charles de Gaulle's state visit, which would date the events of the episode to April 1960 if it does indeed coincide with the real-life visit. Primrose's birthday was revealed to be in May in "Stranger at the gates" and she celebrates it in the ninth serial "The happiest days of your life", dating the events either to May 1960 (using the retconned second series date) or 1961 (going by the date given in the first series). By the eleventh serial ("Climb the greasy pole"), when the children are older and the babies have grown to toddlerhood, another close-up of a calendar reveals the month to be October 1959. At the end of the final episode, Sidney is elected to the Rural District Council on 5 November 1959 (Guy Fawkes Night).

text: Cast[edit]

text: Main cast members[edit]

text: Of the four main cast members, Jason and Ferris appeared in all twenty episodes, while Zeta-Jones and Franks appeared in eighteen, their only absences being in the third series double episode "Cast Not Your Pearls Before Swine" (3.3 & 3.4).

text:
David Jason, as Sidney Charles "Pop" Larkin, the father of the family
Pam Ferris, as Florence Daisy "Ma" (Parker) Larkin, the mother of the family
Catherine Zeta-Jones, as Mariette Charlton, née Larkin, eldest Larkin daughter
Philip Franks, Cedric "Charley" Charlton, husband of Mariette

text: Recurring cast - Larkin family[edit]

text: The actors playing the other Larkin children and grandchild were as below (listed in descending character age). All the children except those yet to be born appeared in the first episode. After appearing in the first six episodes, the actor playing Primrose was replaced, the second appearing from the seventh episode (the first Christmas special) onwards. The actors playing the roles of Oscar and John Blenheim first appear in episodes 1.5 and 2.1 respectively. Although a male character, John Blenheim was played by Daisy-May Bates, granddaughter of the author of the books.

text:
Julie Stichbury, as Primrose Larkin (1991) (6 episodes)
Abigail Rokison, as Primrose Larkin (1991-1993) (12 episodes)
Ian Tucker, as Montgomery 'Monty' Larkin, their eldest son (13 episodes)
Christina Giles, as Petunia Larkin, twin sister to Zinnia (18 episodes)
Katherine Giles, as Zinnia Larkin, twin sister to Petunia (18 episodes)
Stephanie Ralph, as Victoria Larkin, the youngest Larkin daughter (19 episodes)
Ross Marriott, as Oscar Larkin, their youngest child (16 episodes)
Daisy-May Bates, as John Marlborough Churchill Blenheim Charlton, the only son of Charlie and Mariette (11 episodes)

text: Recurring cast - others[edit]

text: Various other actors appeared in more than one story-line, i.e. in more than one double-episode.

text:
Rachel Bell as Edith Pilchester, a local spinster (16 episodes)
Moray Watson as the Brigadier, a local retired army officer (11 episodes)
Kika Mirylees as Angela Snow, a local woman (7 episodes)
Martyn Read as Sergeant Wilson, a local police officer (6 episodes)
Tyler Butterworth as Reverend John Candy, the local vicar (4 episodes)
Michael Jayston as Ernest Bristow, the brewery owner (4 episodes)
Carol MacReady as Mrs. Daws, a local shopkeeper (4 episodes)
Sheila Burrell as Mrs. Kinthley, owner of the hop-garden bought by Charlie (4 episodes)
Steven Brand as Tom Sargent, love interest of Mariette (4 episodes)
Anna Massey as Mademoiselle Antoinette Dupont, a French hotelier (3 episodes)
Michael Culver as Sir George Bluff-Gore, a local landowner (3 episodes)
Richenda Carey as Lady Bluff-Gore, wife of Sir George (3 episodes)
John Carlin as Reverend Spink (3 episodes)

text: Episodes[edit]

text: Series 1[edit]

text:
No.
Title
Original broadcast

1.1 & 1.2
"The Darling Buds of May"
7 and 14 April 1991

Cedric Charlton, the tax inspector, arrives on Home Farm to help the Larkins fill in their tax form. He is distracted by their beautiful daughter, Mariette. The Larkins distract him further by attempting to teach him crib and getting him drunk. He wakes with a hangover, and is unfit to return home. Eventually, he forgets life in the office. He accompanies the family on their annual strawberry-picking trip, where he attracts Pauline Jackson, the local flirt. Mariette and Pauline fight for him but Mariette wins and the episode ends with Mr Charlton (called Charley by the family), proposing to Mariette, and Pop Larkin giving them his blessing.

1.3 & 1.4
"When the green woods laugh"
21 and 28 April 1991

The day of Charley and Mariette's wedding is looming. Pop sells a country mansion to an aristocratic couple. When Pop rejects the advances of Corrine Perrigo (Celia Imrie), she gets her revenge by persuading the woman to charge him with assault, when all he attempted was stop her from falling. The Brigadier is best man for the wedding. Eventually, Pop is found innocent and the wedding goes ahead.

1.5 & 1.6
"A breath of French air"
5 and 12 May 1991

The Larkins go on holiday to Brittany. The weather is appalling, the food revolting, the receptionist unfriendly. The weather improves, and a mechanic sees the crest on the doors of Mr Larkin's car and thinks him a lord. As a result, he is treated better, even by the receptionist, Molet. The hotel patronne, Mademoiselle Dupont, gives Pop and Ma her room. Primrose falls in love with a local boy named Marc - Antoine Gammelin and wants to stay in France. Tension springs up between Charley and Mariette when she attracts local young men and wants to spend time with them on the beach. She refuses to go on a miniature railway with Charlie. Incensed, Charlie says he will go on his own. The train is late and he wanders into a bar, where he meets a tomboy and her pals. They get him drunk; he misses his train and has to be escorted home by Pop. But he sobers up at the sight of Mariette playing in the sea with her new friends. Charley drags her away, and tells her she will come on the train with him next day whether she likes it or not. Mariette surrenders and enjoys it. The Larkins get together with the tomboy, Max (short for Maxime), and Angela Snow (who, by a coincidence, is also visiting Brittany) and her sister Iris, who with the hotel staff organise a wedding anniversary celebration for Charley and Mariette.

1.7
"Christmas is coming!"
22 December 1991

As Christmas approaches, Charley and Mariette go to view a house to rent, unaware that Tommy Mason, an escaped convict is hiding there. Pop later discovers him in the Larkins' hen-house where Victoria is taking food to him. He explains that, since his imprisonment, his wife has severed all ties with him but he is anxious to see his children. Pop usually dresses as Father Christmas to give local children toys but Charley suggests Tommy play the part so he can see his children, which he does, as well as making up with his wife and then returning to prison. Mrs Mason and her children join the throng already invited to spend Christmas Day with the Larkins.

text: Series 2[edit]

text:
No.
Title
Original broadcast

2.1 & 2.2
"Oh! to be in England!"
26 January and 2 February 1992

Mam'selle Dupont comes to stay with the Larkins, and discovers the truth – Mr. Larkin is not a lord. She is disappointed but comes to terms with it, and enjoys her stay. Pop saves an old woman from being cheated, and buys a fair from his friend, Fruity Pears, who is unable to run it after being attacked by thugs. Primrose's relationship with the French boy has fizzled out; back in the UK she falls for Mr Candy, the young vicar in charge of christening the young Larkins ... and a newly arrived Charlton.

2.3 & 2.4
"Stranger at the gates"
9 and 16 February 1992

A young man named Pieter who says he is Danish arrives on the farm, and starts doing odd jobs for the people in the village. Everyone, including Mariette, thinks he's the bee's knees, much to the resentment of Charley. Meanwhile, Montgomery is being bullied by local boys, and Primrose is attempting to win Mr. Candy's heart. She mistakes his sister for a girlfriend, and angrily leaves him. Charley discovers that Pieter is German and has been hiding his identity because of the anti-German sentiment in post-World War II Britain. The villagers turn against him on this discovery, but Pieter is restored to favour again after he rescues John Watson, one of the bullies from a quarry ledge. The Larkins arrange for Pieter to marry his girlfriend, an English lady named Eileen.

2.5 & 2.6
"A season of heavenly gifts"
23 February and 1 March 1992

Pop Larkin unwittingly becomes involved in smuggling when he receives gifts from a grateful pilot he helped after a crash-landing. Meanwhile, an evil Polish man named Mr. Cope attempts to prevent Charley and Mariette from buying Mrs Kinthley's hopgarden. The pilot invites the family to a party at his club, which they greatly enjoy. Montgomery Larkin is unhappy at Naval College, where he is training to be a sailor in the merchant navy. The family go to his Open Day; the Brigadier goes along and helps them solve the problem by showing Pop how to humiliate the bullying instructor, Strickland.

2.7
"Le Grand Weekend"
26 December 1992

Pop and Ma's proposed week-end in Paris is disrupted by a storm, and they spend the time in a country house.

text: Series 3[edit]

text:
No.
Title
Original broadcast

3.1 & 3.2
"The happiest days of your life"
28 February and 7 March 1993

The twins go to boarding school, while Charley starts doing the books as a part-time job for the brewery to which he wishes to sell his hops. Charley and Mariette decide to buy the brewery. The whole family repairs the twins' boarding school, which was otherwise going to be forced to close by the bank for not keeping up with the repairs.

3.3 & 3.4
"Cast not your pearls before swine"
14 and 21 March 1993

Pop builds a swimming-pool, and buys two hundred pigs from George Harran, a confidence trickster who is also cheating Edith, who has fallen in love with him. Meanwhile, Primrose has a new love interest – a member of the swimming pool building crew, from Liverpool. Pop prepares a trick against George to put all to rights without hurting Edith. Primrose runs away to Liverpool in pursuit of her love after Victoria teases her, causing Pop to realise the scam, but returns home when she realises he is not the man for her.

3.5 & 3.6
"Climb the greasy pole"
28 March and 4 April 1993

Pop runs for rural councillor while Charley and Mariette struggle at the brewery and have problems in their relationship. Gypsies get involved in Pop's campaign for rural councillor. Charley and Mariette have to work on their marriage as Mariette is attracted to Tom Sargent, after which they at last finalise the deal to buy Bristow's brewery.

text: Production[edit]

text: Conception and development[edit]

text: Having been sold to MGM films in 1959, it wasn't until 1989 that Richard Bates, son of the author of the original books H.E Bates, was able to purchase the rights to the novels. At the same time, Yorkshire Television were looking for a new project for David Jason, having starred for them in A Bit of a Do.[1] Richard Bates went on to Executive Produce the show, alongside Vernon Lawrence of Yorkshire Television.[2]

text: Casting[edit]

text: Bates had originally considered Bob Hoskins as ideal for the role of Pop, but Lawrence was of the view his increasing fame as a film actor would create problems.[2] Jason was cast first, followed by Ferris and Franks. Finding an actor to fit with the novel's description of Mariette as a black-haired and olive skinned beauty proved difficult, with over 300 rejected until Zeta-Jones was cast. With filming due to start, she had been spotted appearing in 42nd Street at the Drury Lane Theatre.[1]

text: Filming[edit]

text: Each one-hour episode took two weeks to film, followed by two months in post production.[1]

text: Filming locations[edit]

text: Much of the series was filmed in and around the village of Pluckley in Kent; Executive Producer Richard Bates lived just a few miles away.[3]

text: The location for "Home Farm", the Larkin residence, was Buss Farm a few miles south of Pluckley, owned by the Holmes family. All four main buildings of the Grade II listed farm were utilised, the farmhouse itself, a square oast house (depicted in the title sequence), a Tudor barn and cart lodge. After being put up for sale by the family in 2012, it was purchased in 2013 by a businessman. Renaming it "Darling Buds Farm", several buildings were converted into guest accommodation themed around the show.[4][5]

text: Other locations in Pluckley village itself were used extensively; the Black Horse pub in The Street was renamed the Hare and Hounds and used as the Larkins' local. Church Gate Cottage and Fig Tree Cottage in The Street served as Edith Pilchester's and The Brigadier's homes respectively. Pluckley primary school, also in The Street, served as the village hall. The butcher's shop also featured, and the Post Office (dressed as the grocer's). Church scenes were filmed at St Nicholas Church in the village.[6]

text: The cricket scenes were filmed at Little Chart Cricket Club, a village north east of Pluckley.[6]

text: Further afield, in and around Tenterden, Kent, Halden Place in Halden Lane, Cranbrook, served as Mrs Kinthley's hop garden, Wentwood Cottage in Swain Road served as Charley and Mariette's cottage, and the Kent & East Sussex Railway was the location of Charley's arrival in Kent, and the station used by Ma, Charley and Mariette shopping for her wedding dress. Other scenes shot in Kent included the exteriors of "Bristow's Brewery", filmed at Shepherd Neame Brewery in Faversham, and scenes of the Larkin's beach holiday, filmed in Folkestone, including a backdrop of the Leas Lift. Mlle. Dupont is met by the Larkin's at Folkestone Harbour after her channel crossing.[6]

text: Little filming was done inside the farmhouse, the interiors having been shot in a studio at Yorkshire Television. Scenes shot in the former Wennington School near Wetherby in Yorkshire which stood in for Bluff Hall were included. Other filming locations in Yorkshire include the Hotel Metropole in Leeds which stood in for the 'Marble Arch Hotel'.

text: To mark the series' 20th anniversary, Kent County Council established a tourist trail featuring the various film locations and other local attractions and Kent food.[6][7]

text: Music[edit]

text: The series' music producer Pip Burley wrote the title theme, "Perfick!". He had submitted the piece anonymously, having deemed the submissions received from a shortlist of composers missed the point of the essential romanticism of the show. Although it also featured lyrics, drawn from the words used in the novels, the theme music for the series did not feature them. The song with lyrics was later sung by David Jason for the radio adaptation of the last book in the Larkin series, A Little of What You Fancy.[8][9]

text: Future[edit]

text: After the series ended, Ferris wished to film more episodes. Having performed it for radio in 1996, she theorised in 2008 that the reason the fifth book was never adapted for television was because the storyline featured Pop recovering from a heart attack, something the producers likely thought the audience would not want to see.[10]

text: In 2016, having filmed a cinema adaptation of another classic TV series, Dad's Army, Zeta-Jones responded positively to suggestions that The Darling Buds of May might also be similarly remade, stating "I’d be playing Ma Larkin, but I’m up for it".[11]

text: Themes[edit]

text: Locally produced food and drink intentionally played a core role in the series.[1] Due to not being ripe at the right time, the strawberries used in the series were imported from Holland.[3] One of the most iconic scenes features Pop and Ma eating a meal together whilst having a bath.[3] With several scenes featuring eating, the fact Ferris was a vegetarian had to be worked around by the production staff.[3] Both Ferris and Jason gained weight due to the amount of food they had to consume, often doing multiple takes for several scenes at one time, to make the scenes look realistic.[2]

text: Another theme of the series was the Larkin family's habit of giving their children unusual or themed first and middle names. Mariette was created by combining 'Marie' and 'Antoinette'. Montgomery was named after wartime officer Field Marshall Montgomery. Victoria was named for being born during the plum season (Victoria plum). While Monty and Victoria have no middle names, the other children have several: Primrose Violet Anemone Iris Magnolia Narcissa, twins Petunia June Florence Nightingale and Zinnia June Florence Nightingale, and Oscar Columbus Septimus Dupont, the last one being in tribute to the French hotellier Madamoiselle Dupont, who features in the series. Mariette's wedding ceremony in series one reveals her middle name to be Jane. Mariette and Charlie continue the family penchant for elaborate naming by christening their son John Marlborough Churchill Blenheim.

text: Release[edit]

text: Broadcast[edit]

text: The first episode was transmitted on the ITV channel at 8pm on a Sunday night.[1]

text: Home media[edit]

text: When the series was first released on video, it sold £1m worth of copies in the first four days.[2]

text: DVD releases:

text:
Country
Publisher
Title
Rating
Release date
Notes

United Kingdom
Cinema Club
The Best of The Darling Buds of May
PG
15 July 2002

Cinema Club
The Darling Buds of May: The Perfect Collection
PG
10 November 2003
all 20 episodes

ITV Studios
The Darling Buds of May: The Complete Series - Special Edition
PG
7 February 2005
all 20 episodes & exclusive interviews

ITV Studios
The Darling Buds of May: The Complete Series
PG
1 September 2008
contains all 20 episodes & exclusive commentary

ITV Studios
The Darling Buds of May: The Complete 20th Anniversary Collection
PG
8 August 2011
all 20 episodes

Australia
Shock Records
The Darling Buds of May: Series One
PG
3 March 2007[12]
Special 2-Disc Edition - contains all 6 episodes & bonus episode "Christmas is Coming"

Shock Records
The Darling Buds of May: Series Two
G
5 May 2007[13]
Special 2-Disc Edition - contains all 6 episodes & bonus episode "La Grande Weekend"

Shock Records
The Darling Buds of May: The Complete Collection
PG
29 March 2008[14]
all 20 episodes

Reel DVD
The Darling Buds of May: The Complete Collection
PG
6 February 2013[15]
all 20 episodes (contains same packaging as UK 2011 release)

text: Note: The 2008 and 2011 DVD sets from ITV Studios list that there are 11 episodes; this is due to the fact that all episodes in series 1-3 (not including the specials) contain two parts making them count as a whole.

text: Soundtrack[edit]

text: A 16 track soundtrack of the series was released by EMI on CD in 1991.[16]

text: Reception[edit]

text: The series was a ratings success,[17] its "feel-good" factor during economic recession often noted as the reason[citation needed]. Whilst Yorkshire TV classified it as a drama, audiences and critics have generally considered it to be a comedy/drama.

text: The first episode broke a British broadcasting record, becoming the first instance of a new series topping the national ratings, beating the soap opera Coronation Street (also an ITV production) on the night. This came as a shock to producers, although they had been hopeful of good ratings due to dull weather and the belief that people would be looking for something to lift their spirits following the end of the Gulf War.[1]

text: Jason attributed the series' popularity to the public wanting a more wholesome, inclusive and inoffensive viewing option at a time when violence on television was increasing. This was one of the main reasons he decided to take the role.[2]

text: The series generated an upsurge in sales of H.E. Bates' novels.[2]

text: Awards[edit]

text: 1992 Ivor Novello Award - Best Theme from a TV/Radio Production[18]

text: Source novels and other adaptations[edit]

text: The series is based on the works of H. E. Bates, who died in 1974. Having moved from the industrialised English Midlands to a granary in Little Chart in Kent in 1930 in search of new inspirations for his work, he was initially frustrated in his efforts to create a novel based on the Kent way of life. His inspiration for the Larkin stories eventually came in 1955 while on a trip to Sittingbourne. Pausing at Faversham, he observed the joyful camaraderie of a large boisterous family as they emerged from a shop and departed in a large blue truck. Combining this with observations of another family on a nearby small-holding, he set about writing about how these families might live. Originally a short story, he expanded it into a novel, followed by a further four books, the titles of the first four of which were used as episode titles for the TV series:[1]

text:
The Darling Buds of May (1958)
A Breath of French Air (1959)
When the Green Woods Laugh (1960)
Oh! To be in England! (1963)
A Little of What You Fancy? (1970)

text: The first novel in the series was originally adapted to the screen in 1959 as The Mating Game, starring Debbie Reynolds and Tony Randall as Mariette and Charley.

text: The fifth novel, A Little of What You Fancy?, was never adapted for television, but it was adapted into a six-part series by Eric Pringle for BBC Radio, with Jason and Ferris reprising their roles, first airing in February 1996.[19][20]

text: In May 2011 a stage production of the series was put on at Buss Farm.[7]


document_title: Myocardial infarction

question_text: most common cause of death in acute myocardial infarction

question_tokens: most common cause of death in acute myocardial infarction

root

text: Myocardial infarction

text: Terminology[edit]

text: Myocardial infarction (MI) refers to tissue death (infarction) of the heart muscle (myocardium). 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.[21] Unlike other causes of acute coronary syndromes, such as unstable angina, a myocardial infarction occurs when there is cell death, as measured by a blood test of cardiac enzymes such as troponin or CK-MB.[15] 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.[22]

tag: p

text: The phrase "heart attack" is often used non-specifically to refer to a myocardial infarction and to sudden cardiac death. An MI is different from—but can cause—cardiac arrest, where the heart is not contracting at all or so poorly that all vital organs cease to function, thus causing 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.[23]

text: Signs and symptoms[edit]

text: Pain[edit]

text: Chest pain is the most common symptom 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.[24] The pain most suggestive of an acute MI, with the highest likelihood ratio, is pain radiating to the right arm and shoulder.[25] Similarly, chest pain similar to a previous heart attack is also suggestive.[26] The pain associated with MI is usually diffuse, does not change with position, and lasts for more than 20 minutes.[22] Levine's sign, in which 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.[27] Pain that responds to nitroglycerin does not indicate the presence or absence of a myocardial infarction.[28]

text: Other symptoms[edit]

text: Chest pain may be accompanied by sweating, nausea or vomiting, and fainting,[22][25] and these symptoms may also occur without any pain at all.[24] In women, the most common symptoms of myocardial infarction include shortness of breath, weakness, and fatigue.[29] Shortness of breath is 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.[24][30] Other less common symptoms include weakness, light-headedness, palpitations, and abnormalities in heart rate or blood pressure.[15] These symptoms are likely induced by a massive surge of catecholamines from the sympathetic nervous system, which occurs in response to pain and, where present, low blood pressure.[31] Loss of consciousness due to inadequate blood flow to the brain and cardiogenic shock, and sudden death, frequently due to the development of ventricular fibrillation, can occur in myocardial infarctions.[23] Cardiac arrest, and atypical symptoms such as palpitations, occur more frequently in women, the elderly, those with diabetes, in people who have just had surgery, and in critically ill patients.[22]

text: "Silent" myocardial infarctions can happen without any symptoms at all.[11] 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,[11] and are more common in the elderly,[11] in those with diabetes mellitus[15] 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.[32] In heart transplantation, the donor heart is not fully innervated by the nervous system of the recipient.[33]

text: Causes[edit]

text: 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.[18] Many risk factors of myocardial infarction are shared with coronary artery disease, the primary cause of myocardial infarction,[15] with other risk factors including male sex, low levels of physical activity, a past family history, obesity, and alcohol use.[15] Risk factors for myocardial disease are often included in risk factor stratification scores, such as the Framingham risk score.[18] At any given age, men are more at risk than women for the development of cardiovascular disease.[34] High levels of blood cholesterol is a known risk factor, particularly high low-density lipoprotein, low high-density lipoprotein, and high triglycerides.[35]

text: Many risk factors for myocardial infarction are potentially modifiable, with the most important being tobacco smoking (including secondhand smoke).[15] Smoking appears to be the cause of about 36% and obesity the cause of 20% of coronary artery disease.[36] Lack of physical activity has been linked to 7–12% of cases.[36][37] Less common causes include stress-related causes such as job stress, which accounts for about 3% of cases,[36] and chronic high stress levels.[38]

text: Diet[edit]

text: There 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,[39] while other studies find little evidence that reducing dietary saturated fat or increasing polyunsaturated fat intake affects heart attack risk.[40][41] Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed.[42] Trans fats do appear to increase risk.[40] Acute and prolonged intake of high quantities of alcoholic drinks (3–4 or more) increases the risk of a heart attack.[43]

text: Genetics[edit]

text: Family history of ischemic heart disease or MI, particularly if one has a male first-degree relative (father, brother) who had 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.[34]

text: Genome-wide association studies have found 27 genetic variants that are associated with an increased risk of myocardial infarction.[44] 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 the single nucleotide polymorphisms that are implicated are within a non-coding region.[44] 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.[44]

text: Other[edit]

text: The risk of having a myocardial infarction increases with older age, low physical activity, and low socioeconomic status.[34] Heart attacks appear to occur more commonly in the morning hours, especially between 6AM and noon.[45] Evidence suggests that heart attacks are at least three times more likely to occur in the morning than in the late evening.[46] Shift work is also associated with a higher risk of MI.[47]

text: Women who use combined oral contraceptive pills have a modestly increased risk of myocardial infarction, especially in the presence of other risk factors.[48] The use of non-steroidal anti inflammatory drugs (NSAIDs), even for as short as a week, increases risk.[49]

text: Endometriosis in women under the age of 40 is an identified risk factor.[50]

text: Short-term exposure to air pollution such as carbon monoxide, nitrogen dioxide, and sulfur dioxide (but not ozone) have been associated with MI.[51]

text: 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.[52] As of 2013, there is no evidence of benefit from antibiotics or vaccination, however, calling the association into question.[52][53] Myocardial infarction can also occur as a late consequence of Kawasaki disease.[54]

text: 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.[55] High blood levels of the amino acid homocysteine is associated with premature atherosclerosis;[56] whether elevated homocysteine in the normal range is causal is controversial.[57]

text: Mechanism[edit]

text: Atherosclerosis[edit]

text: The most common cause of a myocardial infarction is the rupture of an atherosclerotic plaque on an artery supplying heart muscle.[23][58] 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.[59] Atherosclerotic plaques are often present for decades before they result in symptoms.[59]

text: The gradual buildup of cholesterol and fibrous tissue in plaques in the wall of the coronary arteries or other arteries, typically over decades, is termed atherosclerosis.[60] Atherosclerosis is characterized by progressive inflammation of the walls of the arteries.[59] 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 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).[59]

text: Other causes[edit]

text: Atherosclerotic disease is not the only cause of myocardial infarction, and 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 or coronary artery bypass grafts may cause a myocardial infarction. Spasm of coronary arteries, such as Prinzmetal's angina may cause blockage.[24][22]

text: Tissue death[edit]

text: 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.[59] When an artery 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.[61]

text: Cells in the area with the worst blood supply, just below the inner surface of the heart (endocardium), are most susceptible to damage.[62] Ischemia first affects this region, the subendocardial region, and tissue begins to die within 15–30 minutes of loss of blood supply.[63] The dead tissue is surrounded by a zone of potentially reversible ischemia that progresses to become a full-thickness transmural infarct.[61][63] The initial "wave" of infarction can take place over 3–4 hours.[59][61] These changes are seen on gross pathology and cannot be predicted by the presence or absence of Q waves on an ECG.[62] The position, size and extent of an infarct depends on the affected artery, totality of the blockage, duration of the blockage, the presence of collateral blood vessels, oxygen demand, and success of interventional procedures.[24][58]

text: Tissue death and myocardial scarring alter the normal conduction pathways of the heart, and weaken affected areas. The size and location puts a person at risk of abnormal heart rhythms (arrhythmias) or heart block, aneurysm of the heart ventricles, inflammation of the heart wall following infarction, and rupture of the heart wall that can rupture with catastrophic consequences.[58][64]

text: Diagnosis[edit]

text: Criteria[edit]

text: An acute myocardial infarction, according to current consensus, is defined by an elevated cardiac biomarker and at least one of the following:[22]

text:
Symptoms relating to ischemia
Changes on an electrocardiogram (ECG), such as ST segment changes, new left bundle branch block, or Q waves
Changes in the motion of the heart wall on imaging
Demonstration of a thrombus on angiogram or at autopsy.

tag: ul

text: Types[edit]

text: Myocardial infarctions are generally clinically classified into ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI). These are based on changes to an ECG.[22] STEMIs make up about 25 – 40% of myocardial infarctions.[18] A more explicit classification system, based on international consensus in 2012, also exists. This classifies myocardial infarctions into five types:[22]

text:
Spontaneous MI related to plaque erosion and/or rupture, fissuring, or dissection
MI related to ischemia, such as from increased oxygen demand or decreased supply, e.g. coronary artery spasm, coronary embolism, anemia, arrhythmias, high blood pressure or low blood pressure
Sudden unexpected cardiac death, including cardiac arrest, where symptoms may suggest MI, an ECG may be taken with suggestive changes, or a blood clot is found in a coronary artery by angiography and/or at autopsy, but where blood samples could not be obtained, or at a time before the appearance of cardiac biomarkers in the blood
Associated with coronary angioplasty or stents

Associated with percutaneous coronary intervention (PCI)
Associated with stent thrombosis as documented by angiography or at autopsy

Associated with CABG

tag: ol

text: Cardiac biomarkers[edit]

text: There are a number of different biomarkers used to determine the presence of cardiac muscle damage. Troponins, measured through a blood test, are considered to be the best,[18] and are preferred because they have greater sensitivity and specificity for measuring injury to the heart muscle than other tests.[58] A rise in troponin occurs within 2–3 hours of injury to the heart muscle, and peaks within 1–2 days. The gross value of the troponin, as well as a change over time, are useful in measuring and diagnosing or excluding myocardial infarctions, and the diagnostic accuracy of troponin testing is improving over time.[58] One high-sensitivity cardiac troponin is able to rule out a heart attack as long as the ECG is normal.[65]

text: Other tests, such as CK-MB or myoglobin, are discouraged.[66] 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.[24] Copeptin may be useful to rule out MI rapidly when used along with troponin.[67]

text: Electrocardiogram[edit]

text: Electrocardiograms (ECGs) are a series of leads placed on a person's chest that measure electrical activity associated with contraction of heart muscle.[68] The taking of an ECG is an important part in the workup of an AMI,[22] 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.[22]

text: ECG readouts product a waveform with different labelled features.[68] In addition to 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.[22] In addition, ST elevation can be used to diagnose an ST segment myocardial infarction (STEMI). A rise must be new, in two adjacent adjacent ECG leads, greater than 2 mm (0.2 mV) for males and greater than 1.5 mm (0.15 mV) in females in all leads except for V2 and V3, where it must be greater than 1 mm (0.1 mV).[18][22] ST elevation is associated with infarction, and may be preceded by changes indicating ischemia, such as ST depression or inversion of the T waves.[68] Abnormalities can help localize the location of an infarct, based on the leads that are affected by changes.[15] Early STEMIs may be preceded by peaked T waves.[18] Other ECG abnormalities relating to complications of acute myocardial infarctions may also be evident, such as atrial or ventricular fibrillation.[69]

text: Imaging[edit]

text: Noninvasive imaging plays an important role in the diagnosis and characterisation of myocardial infarction.[22] Tests such as chest X-rays can be used to explore and exclude alternate causes of a person's symptoms.[22] Tests such as stress echocardiography and myocardial perfusion imaging can confirm a diagnosis when a person's history, physical examination (including cardiac examination) ECG, and cardiac biomarkers suggest the likelihood of a problem.[70]

text: 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 a myocardial infarction. The flow of blood can be imaged, and contrast dyes may be given to improve image.[22] 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.[22] These nuclear medicine scans can visualize the perfusion of heart muscle.[22] SPECT may also be used to determine viability of tissue, and whether areas of ischemia are inducible.[22][71]

text: Medical societies and professional guidelines recommend that the physician confirm a person is at high risk for myocardial infarction before conducting imaging tests to make a diagnosis,[70][72] as such tests are unlikely to change management and result in increased costs.[70] Patients who have a normal ECG and who are able to exercise, for example, do not merit routine imaging.[70]

text:
Play media

Poor movement of the heart due to an MI as seen on ultrasound[73]

Play media

Pulmonary edema due to an MI as seen on ultrasound[73]

text: Differential diagnosis[edit]

text: There are many causes of chest pain, which can originate from the heart, lungs, gastrointestinal tract, aorta, and other muscles, bones and nerves surrounding the chest.[74] 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, and other musculoskeletal injuries.[74] Rarer severe differential diagnoses includes aortic dissection, esophageal rupture, tension pneumothorax, and pericardial effusion causing cardiac tamponade.[75] The chest pain in an MI may mimic heartburn.[23] Causes of sudden-onset breathlessness generally involve the lungs or heart – including pulmonary edema, pneumonia, allergic reactions and asthma, and pulmonary embolus, acute respiratory distress syndrome and metabolic acidosis.[74] There are many different causes of fatigue, and myocardial infarction is not a common cause.[76]

text: Management[edit]

text: A myocardial infarction requires immediate medical attention. Treatment aims to preserve as much heart muscle as possible, and to prevent further complications.[24] Treatment depends on whether the myocardial infarction is a STEMI or NSTEMI.[58] Treatment in general aims to unblock blood vessels, reduce blot clot enlargement, reduce ischemia, and modify risk factors with the aim of preventing future MIs.[24] In addition, the main treatment for myocardial infarctions with ECG evidence of ST elevation (STEMI) include thrombolysis or percutaneous coronary intervention, although PCI is also ideally conducted within 1–3 days for NSTEMI.[58] In addition to clinical judgement, risk stratification may be used to guide treatment, sometimes including systems such as the TIMI and GRACE (Global Registry of Acute Coronary Events) scoring systems.[15][58][77]

text: Pain[edit]

text: The pain associated with myocardial infarction may be treated with nitroglycerin or morphine.[24] Nitroglycerin (given under the tongue or intravenously) may improve the blood supply to the heart, and decrease the work the heart must do.[24] It is an important part of therapy for its pain relief, despite there being no benefit to overall mortality.[24][78] Morphine may also be used, and is effective for the pain associated with STEMI.[24] The evidence for benefit from morphine on overall outcomes, however, is poor and there is some evidence of potential harm.[79][80]

text: Anticoagulation[edit]

text: Aspirin, an antiplatelet anticoagulant, is given as a loading dose with the goal of reducing the clot size and reduce further clotting in the affected artery.[24][58] It is known to decrease mortality associated with acute myocardial infarction by at least 50%.[58] P2Y12 inhibitors such as clopidogrel, prasugrel and ticagrelor are given concurrently, also as a loading dose, with the dose depending on whether further surgical management or fibrinolysis is planned.[58] Prasugrel and ticagrelor are recommended in European and American guidelines, as they are active more quickly and consistently than clopidogrel.[58] P2Y12 inhibitors are recommended in both NSTEMI and STEMI, including in PCI, with evidence also to suggest improved mortality.[58] Heparins, particularly in the unfractionated form, act at several points in the clotting cascade, help to prevent the enlargement of a clot, and are also given in myocardial infarction, owing to evidence suggesting improved mortality rates.[58] In very high-risk scenarios, inhibitors of the platelet glycoprotein αIIbβ3a receptor such as eptifibatide or tirofiban may be used.[58]

text: There is varying evidence on the mortality benefits in NSTEMI. A 2014 review of P2Y12 inhibitors such as clopidogrel found they do not change the risk of death when given to people with a suspected NSTEMI prior to PCI,[81] nor do heparins change the risk of death.[82] They do decrease the risk of having a further myocardial infarction.[58][82]

text: Angiogram[edit]

text: Primary percutaneous coronary intervention (PCI) is the treatment of choice for STEMI if it can be performed in a timely manner, ideally within 90–120 minutes of contact with a medical provider.[58][83] Some recommend it is also done in NSTEMI within 1–3 days, particularly when considered high-risk.[58] A 2017 review, however, did not find a difference between early versus later PCI in NSTEMI.[84]

text: PCI involves small probes, inserted through peripheral blood vessels such as the femoral artery or radial artery into the blood vessels of the heart. The probes are then used to identify and clear blockages using small balloons, which are dragged through the blocked segment, dragging away the clot, or the insertion of stents.[24][58] Coronary artery bypass grafting is only considered when the affected area of heart muscle large, and PCI is unsuitable, for example with difficult cardiac anatomy.[85] After PCI, people are generally placed on aspirin indefinitely and on dual antiplatelet therapy (generally aspirin and clopidogrel) for at least a year.[18][58][86]

text: Fibrinolysis[edit]

text: If PCI cannot be performed within 90 to 120 minutes in STEMI then fibrinolysis, preferably within 30 minutes of arrival to hospital, is recommended.[58][87] If a person has had symptoms for 12 to 24 hours evidence for effectiveness of thrombolysis is less and if they have had symptoms for more than 24 hours it is not recommended.[88] Thrombolysis involves the administration of medication that activates the enzymes that normally dissolve blood clots. These medications include tissue plasminogen activator, reteplase, streptokinase, and tenecteplase.[24] Thrombolysis is not recommended in a number of situations, particularly when associated with a high risk of bleeding or the potential for problematic bleeding, such as active bleeding, past strokes or bleeds into the brain, or severe hypertension. Situations in which thrombolysis may be considered, but with caution, include recent surgery, use of anticoagulants, pregnancy, and proclivity to bleeding.[24] Major risks of thrombolysis are major bleeding and intracranial bleeding.[24] Pre-hospital thrombolysis reduces time to thrombolytic treatment, based on studies conducted in higher income countries, however it is unclear whether this has an impact on mortality rates.[89]

text: Other[edit]

text: In the past, high flow oxygen was recommended for everyone with a possible myocardial infarction.[66] More recently, no evidence was found for routine use with potential of harm.[90][91][92] Therefore, oxygen is currently only recommended if oxygen levels are found to be low or if someone is in respiratory distress.[24][66]

text: If despite thrombolysis there is significant cardiogenic shock, continued severe chest pain, or less than a 50% improvement in ST elevation on the ECG recording after 90 minutes, then rescue PCI is indicated emergently.[93][94]

text: Those who have had cardiac arrest may benefit from targeted temperature management with evaluation for implementation of hypothermia protocols. Furthermore, those with cardiac arrest, and ST elevation at any time, should usually have angiography.[95]

text: Rehabilitation[edit]

text: Cardiac rehabilitation benefits many who have experienced myocardial infarction,[58] even if there has been substantial heart damage and resultant left ventricular failure. It should start soon after discharge from the hospital. The program may include lifestyle advice, exercise, social support, as well as recommendations about driving, flying, sport participation, stress management, and sexual intercourse.[96]

text: Prevention[edit]

text: 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,[58] because of shared risk factors and an aim to reduce atherosclerosis affecting heart vessels.[24]

text: Primary prevention[edit]

text: Lifestyle[edit]

text: 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.[97] Keeping a healthy weight, drinking alcohol within the recommended limits, and quitting smoking reduce the risk of cardiovascular disease.[97]

text: Substituting polyunsaturated fats such as olive oil and rapeseed oil instead saturated fats may reduce the risk of myocardial infarction,[39] although there is not universal agreement.[40] 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.[97] The dietary pattern with the greatest support is the Mediterranean diet.[98] Vitamins and mineral supplements are of no proven benefit,[99] and neither are plant stanols or sterols.[97]

text: Public health measures may also act at a population level to reduce the risk of myocardial infarction, for example by reduce 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 the health impact assessment of regional and local plans and policies.[100]

text: 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.[101]

text: Medication[edit]

text: Statins, drugs that act to lower blood cholesterol, decrease the incidence and mortality rates of myocardial infarctions.[102] They are often recommended in those at an elevated risk of cardiovascular diseases.[97]

text: 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 the risk of excessive bleeding.[103][104] Nevertheless, many clinical practice guidelines continue to recommend aspirin for primary prevention,[105] and some researchers feel that those with very high cardiovascular risk but low risk of bleeding should continue to receive aspirin.[106]

text: Secondary prevention[edit]

text: 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 infarct.[58] Recommendations include stopping smoking, a gradual return to exercise, eating a healthy diet, low in saturated fat and low in cholesterol, and drinking alcohol within recommended limits, exercising, and trying to achieve a healthy weight.[58][96] Exercise is both safe and effective even if people have had stents or heart failure,[107] and is recommended to start gradually after 1–2 weeks.[58] Counselling should be provided relating to medications used, and for warning signs of depression.[58] Previous studies suggested a benefit from omega-3 fatty acid supplementation but this has not been confirmed.[96]

text: Medications[edit]

text: Following a heart attack, nitrates, when taken for two days, and ACE-inhibitors decrease the risk of death.[108] Other medications include:

text: Aspirin is continued indefinitely, as well as another antiplatelet agent such as clopidogrel or ticagrelor ("dual antiplatelet therapy" or DAPT) for up to twelve months.[96] If someone has another medical condition that requires anticoagulation (e.g. with warfarin) this may need to be adjusted based on risk of further cardiac events as well as bleeding risk.[96] In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death.[109]

text: Beta blocker therapy such as metoprolol or carvedilol is recommended to be started within 24 hours, provided there is no acute heart failure or heart block.[18][66] The dose should be increased to the highest tolerated.[96] Contrary to what was long believed, the use of beta blockers does not appear to affect the risk of death, possibly because other treatments for MI have improved.[110] When beta blocker medication is given within the first 24–72 hours of a STEMI no lives are saved. However, 1 in 200 people were prevented from a repeat heart attack, and another 1 in 200 from having an abnormal heart rhythm. Additionally, for 1 in 91 the medication causes a temporary decrease in the heart's ability to pump blood.[111]

text: ACE inhibitor therapy should be started within 24 hours, and continued indefinitely at the highest tolerated dose. This is provided there is no evidence of worsening kidney failure, high potassium, low blood pressure, or known narrowing of the renal arteries.[58] Those who cannot tolerate ACE inhibitors may be treated with an angiotensin II receptor antagonist.[96]

text: Statin therapy has been shown to reduce mortality and subsequent cardiac events, and should be commenced with the aim of lowering LDL cholesterol. Other medications, such as ezetimibe, may also be added with this goal in mind.[58]

text: Aldosterone antagonists (spironolactone or eplerenone) may be used if there is evidence of left ventricular dysfunction after an MI, ideally after beginning treatment with an ACE inhibitor.[96]

text: Other[edit]

text: A defibrillator, an electric device connected to the heart and surgically inserted under the skin, may be recommended. This is particularly if there are any ongoing signs of heart failure, with a low left ventricular ejection fraction and a New York Heart Association grade II or III after 40 days of the infarction.[58] Defibrillators detect potentially fatal arrhythmia and deliver an electrical shock to the person to depolarize a critical mass of the heart muscle.[112]

text: Prognosis[edit]

text: The prognosis after myocardial infarction varies greatly depending on the extent and location of the affected heart muscle, and the development and management of complications.[15] Prognosis is worse with older age, and social isolation.[15] Anterior infarcts, persistent ventricular tachycardia or fibrillation, development of heart blocks, and left ventricular impairment are all associated with poorer prognosis.[15] Without treatment, about a quarter of those affected by MI die within minutes, and about forty percent within the first month.[15] Morbidity and mortality from myocardial infarction has however improved over the years due to earlier and better treatment:[25] in those who have an STEMI in the United States, between 5 and 6 percent die before leaving the hospital and 7 to 18 percent die within a year.[18]

text: Complications[edit]

text: Complications may occur immediately following the myocardial infarction or may take time to develop. Disturbances of heart rhythms, including atrial fibrillation, ventricular tachycardia and fibrillation and heart block can arise as a result of ischemia, cardiac scarring, and infarct location.[15][58] Stroke is also a risk, either as a result of clots transmitted from the heart during PCI, as a result of bleeding following anticoagulation, or as a result of disturbances in the heart's ability to pump effectively as a result of the infarction.[58] Regurgitation of blood through the mitral valve is possible, particularly if the infarction causes dysfunction of the papillary muscle.[58] Cardiogenic shock as a result of the heart being unable to adequately pump blood may develop, dependent on infarct size, and is most likely to occur within the days following an acute myocardial infarction. Cardiogenic shock is the largest cause of in-hospital mortality.[25][58] Rupture of the ventricular dividing wall or left ventricular wall may occur within the initial weeks.[58] Dressler's syndrome, a reaction following larger infarcts and a cause of pericarditis is also possible.[58]

text: Heart failure may develop as a long-term consequence, with an impaired ability of heard muscle to pump, scarring, and increase in size of the existing muscle. Aneurysm of the left ventricle myocardium develops in about 10% of MI and is itself a risk factor for heart failure, ventricular arrhythmia and the development of clots.[15]

text: Risk factors for complications and death risk factors for death 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.[113][114][115]

text: Epidemiology[edit]

text: Myocardial infarction is a common presentation of coronary artery disease. The World Health Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease;[116] with it being the leading cause of death in high- or middle-income countries and second only to lower respiratory infections in lower-income countries.[116] Worldwide, more than 3 million people have STEMIs and 4 million have NSTEMIs a year.[17] STEMIs occur about twice as often in men as women.[18]

text: Rates of death from ischemic heart disease (IHD) have slowed or declined in most high-income countries, although cardiovascular disease still accounted for one in three of all deaths in the USA in 2008.[117] For example, rates of death from cardiovascular disease have decreased almost a third between 2001 and 2011 in the United States.[118]

text: In contrast, IHD is becoming a more common cause of death in the developing world. For example, in India, IHD had become the leading cause of death by 2004, accounting for 1.46 million deaths (14% of total deaths) and deaths due to IHD were expected to double during 1985–2015.[119] Globally, disability adjusted life years (DALYs) lost to ischemic heart disease are predicted to account for 5.5% of total DALYs in 2030, making it the second-most-important cause of disability (after unipolar depressive disorder), as well as the leading cause of death by this date.[116]

text: Society and culture[edit]

text: Depictions of heart attacks in popular media often include collapsing or loss of consciousness which are not common symptoms; these depictions contribute to widespread misunderstanding about the symptoms of myocardial infarctions, which in turn contributes to people not getting care when they should.[120]

text: Legal implications[edit]

text: At common law, in general, a myocardial infarction is a disease, but may sometimes be an injury. This can create coverage issues in the administration of no-fault insurance schemes such as workers' compensation. In general, a heart attack is not covered;[121] however, it may be a work-related injury if it results, for example, from unusual emotional stress or unusual exertion.[122] 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 an MI may be prevented from participating in activity that puts other people's lives at risk, for example driving a car or flying an airplane.[123]


document_title: Orange Is the New Black (season 5)

question_text: orange is the new black season 5 humps

question_tokens: orange is the new black season 5 humps

text: Orange Is the New Black (season 5)

text: Episodes[edit]

text:
No.overallNo. inseasonTitleDirected byWritten byFeatured character(s)Original release date531"Riot FOMO"Andrew McCarthyJenji KohannoneJune 9, 2017 (2017-06-09)
Litchfield Prison erupts into a riot when the inmates are not satisfied with Caputo's handling of Poussey's death. Daya shoots CO Thomas Humphrey in the thigh after he begins begging for his life in Spanish, a language she does not speak. His life is eventually saved by Sophia, who has paramedic training from her days as a firefighter. Piper and Alex try to take Linda hostage, but then feel bad for her and help her disguise herself as an inmate. Taystee, Black Cindy, Janae and Alison force Caputo to read a statement about Poussey's death, which Taystee records on an iPad. Josh, a PR representative from MCC who was visiting Caputo, helps her upload it to Twitter, since he thinks the story of a renegade CO reflects better on the company than out-of-control inmates. Daya attempts to contact Aleida, but an unseen person knocks her unconscious and steals the gun from her.
542"Fuck, Marry, Frieda"Constantine MakrisJordan HarrisonFriedaJune 9, 2017 (2017-06-09)
The prison stays under control of the inmates, who are holding several corrections officers hostage. The Hispanics force the COs to strip down to their underwear in front of a packed chapel. The video of Caputo, meant to spark outrage, instead gets mocked with memes featuring the hashtag #BlackLattesMatter because Cindy is shown drinking a latte. Humphrey, who suffered major blood loss, has a stroke in the prison infirmary, which is staffed by only a nurse. Daya, nearing an emotional breakdown worrying over her future, claims she lost the gun, while CO Artesian McCullough suspects the gun is gone. Taystee uploads a photo of all the COs, plus Caputo, in their underwear. It is revealed that Frieda has a secret "bunker" built out of an unused pool that was never filled in, also stocked with food she has hoarded.

Flashback: Frieda's life as a child during the Cuban Missile Crisis reveals her father was paranoid about the Soviet Union and a nuclear war, and had an underground bunker in the woods, also stocked with food and weapons.
553"Pissters!"Phil AbrahamRebecca Angelo & Lauren Schuker BlumLindaJune 9, 2017 (2017-06-09)
Worried over the public backlash—and celebrity chef Judy King—MCC decides to give in to the inmates and meet their demands. Linda tries to fit in with the inmates, but is shocked at the substandard conditions of the prison. Piper and Alex, looking at Linda's phone, are shocked to find photos of her kissing Caputo. The inmates work together to compile a list of demands, which includes reinstating the GED program, better healthcare, amnesty for the inmates involved in the riot, the arrest of CO Bayley for Poussey's death, and Flaming Hot Cheetos. Bayley, meanwhile, goes to the police station and tries to confess murder, but the police dismiss him as a drunk veteran back from the Iraq War with PTSD and put him in the drunk tank. A frightened Judy King, a victim of a random pantsing by meth heads Angie and Leanne, attempts to escape but is attacked by the white supremacists. The COs, locked in a room, plot to regain control of the prison after Artesian's tip that the inmates do not have the gun anymore. As they prepare to attack the inmates, Caputo sees Linda among them.

Flashback: Linda's college days in a sorority in the 1990s show that while at a party, she left her drunk friend outside in the snow and she ended up freezing to death.
564"Litchfield's Got Talent"Nick SandowJosh Koenigsberg, Jenji Kohan & Tara HerrmannAlisonJune 9, 2017 (2017-06-09)
The COs, who are preparing to attack once they are brought food, abort the mission on Caputo's command. Meth heads Angie and Leanne try to pants Gloria, and the gun falls to the crowd, which they recover. High, they want the COs to perform a talent show for their enjoyment. The "talents" include singing from CO Dixon; a Mormon-themed magic show from CO Blake; an Italian monologue from Josh; and a strip show from CO Stratman. Leanne declares Josh the winner merely because he is the prettiest. Suzanne, who believes Poussey's spirit is still where she died, sets up a shrine on the spot of her death and organizes a séance. Blanca and Red, high on amphetamines that Blanca claimed were vitamins, raid the administrative files looking for dirt on the COs. They discover that Piscatella was transferred to Litchfield from a male prison after the death of an inmate, who was discovered in the shower with burns on 80% of his body. Judy King is tied to a board, crucifixion-style, by the white supremacists, who think she has a stash of food. She lies to them and says she is expecting a drop of supplies on the roof of the prison from a helicopter. They go up to the roof and realizing she lied, they try to throw her off, and she faints. Then, a helicopter arrives, but it is a news helicopter carrying cameramen, who take photos and record Judy tied up and unconscious.

Flashback: Alison persuades her husband to accept a polygamous lifestyle because she feels overwhelmed by the time constraints of the housework and raising their daughter, Farah. Then, another woman, Sahar, moves in, but Alison gets jealous.
575"Sing It, White Effie"Phil AbrahamMolly Smith MetzlerWatsonJune 9, 2017 (2017-06-09)
Video of Judy King is widely misreported as a terrorist attack against Christians, as the white supremacists had their heads covered and are mistaken for Muslims. The governor is livid about MCC's passive stance and sends his own team to Litchfield. On the outside, Aleida struggles to find employment. Gloria calls her but is unable to tell her about Daya. Janae, Alison, Black Cindy and Taystee free Judy in order to stop the disinformation about the situation. They clean her up and have Josh give her talking points, before all four go outside to face the press. Judy begins to give her statement but Taystee interrupts her with an emotional speech about how Judy was kept separately from them because of her wealth and status. She says their fight is not with Judy but with the system that punishes poor and black people. Meanwhile, Angie and Leanne find Charlie Coates in the laundry room after he had been with Pennsatucky. They plan to take him hostage but Pennsatucky grabs the gun from Angie's waistband. She throws the gun to Charlie and it accidentally fires, shooting Leanne in the finger. Charlie uses the weapon to escape the prison and goes outside, where the CERT greets him with guns drawn; then, he faints.

Flashback: A teenaged Watson tours an elite prep school and is mesmerized by the wealth and depth of education. She witnesses a rehearsal for the school's (all-white) production of Dreamgirls and is shocked by a white girl in an Afro wig performing "And I Am Telling You I'm Not Going." Returning to her school, she is discouraged by her poor conditions and develops a negative attitude.
586"Flaming Hot Cheetos, Literally"Andrew McCarthyLauren MorelliTaysteeJune 9, 2017 (2017-06-09)
The inmates organize a mock trial for Pennsatucky, with Big Boo acting as her representative. Using Saved by the Bell episodes, Big Boo casts doubt on Angie's credibility, and Pennsatucky is given community service as a sentence. Aleida appears on the local news to talk about Litchfield, but it is a disaster. Morello has sex with Nicky and realizes she is pregnant. The inmates receive boxes of Flaming Hot Cheetos and tampons from the governor, who wants them to release the hostages. They refuse to do so until the rest of their demands are met. Then, they have a bonfire of Cheetos in front of the press.

Flashback: Taystee celebrates her 18th birthday in a group home. She meets her birth mother, who was 15 when she first got pregnant. Her mother now has a husband and a young daughter and does not want to tell them about Taystee. Then, Taystee, who mistakenly believed she was going to go live with her mother, runs away from the group home.
597"Full Bush, Half Snickers"Uta BriesewitzAnthony NatolinoneJune 9, 2017 (2017-06-09)
Morello's husband leaves her after she announces her pregnancy. The imprisoned guards are forced to clean bunks. Poussey's friends try to think of the best way to honor her memory; Soso wants it to be something Poussey herself would have wanted, and they reinvigorate the library by putting books all over the prison. Red, with help from Blanca, tries to entice Piscatella into the prison. Linda has sex with Big Boo. Red tries to guess Humphrey's smartphone password, and cuts off his fingertip to access it using his thumbprint. Another riot breaks out, but this time it is because the inmates are out of coffee.
608"Tied to the Tracks"Michael TrimCarolina PaizDayaJune 9, 2017 (2017-06-09)
Red and Blanca send text messages from Humphrey's phone to Piscatella claiming the inmates are not armed anymore and encouraging him to break into the prison via a window at night. He takes the information to the CERT, who blow him off. Aleida does a live TV interview with Meredith Vieira and Judy King, who breaks the news about Humphrey being shot. She does not remember the shooter's name but describes Daya, leaving Aleida in shock. The news reaches Piscatella, who is mocked by the CERT members. Figueroa returns to the prison, this time as a negotiator for MCC. She claims they cannot afford to meet the inmates' demands, but Taystee—who has done her research via the Internet and Caputo's files—shuts her down. However, once Figueroa receives a phone call about Humphrey, she says amnesty for all the inmates is off the table. After a discussion with Piper and others, Taystee agrees to hand over Daya, who first calls Mendez's mother to ask her to adopt her daughter out of foster care and asks her to give the child some space due to Aleida's control she received when she was younger. Gloria learns that her son is in the ICU after being severely beaten. Piscatella, after texting "Humphrey" that he was going to stand down, enters the prison after dark instead.

Flashback: A 14-year-old Daya pursues a boy based on her mother's insistence, despite her best friend's feelings for him. Daya ends up rejected by the boy and dumped by her friend.
619"The Tightening"Erin FeeleyJordan HarrisonRedJune 9, 2017 (2017-06-09)
Red, coming down from her drug high, is nursed by Nicky, who thinks her warnings about Piscatella being in the prison are hallucinations. Piscatella, in full riot gear, attacks Blanca in a utility room, where she had gone to set a boobytrap in case he showed up anyway. Inmates begin disappearing one by one, including Nicky and Boo, but nobody believes Red. Gloria begs Caputo—locked in a Porta-Potty—to let her out on furlough to see her son, but Caputo says he cannot help her until she lets the hostages go. After Boo disappears, Linda desperately seeks out Caputo, who was let out to back up the inmates' claim of slave labor to Figueroa. Zirconia, who had turned Linda's high heels into shivs after Piper and Alex first found her, recognizes her as a hostage, but Linda runs away with one of the shoe shivs. Morello, hurt by Nicky's comments that her pregnancy is all in her head, convinces Suzanne to stop taking her psych medicine. Red finds Frieda's map to the "bunker" in her cooking book and discovers Piscatella prisoners on her way there by accident. However, while trying to free them, Piscatella arrives.

Flashback: In the late 1970s, Red is a young woman in the Soviet Union working a menial factory job. Her rebellious friend Nadezhda introduces her to the world of underground discos and black-market Levi's jeans, but Nadezhda soon vanishes. Red's ex-boyfriend, Dmitri—whom she had dumped for being too dull—proposes they lie about being Jewish in order to escape to the United States, as Jews were being allowed to immigrate to countries other than Israel.
6210"The Reverse Midas Touch"Laura PreponRebecca Angelo & Lauren Schuker BlumPiscatellaJune 9, 2017 (2017-06-09)
Piscatella has Red, Piper, Alex and other inmates tied up in a room, where he uses a knife to cut off Red's hair. Piper gets the duct tape off her mouth and yells for help, which is heard by Gina, who is holed up playing cards in Frieda's basement "bunker" with Yoga Jones, Anita and other inmates. The entrance to the room they are in leads to where Piscatella is. Gloria tries to free the prison guards but is interrupted. Maureen, who has still not recovered from the beating, is found delirious in the bathroom by Suzanne, who takes her to the infirmary. Suzanne, by now in a psychotic state, finds Humphrey dead. Gina lures Piscatella into the basement, where Frieda knocks him out with a homemade poison dart.

Flashback: At his earlier job as CO in a male prison, Piscatella, then soft at heart, and inmate Driscoll are having an affair. Driscoll is supportive and loving of Piscatella, whose mother had hoped to "fix" him. Another inmate, Resado, spies on them together in the kitchen, and later, he and other inmates beat and rape Driscoll in a bathroom. Piscatella handcuffs Resado to the shower and leaves him under scalding hot water to die.
6311"Breaking the Fiberboard Ceiling"Wendey StanzlerLauren MorellinoneJune 9, 2017 (2017-06-09)
The inmates drag the unconscious Piscatella into Frieda's "bunker", where they argue about what should be done. Once Red says she wants revenge, they end up tying her up too, which makes her despair that Piscatella will never see justice. Gina reveals she recorded a video of Piscatella brutally breaking Alex's arm, and they post it on the Internet. Gloria, desperate to see her son in the hospital, tries sneaking each of the hostage guards outside one at a time while the other inmates, including Ouija, get high on drugs. Claiming she is going to teach them a lesson, she drags them out and locks them in the Porta-Pottys. Taystee, after 12 hours of trying to get Figueroa to see the benefits of improving prison conditions, discovers she truly has a knack for advocacy. Boo continues her romance with Linda, but is crushed when she sees a photo of her with Caputo on her phone and discovers her whole story is a lie. Suzanne goes into a psychotic break, but Morello, in the dispensary, refuses to say what medicine Suzanne takes; she is overpowered by Cindy, who takes a bottle of lithium that she believes to help calm people down. Morello finds a pregnancy test and takes it, confirming her suspicion that she is pregnant. As her unconscious son is taken to have a brain surgery, Gloria confesses her plan to Maria, who gives her full support; Maria says she always thinks of her little girl and understands that parents would do anything for their children. Gloria sneaks Luschek, the final guard, outside, but discovers that her plan of delivering the guards to Caputo has been dashed when she sees that there is a hole in the fence and the guards have escaped. Gloria breaks down and tries to escape through the hole, crying about her son, which makes the other inmates realize what she had been planning.
6412"Tattoo You"Mark A. BurleyTara Herrmann & Carolina PaizPiper & AlexJune 9, 2017 (2017-06-09)
The guards—except Luschek—are led to the MCC management, but are led by Maria, who wants to get out to see her little girl. Maria explains the "deal" to shorten her sentence if she lets the guards go, but is told by a state employee that that is not possible. The MCC learns that it was not Taystee who sent out the guards as part of an acceptance of the negotiation, and decide to send the CERT in to end the riot. Morello shows half a dozen positive pregnancy tests to a stunned Nicky, who calls her husband and convinces him to take responsibility. Linda makes excuses to Big Boo, telling her that she now understands the inmates are not living in a decent environment, but Big Boo is unmoved and demands Linda send her US$5,000 via PayPal to keep the secret of her affair with Caputo. A distraught Bayley travels by bus to meet Poussey's father and confess that her death was his fault. Her father angrily tells him that he is not going to give Bayley the peace he seeks by forgiving him, nor punish him by beating him, and that his punishment will be having to live the rest of his life with what he has done—which is a better fate, he says, than the fate Poussey got. Pennsatucky escapes from the prison via the hole in the fence and breaks into Charlie's cabin. In Frieda's "bunker", Piper proposes to Alex, who says yes. Taystee discovers the guards escaped and tries to go to the prison doors to talk to the CERT officers, but it is too late as they immediately swarm Litchfield.

Flashback: Piper and her then-boyfriend, Larry Bloom, get tattoos. She later drunk dials Alex, saying that she is still on her mind and misses her.
6513"Storm-y Weather"Jesse PeretzLauren MorellinoneJune 9, 2017 (2017-06-09)
Dozens of CERT members in riot gear break down the prison doors, with smoke bombs, stun guns and batons in hand, causing pandemonium as they handcuff all the inmates. The CERT members discover the dead Humphrey, and escalate their tactics to "by any means necessary." Black Cindy and Taystee panic as Suzanne is unconscious from the lithium. They eventually get help from Nicky, who takes them down to Frieda's hiding place, where they inject her with the only thing they can find, an epi-pen, which finally revives Suzanne. Angie and Leanne burn all the prison records to erase their history of infractions. Deciding not to go down without a fight, Ouija, Pidge and the white supremacists barricade themselves inside a dorm and manage to injure some of the CERT members with booby traps before being restrained. The inmates are led outside in handcuffs in front of a crowd of families and the press. Maritza and Flaca are thrilled to see rabid fans of their beauty tutorials on the Internet cheering for them. Linda tries to tell an officer she is from MCC, but she is ignored after Big Boo and other inmates mock her by also claiming the same thing. The count of the inmates leaves them 10 short, and Caputo tells them about the old pool that Figueroa never got filled. The CERT chief assumes the fact that the remaining inmates are hiding "strategically" means they are planning an offensive against the officers, and says that the governor has already approved any casualties necessary. Pennsatucky and Charlie watch TV together inside his cabin. Nicky brings Taystee, Black Cindy and Suzanne to Frieda's "bunker", where Taystee is shocked to see Piscatella tied up. She takes Frieda's gun and points it at him, telling him he is to blame for Poussey's death. Instead of killing him, she breaks down crying. Red, surprisingly, releases Piscatella and tells him to leave without touching anyone. Piscatella slowly walks out into one of the prison halls, only to be shot and killed by an inexperienced CERT officer, who did not recognize him through the smokebombs. As night falls, the inmates outside are loaded onto buses and figure they are headed to new prisons; Flaca and Maritza are separated. In the "bunker", the remaining inmates—Alex, Piper, Taystee, Nicky, Red, Black Cindy, Frieda, Suzanne, Blanca, and Gloria—link arms as the CERT blows the doors off.

tag: table

text: Cast and characters[edit]

text: Main cast[edit]

text:
Taylor Schilling as Piper Chapman, inmate
Natasha Lyonne as Nicky Nichols, inmate
Uzo Aduba as Suzanne "Crazy Eyes" Warren, inmate
Danielle Brooks as Tasha "Taystee" Jefferson, inmate
Jackie Cruz as Marisol "Flaca" Gonzales, inmate
Lea DeLaria as Carrie "Big Boo" Black, inmate
Michael Harney as Sam Healy, correctional officer[a]
Selenis Leyva as Gloria Mendoza, inmate
Taryn Manning as Tiffany "Pennsatucky" Doggett, inmate
Adrienne C. Moore as Cindy "Black Cindy" Hayes, inmate
Jessica Pimentel as Maria Ruiz, inmate
Dascha Polanco as Dayanara "Daya" Diaz, inmate
Elizabeth Rodriguez as Aleida Diaz, former inmate
Nick Sandow as Joe Caputo, warden
Yael Stone as Lorna Morello, inmate
Kate Mulgrew as Galina "Red" Reznikov, inmate
Laura Prepon as Alex Vause, inmate

text: Jump up ^ Michael J. Harney was credited as main cast for season 5 but did not make a single appearance.

text: Special guest stars[edit]

text:
Jason Biggs as Larry Bloom
Samira Wiley as Poussey Washington

text: Recurring cast[edit]

text: Inmates[edit]

text:
Laverne Cox as Sophia Burset
Annie Golden as Norma Romano
Laura Gómez as Blanca Flores
Diane Guerrero as Maritza Ramos
Vicky Jeudy as Janae Watson
Julie Lake as Angie Rice
Emma Myles as Leanne Taylor
Abigail Savage as Gina Murphy
Constance Shulman as Erica "Yoga" Jones
Lori Tan Chinn as Mei Chang
Tamara Torres as Gerrman "Weeping Woman"
Lin Tucci as Anita DeMarco
Kimiko Glenn as Brook Soso
Dale Soules as Frieda Berlin
Emily Althaus as Maureen Kukudio
Blair Brown as Judy King
Rosal Colon as Carmen "Ouija" Aziza
Francesca Curran as Helen "Skinhead Helen" Van Maele
Daniella De Jesus as Irene "Zirconia" Cabrera
Asia Kate Dillon as Brandy Epps
Shannon Esper as Alana Dwight
Arianda Fernandez as Michelle Carreras
Kelly Karbacz as Kasey Sankey
Miriam Morales as Ramona "Pidge" Contreras
Jolene Purdy as Stephanie Hapakuka
Amanda Stephen as Alison Abdullah

text: Staff

text:
Catherine Curtin as Wanda Bell
Joel Marsh Garland as Scott O'Neill
Matt Peters as Joel Luschek
Alysia Reiner as Natalie "Fig" Figueroa
Alan Aisenberg as Baxter "Gerber" Bayley
Beth Dover as Linda Ferguson / "Amelia Von Barlow"
Jimmy Gary Jr. as Felix Rikerson
James McMenamin as Charlie "Donuts" Coates
Nick Dillenburg as Ryder Blake
Evan Arthur Hall as Stratman
Mike Houston as Lee Dixon
Brad William Henke as Desi Piscatella
John Palladino as Josh
Emily Tarver as Artesian McCullough
Michael Torpey as Thomas "Humps" Humphrey

text: Others

text:
Berto Colon as Cesar
Deborah Rush as Carol Chapman
Ian Paola as Yadriel
John Magaro as Vince Muccio
Mary Steenburgen as Delia Powell-Mendez (guest)

text: Production[edit]

text: In February 2016, the series was renewed for a fifth, sixth, and seventh season.[1] The fifth season was released on June 9, 2017.[2]

text: Cyberhack[edit]

text: In April 2017, it was reported that a cybercriminal had stolen the first ten episodes of the fifth season in a security breach of a post-production company. Netflix failed to respond to ransom demands, and the cybercriminal leaked the episodes online. Netflix confirmed the security breach and an ongoing investigation by federal law enforcement.[3][4] Multichannel News reported that demand for the series significantly increased over the seven-day period following the leak of the episodes. It was also said that the leak would likely cause a decrease in demand for the fifth season when Netflix releases it in June.[5]

text: Reception[edit]

text: Critical reception[edit]

text: The fifth season has received "generally favorable reviews".[6] On Metacritic, it has a score of 67 out of 100 based on 20 reviews.[6] On Rotten Tomatoes, it has a 76% rating with an average score of 7.47 out of 10 based on 33 reviews.[7]