ST elevation myocardial infarction: Difference between revisions
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{{CMG}}; '''Associate Editor(s)-In-Chief:''' Anne-Marie Anagnostopoulos, M.D.; Debanik Chaudhuri, M.D. | |||
'''''Keywords and synonyms:''''' <small>AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis </small> | '''''Keywords and synonyms:''''' <small>AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis </small> | ||
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==See also== | ==See also== | ||
* [[The Living Guidelines: STEMI]] | * [[The Living Guidelines: STEMI]] | ||
*In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme used by the ACC / AHA guidelines. [[ACC AHA Guidelines Classification Scheme|Read more about the classification scheme used by the ACC / AHA Guidelines Committee here]]. | |||
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==Disclaimer== | ==Disclaimer== | ||
Revision as of 16:57, 28 July 2011
For patient information click here
| Myocardial infarction | |
| ICD-10 | I21-I22 |
|---|---|
| ICD-9 | 410 |
| DiseasesDB | 8664 |
| MedlinePlus | 000195 |
| eMedicine | med/1567 emerg/327 ped/2520 |
| Cardiology Network |
 Discuss ST elevation myocardial infarction further in the WikiDoc Cardiology Network |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Anne-Marie Anagnostopoulos, M.D.; Debanik Chaudhuri, M.D.
Keywords and synonyms: AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis
Overview
Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a medical condition that occurs when the blood supply to a part of the heart muscle or myocardium is interrupted. The resulting ischemia or oxygen shortage causes damage and / or irreversible death (necrosis) of the myocardium (heart muscle). It is a medical emergency, and the leading cause of death for both men and women worldwide, particularly in developed countries.[1] The term myocardial infarction is derived from myocardium (the heart muscle) and infarction (tissue death due to oxygen starvation). 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.
There are two types of acute MI: ST elevation myocardial infarction (STEMI), the topic of this chapter and non ST elevation MI (NSTEMI) which is discussed in another chapter of WikiDoc. ST elevation myocardial infarction refers to an electrocardiographic pattern in which the ST segments are elevated reflecting complete epicardial vessel occlusion. Once the vessel is opened by percutaneous coronary angioplasty, the ST segments can remain elevated due to absence of perfusion or flow into the myocardium itself. At this point in the evolution of the ST elevation MI, the epicardial artery is open, but the capillary network is occluded due to swelling, embolization, and / or vasospasm.
Non ST elevation myocardial infarction refers to a disease state in which the epicardial artery is open, but there is inadequate blood flow to the myocardium which results in an electrocardiographic pattern of ST segment depression. While ST elevation reflects transmural injury, ST depression may reflect ongoing subendocardial ischemia. Inadequate blood flow to the muscle may be due to embolization of material downstream into the myocardium or a restriction of blood flow due to severe narrowing of the epicardial artery. [2] [3] [4]
Epidemiology and Demographics
Pathophysiology
Risk Factors
Triggers
Pathophysiology of Vessel Occlusion
Pathophysiology of Reperfusion
Diagnosis
Diagnosis, classification and biomarkers
Symptoms
Differential diagnosis of chest pain
Physical Examination
Electrocardiogram
Coronary Angiography
Gross Pathology
Histopathology
Treatment
Pre-Hospital Care
Initial Care
Oxygen | Nitrates | Analgesics | Aspirin | Beta Blockers | Antithrombins | The coronary care unit | The step down unit
Pharmacologic Reperfusion | Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI) | Fibrinolysis
Mechanical Reperfusion | The importance of reducing Door-to-Balloon times | Primary PCI | Adjunctive and Rescue PCI | Rescue PCI | Facilitated PCI | Adjunctive PCI | CABG | Management of Patients Who Were Not Reperfused | Assessing Success of Reperfusion
Antithrombin Therapy • Antithrombin therapy • Unfractionated heparin • Low Molecular Weight Heparinoid Therapy • Direct Thrombin Inhibitor Therapy • Factor Xa Inhibition • DVT prophylaxis • Long term anticoagulation
Antiplatelet Agents | Aspirin | Thienopyridine Therapy | Glycoprotein IIbIIIa Inhibition
Other Initial Therapy | Inhibition of the Renin-Angiotensin-Aldosterone System | Magnesium Therapy | Glucose Control | Calcium Channel Blocker Therapy
Discharge Care
Secondary Prevention | Inhibition of the Renin-Angiotensin-Aldosterone System | Cardiac Rehabilitation | Prognosis | Pacemaker Implantation | Long term anticoagulation
Complications
Overview
Ischemic Complications: Reinfarction
Mechanical Complications:Cardiogenic shock | Left ventricular aneurysm | Myocardial rupture | Pseudoaneurysm | Papillary muscle rupture | Rupture of the ventricular septum
Arrhythmic Complications: Sudden cardiac death
Embolic Complications: Stroke | DVT
Pericarditis: Post myocardial infarction pericarditis | Dressler's syndrome
See also
- The Living Guidelines: STEMI
- In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme used by the ACC / AHA guidelines. Read more about the classification scheme used by the ACC / AHA Guidelines Committee here.
Disclaimer
Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the disclaimers page for important information regarding limitations of the information found here.
External links
- The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research
- Clinical Trial Results: An up to date resource of Cardiovascular Research
- Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack - based on information of the Framingham Heart Study from the United States National Heart, Lung and Blood Institute
- Heart Attack overview from MedlinePlus
- Heart Attack Warning Signals from the Heart and Stroke Foundation of Canada
- A Regional PCI and Resource Center for STEMI
- STEMI Systems' Quarterly newsletter
- American Heart Association's Heart Attack web site
References
- ↑ The World Health Report 2004 - Changing History (PDF). World Health Organization. 2004. pp. 120–4. ISBN 92-4-156265-X.
- ↑ Hurst’s The Heart, Fuster V, 12th edition, 2008
- ↑ Topol’s Textbook of Cardiovascular Medicine, Topol E, 3rd edition, 2007
- ↑ Mayo Textbook of Cardiology, 2007
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