This review focuses on the initial presentation and in-hospital management of acute myocardial infarction, including selection of a management strategy and options for antithrombotic therapy. Furthermore, although an elevated cTn level indicates myocardial cell injury, it does not indicate the cause of the damage (although any cTn elevation increases the risk of adverse outcomes in many disorders). Angiography is obtained urgently for patients with STEMI, patients with persistent chest pain despite maximal medical therapy, and patients with complications (eg, markedly elevated cardiac markers, presence of cardiogenic shock, acute mitral regurgitation, ventricular septal defect, unstable arrhythmias). See additional information. Also, urgent cardiac catheterization is indicated for patients with acute STEMI but not generally for those with NSTEMI. We evaluated the association between laboratory-confirmed influenza infection and acute myocardial … Symptoms include chest discomfort with or without dyspnea, nausea, and diaphoresis. Standard therapy for all patients with unstable angina includes beta-blockers, ACE inhibitors, and statins. Methods:
Clipboard, Search History, and several other advanced features are temporarily unavailable. This is usually caused by arteriosclerosis with narrowing of the coronary arteries, the culminating event being a thrombosis (clot). It is part of a spectrum of conditions that result from myocardial ischemia known as … Usually, the first symptom of infarction is deep, substernal, visceral pain, described as aching or pressure, often radiating to the back, jaw, left arm, right arm, shoulders, or all of these areas. Evaluation begins with initial and serial ECG and serial measurements of cardiac markers to help distinguish between unstable angina, ST segment elevation myocardial infarction (STEMI), and non ST segment elevation myocardial infarction (NSTEMI). The authorized source of trusted medical research and education for the Chinese-language medical community.
2018 Feb;160(3):33. doi: 10.1007/s15006-018-0190-0. May 25, 2017N Engl J Med 2017; 376:2053-2064 For STEMI patients, emergency PCI is the preferred treatment of ST-segment elevation myocardial infarction when available in a timely fashion (door to balloon-inflation time < 90 minutes) by an experienced operator. But generally, any patient with suggestive symptoms and new-onset (or not known to be old) left bundle branch block is treated as for STEMI. If the patient is unstable (eg, ongoing symptoms, hypotension or sustained arrhythmias), then angiography must be done immediately (see figure Approach to myocardial infarction). Coronary angiography most often combines diagnosis with percutaneous coronary intervention (PCI—ie, angioplasty, stent placement). All patients are given aspirin 160 to 325 mg (not enteric-coated), if not contraindicated, at presentation and 81 mg once a day indefinitely thereafter.
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Choice of reperfusion strategy is further discussed in Revascularization for Acute Coronary Syndromes. Hanania G, Cambou JP, Guéret P, Vaur L, Blanchard D, Lablanche JM, Boutalbi Y, Humbert R, Clerson P, Genès N, Danchin N; USIC 2000 Investigators. Are you a member of an institution such as a university or hospital? Choice of drug therapy and choice of reperfusion strategy are discussed elsewhere. Pathologic Q waves are not necessary for the diagnosis.
NLM The chest wall is tender when palpated in about 15% of patients. Stay connected to what's important in medical research and clinical practice, Subscribe to the most trusted and influential source ofmedical knowledge, This article is available to subscribers. Med Monatsschr Pharm. USA.gov. N Engl J Med. No increased incidence was observed after day 7. Wang J, Li L, Ma N, Zhang X, Qiao Y, Fang G, Li G, Zhong T. Exp Ther Med. Nontransmural (including subendocardial) infarcts do not extend through the ventricular wall and cause only ST-segment and T-wave (ST-T) abnormalities. However, in developing countries, which of the following is the most common cause of AS in all age groups?
Also, lesions that are long or near bifurcation points are often not amenable to PCI.
Applying imaging in acute myocardial infarction. Beta-blockers are recommended unless contraindicated (eg, by bradycardia, heart block, hypotension, or asthma), especially for high-risk patients. Submaximal or symptom-limited stress ECG before or after discharge, Exercise echocardiography or nuclear scanning, Pharmacologic stress testing (echocardiography or nuclear scanning). If right ventricular (RV) infarction is suspected, a 15-lead ECG is usually recorded; additional leads are placed at V4-6R, and, to detect posterior infarction, V8 and V9. Circulation 126:2020–2035, 2012. doi: 10.1161/CIR.0b013e31826e1058. Peripheral or central cyanosis may be present.
The incidence ratio of an admission for acute myocardial infarction during the risk interval as compared with the control interval was 6.05 (95% confidence interval [CI], 3.86 to 9.50). For STEMI, reperfusion strategy can include fibrinolytic therapy or immediate PCI. 2018 Jun 28;378(26):2540. doi: 10.1056/NEJMc1805679. | The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. J Am Coll Cardiol 2019;73:1846-60. de Lemos JA, Newby LK, Mills NL. Modified from Killip T, Kimball JT: Treatment of myocardial infarction in a coronary care unit.
The earlier a fibrinolytic is begun, the better. However, discomfort may be mild; about 20% of acute MIs are silent (ie, asymptomatic or causing vague symptoms not recognized as illness by the patient), more commonly in patients with diabetes. Right ventricular infarction usually results from obstruction of the right coronary or a dominant left circumflex artery; it is characterized by high RV filling pressure, often with severe tricuspid regurgitation and reduced cardiac output.
Fibrinolytics are not indicated for any NSTEMI patients. Please enable it to take advantage of the complete set of features! Learn more about Institutional Access.
2020 Jun 30;51(2):e4320. We found a significant association between respiratory infections, especially influenza, and acute myocardial infarction. For patients with NSTEMI, angiography may be done within 24 to 48 hours of admission if the patient is clinically stable. Clipboard, Search History, and several other advanced features are temporarily unavailable. Morphine 2 to 4 mg IV, repeated every 15 minutes as needed, is highly effective but can depress respiration, can reduce myocardial contractility, and is a potent venous vasodilator. 2014 May;18(36):1-274, vii-viii.
Acute Myocardial Infarction (AMI) also known as a heart attack is caused by the complete or partial occlusion of a coronary artery and requires prompt hospitalization and extensive care management. Cardiac performance after recovery depends largely on how much functioning myocardium survives the acute attack. Anticoagulants are continued for: Duration of PCI in patients undergoing this procedure, Duration of hospital stay (in patients on LMWH) or 48 hours (in patients on unfractionated heparin) in all other cases. Heart sounds are usually somewhat distant; a 4th heart sound is almost universally present.
Cardiac markers (serum markers of myocardial cell injury) are cardiac enzymes (eg, creatine kinase-MB isoenzyme [CK-MB]) and cell contents (eg, troponin I, troponin T, myoglobin) that are released into the bloodstream after myocardial cell necrosis.
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