Myocardial infarction MI

• Facts:
  STEMI
  NSTEMI
• History / PE:
  Substernal chest pain, radiates to back
  Women and diabetics have atypical presentations
• Diagnosis:
  ST elevation in inferior leads (II, II, aVF)
  Right coronary artery occlusion, left circumflex artery (rare)
  
  Troponin T (most sensitive and specific marker for cardiac injury because it takes up to 10 days to normalize)
  
  CK-MB (most useful in assessing coronary re-occlusion post MI because it typically normalizes within 1-2 days)
• Treatment:
  Acute treatment
  1) Percutaneous coronary intervention (PCI)
  2) Thrombolysis
  
  Discharge medications
  1) ASA (75-325mg/day)
  2) Beta blocker (metoprolol)
  3) Statin (simvastatin)
  4) ACEI (lisinopril)
  4) Antiplatelet (clopidogrel)
• Complications:
  MI complications
  MCC of death is reentrant ventricular arrhythmia (vfib)
  Premature ventricular contractions (PVCs)
  Flash pulmonary edema (treat with diuretic, eg. furosemide)
• Notes:
  An acute anterior wall myocardial infarction may lead to "flash pulmonary edema" and requires treatment with a diuretic (beta blockers contraindicated, can worsen heart failure)
• See Also:
  Acute coronary syndrome