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



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August 10th 2010