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Encyclopedia > Myocardial infarction
Myocardial infarction
Classification & external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA).
ICD-10 I21.-I22.
ICD-9 410
DiseasesDB 8664
MedlinePlus 000195
eMedicine med/1567  emerg/327 ped/2520

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 is interrupted, most commonly due to rupture of a vulnerable plaque. The resulting ischemia or oxygen shortage causes damage and potential death of heart tissue. It is a medical emergency, and the leading cause of death for both men and women all over the world.[1] Important risk factors are a previous history of vascular disease such as atherosclerotic coronary heart disease and/or angina, a previous heart attack or stroke, any previous episodes of abnormal heart rhythms or syncope, older age—especially men over 40 and women over 50, smoking, excessive alcohol consumption, the abuse of certain drugs, high triglyceride levels, high LDL ("Low-density lipoprotein") and low HDL ("High density lipoprotein"), diabetes, high blood pressure, obesity, and chronically high levels of stress in certain persons. Look up heart attack in Wiktionary, the free dictionary. ... Image File history File links Download high-resolution version (580x750, 420 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Myocardial infarction Left coronary artery Right coronary artery ... The sternocostal surface of the heart (anterior surface of the heart) is directed forward, upward, and to the left. ... The left coronary artery, also abbreviated LCA, arises from the aorta above the left cusp of the aortic valve. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Blood flow is the flow of blood in the cardiovascular system. ... The heart and lungs, from an older edition of Grays Anatomy. ... A vulnerable plaque is an atheromatous plaque which is particularly prone to produce sudden major problems, such as a heart attack or stroke. ... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... Hypoxia is a pathological condition in which the body as a whole (generalised hypoxia) or region of the body (tissue hypoxia) is deprived of adequate oxygen supply. ... {{Otheruses4|the medical term|the Australian television series|Medical Emergenc an immediate threat to a persons life or long term health. ... A risk factor is a variable associated with an increased risk of disease or infection but risk factors are not necessarily causal. ... Atherosclerosis is a disease affecting arterial blood vessels. ... Coronary heart disease (CHD), also called coronary artery disease (CAD), ischaemic heart disease, atherosclerotic heart disease, is the end result of the accumulaation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. ... angina tonsillaris see tonsillitis. ... For other uses, see Stroke (disambiguation). ... It has been suggested that Central Ischaemic Response be merged into this article or section. ... The cigarette is the most common method of smoking tobacco. ... Low-density lipoprotein (LDL) belongs to the lipoprotein particle family. ... High-density lipoproteins (HDL) form a class of lipoproteins, varying somewhat in their size (8–11 nm in diameter), that carry cholesterol from the bodys tissues to the liver. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... For other forms of hypertension, see Hypertension (disambiguation). ...


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. Myocardium is the muscular tissue of the heart. ... This article does not adequately cite its references or sources. ... A cardiac arrest is the cessation of normal circulation of the blood due to failure of the ventricles of the heart to contract effectively during systole. ...


Classical symptoms of acute myocardial infarction include chest pain (typically radiating to the left arm), shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety. Patients frequently feel suddenly ill. Women often experience different symptoms from men. The most common symptoms of MI in women include shortness of breath, weakness, and fatigue. Approximately one third of all myocardial infarctions are silent, without chest pain or other symptoms. In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... Dyspnea (R06. ... For other uses, see Nausea (disambiguation). ... Emesis redirects here. ... This article does not cite any references or sources. ... Perspiration (also called sweating or sometimes transpiration) is the production and evaporation of a fluid, consisting primarily of water as well as a smaller amount of sodium chloride (the main constituent of table salt), that is excreted by the sweat glands in the skin of mammals. ... what up?? Anxiety is a physiological state characterized by cognitive, somatic, emotional, and behavioral components (Seligman, Walker & Rosenhan, 2001). ... The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work induced burning sensation within muscle. ...


Immediate treatment for suspected acute myocardial infarction includes oxygen, aspirin, glyceryl trinitrate and pain relief, usually morphine sulfate. The patient will receive a number of diagnostic tests, such as an electrocardiogram (ECG, EKG), a chest X-ray and blood tests to detect elevated creatine kinase or troponin levels (these are chemical markers released by damaged tissues, especially the myocardium). Further treatment may include either medications to break down blood clots that block the blood flow to the heart, or mechanically restoring the flow by dilatation or bypass surgery of the blocked coronary artery. Coronary care unit admission allows rapid and safe treatment of complications such as abnormal heart rhythms. Oxygen first aid kit showing a demand valve and a constant flow mask Oxygen therapy is the administration of oxygen as a therapeutic modality. ... This article is about the drug. ... Glyceryl trinitrate (GTN) has been used to treat angina and heart failure since at least 1880. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ... Morphine (INN), the principal active agent in opium, is a powerful opioid analgesic drug. ... “QRS” redirects here. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Creatine Kinase Creatine kinase (CK), also known as phosphocreatine kinase or creatine phosphokinase (CPK) is an enzyme (EC 2. ... Troponin Troponin is a complex of three proteins that is integral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle. ... This article does not cite any references or sources. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... This article does not cite any references or sources. ... Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ... A coronary care unit (CCU) is a hospital ward specialised in the care of patients with heart attacks, unstable angina and (in practice) various other cardiac conditions that require continuous monitoring and treatment. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ...

Contents

Epidemiology

Myocardial infarction is a common presentation of ischemic heart disease. The WHO estimated that in 2002, 12.6 percent of deaths worldwide were from ischemic heart disease.[1] Ischemic heart disease is the leading cause of death in developed countries, but third to AIDS and lower respiratory infections in developing countries.[2] Ischaemic heart disease is a disease characterized by reduced blood supply to the heart. ... For other uses, see AIDS (disambiguation). ... While often used as a synonym for pneumonia, the rubric of lower respiratory tract infection can also be applied to other types of infection including lung abscess, acute bronchitis, and empyema. ...


In the United States, diseases of the heart are the leading cause of death, causing a higher mortality than cancer (malignant neoplasms).[3] Coronary heart disease is responsible for 1 in 5 deaths in the U.S.. Some 7,200,000 men and 6,000,000 women are living with some form of coronary heart disease. 1,200,000 people suffer a (new or recurrent) coronary attack every year, and about 40% of them die as a result of the attack.[4] This means that roughly every 65 seconds, an American dies of a coronary event. Heart disease is an umbrella term for a number of different diseases which affect the heart and as of 2007 it is the leading cause of death in the United States,[1] and England and Wales. ... It has been suggested that Big killer be merged into this article or section. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... In medicine, malignant is a clinical term that means to be severe and become progressively worse, as in malignant hypertension. ... Neoplasia (new growth in Greek) is abnormal proliferation of cells in a tissue or organ. ... Coronary heart disease (CHD), also called coronary artery disease (CAD), ischaemic heart disease, atherosclerotic heart disease, is the end result of the accumulaation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. ...


Risk factors

Risk factors for atherosclerosis are generally risk factors for myocardial infarction:

Many of these risk factors are modifiable, so many heart attacks can be prevented by maintaining a healthier lifestyle. Physical activity, for example, is associated with a lower risk profile.[7] Non-modifiable risk factors include age, sex, and family history of an early heart attack (before the age of 60), which is thought of as reflecting a genetic predisposition.[5] Paul Kruger in his old age. ... This article is about the Male sex. ... The cigarette is the most common method of smoking tobacco. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ... Hyperlipoproteinemia is the presence of elevated levels of lipoprotein in the blood. ... Low-density lipoprotein (LDL) belongs to the lipoprotein particle family. ... High-density lipoproteins (HDL) form a class of lipoproteins, varying somewhat in their size (8–11 nm in diameter), that carry cholesterol from the bodys tissues to the liver. ... Hyperhomocysteinemia is a medical condition characterized by an abnormally large level of homocysteine in the blood. ... Homocysteine is a chemical compound with the formula HSCH2CH2CH(NH2)CO2H. It is a homologue of the naturally-occurring amino acid cysteine, differing in that its side-chain contains an additional methylene (-CH2-) group before the thiol (-SH) group. ... This article is about the class of chemicals. ... Retinol (Vitamin A) Vitamins are nutrients required in very small amounts for essential metabolic reactions in the body [1]. The term vitamin does not encompass other essential nutrients such as dietary minerals, essential fatty acids, or essential amino acids. ... Folic acid and folate (the anion form) are forms of the water-soluble Vitamin B9. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... For other forms of hypertension, see Hypertension (disambiguation). ... A graph of body mass index is shown above. ... Waist-to-hip ratio or Waist-hip ratio (WHR) is the ratio of the girth of waist and the girth of hip. ... A genetic predisposition is a genetic effect which influences the phenotype of an organism but which can be modified by the environmental conditions. ...


Socioeconomic factors such as a shorter education and lower income (particularly in women), and living with a partner may also contribute to the risk of MI.[8] To understand epidemiological study results, it's important to note that many factors associated with MI mediate their risk via other factors. For example, the effect of education is partially based on its effect on income and marital status.[8] Socioeconomics or Socio-economics is the study of the relationship between economic activity and social life. ... Income, generally defined, is the money that is received as a result of the normal business activities of an individual or a business. ... This article is about a living arrangement. ... A persons marital status describes their relationship with a significant other. ...


Women who use combined oral contraceptive pills have a modestly increased risk of myocardial infarction, especially in the presence of other risk factors, such as smoking.[9] The Pill redirects here. ...


Inflammation is known to be an important step in the process of atherosclerotic plaque formation.[10] C-reactive protein (CRP) is a sensitive but non-specific marker for inflammation. Elevated CRP blood levels, especially measured with high sensitivity assays, can predict the risk of MI, as well as stroke and development of diabetes.[10] Moreover, some drugs for MI might also reduce CRP levels.[10] The use of high sensitivity CRP assays as a means of screening the general population is advised against, but it may be used optionally at the physician's discretion, in patients who already present with other risk factors or known coronary artery disease.[11] Whether CRP plays a direct role in atherosclerosis remains uncertain.[10] In pathology, an atheroma (plural: atheromata) is an accumulation and swelling (-oma) in artery walls that is made up of cells, or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue. ... C-reactive protein (CRP) is a plasma protein, an acute phase protein produced by the liver. ... In medicine, a biomarker is an indicator of a particular disease state or a particular state of an organism. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... For other uses, see Stroke (disambiguation). ... Screening, in medicine, is a strategy used to identify disease in an unsuspecting population. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ...


Inflammation in periodontal disease may be linked coronary heart disease, and since periodontitis is very common, this could have great consequences for public health.[12] Serological studies measuring antibody levels against typical periodontitis-causing bacteria found that such antibodies were more present in subjects with coronary heart disease.[13] Periodontitis tends to increase blood levels of CRP, fibrinogen and cytokines;[14] thus, periodontitis may mediate its effect on MI risk via other risk factors.[15] Preclinical research suggests that periodontal bacteria can promote aggregation of platelets and promote the formation of foam cells.[16][17] A role for specific periodontal bacteria has been suggested but remains to be established.[18] PeBold textriodontium is a word of Medical terminology for the specialized tissues surrounding and supporting the teeth. ... Periodontitis, formerly known as Pyorrhea alveolaris, is the name of a collection of inflammatory diseases affecting the tissues that surround and support the teeth. ... Public health is concerned with threats to the overall health of a community based on population health analysis. ... Serology is the scientific study of blood serum. ... Each antibody binds to a specific antigen; an interaction similar to a lock and key. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Fibrin is a protein involved in the clotting of blood. ... Cytokines are small protein molecules that are the core of communication between immune system cells, and even between immune system cells and cells belonging to other tissue types. ... Medical research (or experimental medicine) is basic research and applied research conducted to aid the body of knowledge in the field of medicine. ... A 250 ml bag of newly collected platelets. ... Foam cells are cells in an atheroma derived form both macrophages and smooth muscle cells which have accumulated LDLs by endocytosis. ...


Baldness, hair greying, a diagonal earlobe crease[19] and possibly other skin features are independent risk factors for MI. Their role remains controversial; a common denominator of these signs and the risk of MI is supposed, possibly genetic.[20] Bald redirects here; for other uses see Bald (disambiguation). ... Human beings have many variations in hair color and texture. ... On the ear of humans and many other animals, the earlobe (lobulus auriculæ, sometimes simply lobe or lobule) is the soft lower part of the external ear or pinna. ... Beyond overall skin structure, refer below to: See-also. ...


Pathophysiology

A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream.
A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream.

Acute myocardial infarction is a type of acute coronary syndrome, which is most frequently (but not always) a manifestation of coronary artery disease. The most common triggering event is the disruption of an atherosclerotic plaque in an epicardial coronary artery, which leads to a clotting cascade, sometimes resulting in total occlusion of the artery. Atherosclerosis is the gradual buildup of cholesterol and fibrous tissue in plaques in the wall of arteries (in this case, the coronary arteries), typically over decades. Blood stream column irregularities visible on angiographies reflect artery lumen narrowing as a result of decades of advancing atherosclerosis. Plaques can become unstable, rupture, and additionally promote a thrombus (blood clot) that occludes the artery; this can occur in minutes. When a severe enough plaque rupture occurs in the coronary vasculature, it leads to myocardial infarction (necrosis of downstream myocardium). source File links The following pages link to this file: Myocardial infarction Categories: United States government images ... source File links The following pages link to this file: Myocardial infarction Categories: United States government images ... Atherosclerosis is a disease affecting arterial blood vessels. ... In pathology, an atheroma (plural: atheromata) is an accumulation and swelling (-oma) in artery walls that is made up of cells, or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... An acute coronary syndrome (ACS) is a set of signs and symptoms suggestive of sudden cardiac ischemia, usually caused by disruption of atherosclerotic plaque in an epicardial coronary artery. ... An acute coronary syndrome (ACS) is a set of signs and symptoms suggestive of sudden cardiac ischemia, usually caused by disruption of atherosclerotic plaque in an epicardial coronary artery. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ... Atherosclerosis is a disease affecting arterial blood vessels. ... In pathology, an atheroma (plural: atheromata) is an accumulation and swelling (-oma) in artery walls that is made up of cells, or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue. ... Cholesterol is a sterol (a combination steroid and alcohol). ... Section of an artery For other uses, see Artery (disambiguation). ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band... For Trombe wall (used in solar homes), see Trombe wall. ...


If impaired blood flow to the heart lasts long enough, it triggers a process called the ischemic cascade; the heart cells die (chiefly through necrosis) and do not grow back. A collagen scar forms in its place. Recent studies indicate that another form of cell death called apoptosis also plays a role in the process of tissue damage subsequent to myocardial infarction.[21] As a result, the patient's heart can be permanently damaged. This scar tissue also puts the patient at risk for potentially life threatening arrhythmias. The ischemic cascade is a series of biochemical reactions that take place in the brain after seconds to minutes of ischemia (inadequate blood supply) (Arnold, 2003). ... Necrosis (in Greek Νεκρός = Dead) is the name given to accidental death of cells and living tissue. ... Tropocollagen triple helix. ... This article does not cite any references or sources. ... A section of mouse liver showing an apoptotic cell indicated by an arrow Apoptosis (pronounced apo tō sis) is a process of suicide by a cell in a multicellular organism. ...


Injured heart tissue conducts electrical impulses more slowly than normal heart tissue. The difference in conduction velocity between injured and uninjured tissue can trigger re-entry or a feedback loop that is believed to be the cause of many lethal arrhythmias. The most serious of these arrhythmias is ventricular fibrillation (V-Fib/VF), an extremely fast and chaotic heart rhythm that is the leading cause of sudden cardiac death. Another life threatening arrhythmia is ventricular tachycardia (V-Tach/VT), which may or may not cause sudden cardiac death. However, ventricular tachycardia usually results in rapid heart rates that prevent the heart from pumping blood effectively. Cardiac output and blood pressure may fall to dangerous levels, which is particularly bad for the patient experiencing acute myocardial infarction. Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... Cardiac output (CO) is the volume of blood being pumped by the heart, in particular by a ventricle in a minute. ... A sphygmomanometer, a device used for measuring arterial pressure. ...


The cardiac defibrillator is a device that was specifically designed to terminate these potentially fatal arrhythmias. The device works by delivering an electrical shock to the patient in order to depolarize a critical mass of the heart muscle, in effect "rebooting" the heart. This therapy is time dependent, and the odds of successful defibrillation decline rapidly after the onset of cardiopulmonary arrest. This article or section does not adequately cite its references or sources. ... This article is about the television program ReBoot. ...


Triggers

Heart attack rates are higher in association with intense exertion, be it psychological stress or physical exertion, especially if the exertion is more intense than the individual usually performs.[5] Quantitatively, the period of intense exercise and subsequent recovery is associated with about a 6-fold higher myocardial infarction rate (compared with other more relaxed time frames) for people who are physically very fit.[5] For those in poor physical condition, the rate differential is over 35-fold higher.[5] One observed mechanism for this phenomenon is the increased arterial pulse pressure stretching and relaxation of arteries with each heart beat which, as has been observed with intravascular ultrasound, increases mechanical "shear stress" on atheromas and the likelihood of plaque rupture.[5] Stress (roughly the opposite of relaxation) is a medical term for a wide range of strong external stimuli, both physiological and psychological, which can cause a physiological response called the general adaptation syndrome, first described in 1936 by Hans Selye in the journal Nature. ... Intravascular ultrasound (IVUS) is an medical imaging methodology using (a) specially designed long thin complex manufactured catheters attached to (b) computerized ultrasound equipment. ... In pathology, an atheroma (plural: atheromata) is an accumulation and swelling (-oma) in artery walls that is made up of cells, or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue. ...


Acute severe infection, such as pneumonia, can trigger myocardial infarction. A more controversial link is that between Chlamydophila pneumoniae infection and atherosclerosis.[22] While this intracellular organism has been demonstrated in atherosclerotic plaques, evidence is inconclusive as to whether it can be considered a causative factor.[22] Treatment with antibiotics in patients with proven atherosclerosis has not demonstrated a decreased risk of heart attacks or other coronary vascular diseases.[23] This article is about human pneumonia. ... Chlamydophila pneumoniae (previously known as Chlamydia pneumoniae) is a species of chlamydiae bacteria which infects humans and is a major cause of pneumonia. ...


Classification

Acute myocardial infarction is a type of acute coronary syndrome, which is most frequently (but not always) a manifestation of coronary artery disease. The acute coronary syndromes include ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). Image File history File linksMetadata Download high-resolution version (741x700, 132 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Myocardial infarction Metadata This file contains additional information, probably added from the digital camera or scanner used to... Image File history File linksMetadata Download high-resolution version (741x700, 132 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Myocardial infarction Metadata This file contains additional information, probably added from the digital camera or scanner used to... An acute coronary syndrome (ACS) is a set of signs and symptoms suggestive of sudden cardiac ischemia, usually caused by disruption of atherosclerotic plaque in an epicardial coronary artery. ... An acute coronary syndrome (ACS) is a set of signs and symptoms suggestive of sudden cardiac ischemia, usually caused by disruption of atherosclerotic plaque in an epicardial coronary artery. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ... This page meets Wikipedias criteria for speedy deletion. ...


Depending on the location of the obstruction in the coronary circulation, different zones of the heart can become injured. Using the anatomical terms of location, one can describe anterior, inferior, lateral, apical and septal infarctions (and combinations, such as anteroinferior, anterolateral, and so on).[25] For example, an occlusion of the left anterior descending coronary artery will result in an anterior wall myocardial infarct.[26] The coronary circulation consists of the blood vessels that supply blood to and from the heart muscle itself. ... In sciences dealing with the anatomy of animals, precise anatomical terms of location are necessary for a variety of reasons. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ...


Another distinction is whether a MI is subendocardial, affecting only the inner third to one half of the heart muscle, or transmural, damaging (almost) the entire wall of the heart.[27] The inner part of the heart muscle is more vulnerable to oxygen shortage, because the coronary arteries run inward from the epicardium to the endocardium, and because the blood flow through the heart muscle is hindered by the heart contraction.[26] Epicardium describes the outer layer of heart tissue (from Greek; epi- outer, cardium heart). ... In the heart, the endocardium is the innermost layer of tissue that lines the chambers of the heart. ... Ventricular systole The parts of a QRS complex. ...


The phrases transmural and subendocardial infarction used to be considered synonymous with Q-wave and non-Q-wave myocardial infarction respectively, based on the presence or absence of Q waves on the ECG. It has since been shown that there is no clear correlation between the presence of Q waves with a transmural infarction and the absence of Q waves with a subendocardial infarction,[28] but Q waves are associated with larger infarctions, while the lack of Q waves is associated with smaller infarctions. The presence or absence of Q-waves also has clinical importance,[29] with improved outcomes associated with a lack of Q waves.[30] Positive linear correlations between 1000 pairs of numbers. ...


The phrase "massive attack" is not a recognized medical term.


Symptoms

Rough diagram of pain zones in myocardial infarction (dark red = most typical area, light red = other possible areas, view of the chest).
Rough diagram of pain zones in myocardial infarction (dark red = most typical area, light red = other possible areas, view of the chest).
Back view.
Back view.

The onset of symptoms in myocardial infarction (MI) is usually gradual, over several minutes, and rarely instantaneous.[31] Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle is termed angina pectoris. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and epigastrium, where it may mimic heartburn. Any group of symptoms compatible with a sudden interruption of the blood flow to the heart are called an acute coronary syndrome.[32] Other conditions such as aortic dissection or pulmonary embolism may present with chest pain and must be considered in the differential diagnosis. Image File history File links AMI_pain_front. ... Image File history File links AMI_pain_front. ... Image File history File links AMI_pain_back. ... Image File history File links AMI_pain_back. ... In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... Look up ARM in Wiktionary, the free dictionary. ... Human jaw front view Human jaw left view Human jaw top view The jaw is either of the two opposable structures forming, or near the entrance to, the mouth. ... A human neck. ... Illustration of a human back from Grays Anatomy. ... The epigastrium is the upper central region of the abdomen. ... An acute coronary syndrome (ACS) is a set of signs and symptoms suggestive of sudden cardiac ischemia, usually caused by disruption of atherosclerotic plaque in an epicardial coronary artery. ... Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). ... This article does not cite any references or sources. ...


Shortness of breath (dyspnea) occurs when the damage to the heart limits the output of the left ventricle, causing left ventricular failure and consequent pulmonary edema. Other symptoms include diaphoresis (an excessive form of sweating), weakness, light-headedness, nausea, vomiting, and palpitations. Loss of consciousness and even sudden death can occur in myocardial infarctions. Dyspnea (R06. ... Cardiac output (CO) is the volume of blood being pumped by the heart, in particular by a ventricle in a minute. ... In the heart, a ventricle is a chamber which collects blood from an atrium (another heart chamber) and pumps it out of the heart. ... Congestive heart failure (CHF) (also called congestive cardiac failure and heart failure) is the inability of the heart to pump a sufficient amount of blood throughout the body, or requiring elevated filling pressures in order to pump effectively. ... Pulmonary edema is swelling and/or fluid accumulation in the lungs. ... Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions. ... Perspiration (also called sweating or sometimes transpiration) is the production and evaporation of a fluid, consisting primarily of water as well as a smaller amount of sodium chloride (the main constituent of table salt), that is excreted by the sweat glands in the skin of mammals. ... Light-headedness is a common ailment where individuals feel as though their head are weightless. ... For other uses, see Nausea (disambiguation). ... Emesis redirects here. ... This article does not cite any references or sources. ... Unconsciousness is the absence of consciousness. ... A cardiac arrest is the cessation of normal circulation of the blood due to failure of the ventricles of the heart to contract effectively during systole. ...


Women often experience markedly different symptoms than men. The most common symptoms of MI in women include dyspnea, weakness, and fatigue. Fatigue, sleep disturbances, and dyspnea have been reported as frequently occurring symptoms which may manifest as long as one month before the actual clinically manifested ischemic event. In women, chest pain may be less predictive of coronary ischemia than in men.[33] The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work induced burning sensation within muscle. ... Dyspnea (R06. ... In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ...


Approximately half of all MI patients have experienced warning symptoms such as chest pain prior to the infarction.[34]


Approximately one fourth of all myocardial infarctions are silent, without chest pain or other symptoms.[35] These cases can be discovered later on electrocardiograms or at autopsy without a prior history of related complaints. A silent course is more common in the elderly, in patients with diabetes mellitus[36] and after heart transplantation, probably because the donor heart is not connected to nerves of the host.[37] In diabetics, differences in pain threshold, autonomic neuropathy, and psychological factors have been cited as possible explanations for the lack of symptoms.[36] Old age consists of ages nearing the average lifespan of human beings, and thus the end of the human life cycle. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Organ donationcan only be peformed by untrained workers who do not have a drivers license and are poor. ... The term pain threshold refers to the minimum intensity or duration of a sensory stimulus at which it becomes interpreted as painful. ... Autonomic neuropathy is a disease of the non-voluntary, non-sensory nervous system affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. ... Psychological science redirects here. ...


Diagnosis

The diagnosis of myocardial infarction is made by integrating the history of the presenting illness and physical examination with electrocardiogram findings and cardiac markers (blood tests for heart muscle cell damage).[38] A coronary angiogram allows to visualize narrowings or obstructions on the heart vessels, and therapeutic measures can follow immediately. At autopsy, a pathologist can diagnose a myocardial infarction based on anatomopathological findings. “QRS” redirects here. ... Medical tests that are often referred to as cardiac markers include: cardiac troponin (the most sensitive and specific test for myocardial damage) creatine kinase (CK, also known as phosphocreatine kinase or creatine phosphokinase) Aspartate transaminase (AST, also called Glutamic Oxaloacetic Transaminase (GOT/SGOT) or aspartate aminotransferase (ASAT)) lactate dehydrogenase (LDH... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Cardiac muscle is a type of involuntary striated muscle found within the heart. ... Drawing of the structure of cork as it appeared under the microscope to Robert Hooke from Micrographia which is the origin of the word cell being used to describe the smallest unit of a living organism Cells in culture, stained for keratin (red) and DNA (green) The cell is the... Coronary angiogram A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. ... Post-mortem, postmortem and post mortem redirect here. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Anatomic pathology is a medical specialty (a branch of pathology) that is concerned with the diagnosis of disease based on the gross, microscopic, and molecular examination of cells and tissues. ...


A chest radiograph and routine blood tests may indicate complications or precipitating causes and are often performed on admittance to an emergency department. New regional wall motion abnormalities on an echocardiogram are also suggestive of a myocardial infarction and are sometimes performed in equivocal cases.[39] Technetium and thallium can be used in nuclear medicine to visualize areas of reduced blood flow and tissue viability, respectively.[39][40] Technetium is used in a MUGA scan. Image A: A normal chest X-ray. ... The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and... Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions. ... General Name, Symbol, Number technetium, Tc, 43 Chemical series transition metals Group, Period, Block 7, 5, d Appearance silvery gray metal Standard atomic weight [98](0) g·mol−1 Electron configuration [Kr] 4d5 5s2 Electrons per shell 2, 8, 18, 13, 2 Physical properties Phase solid Density (near r. ... General Name, Symbol, Number thallium, Tl, 81 Chemical series poor metals Group, Period, Block 13, 6, p Appearance silvery white Standard atomic weight 204. ... Shown above is the bone scintigraphy of a young woman. ... MUGA scan (Multiple Gated Acquisition scan) is noninvasive test to evaluate the function of the heart. ...


Diagnostic criteria

WHO criteria[41] have classically been used to diagnose MI; a patient is diagnosed with myocardial infarction if two (probable) or three (definite) of the following criteria are satisfied:

  1. Clinical history of ischaemic type chest pain lasting for more than 20 minutes
  2. Changes in serial ECG tracings
  3. Rise and fall of serum cardiac biomarkers such as creatine kinase, troponin I, and lactate dehydrogenase isozymes specific for the heart.

The WHO criteria were refined in 2000 to give more prominence to cardiac biomarkers.[24] According to the new guidelines, a cardiac troponin rise accompanied by either typical symptoms, pathological Q waves, ST elevation or depression or coronary intervention are diagnostic of MI. Creatine Kinase Creatine kinase (CK), also known as phosphocreatine kinase or creatine phosphokinase (CPK) is an enzyme (EC 2. ... Troponin Troponin is a complex of three proteins that is integral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle. ... Lactate dehydrogenase (LDH) is an enzyme (EC 1. ... Isozymes, (or isoenzymes) are isoforms (closely related variants) of enzymes. ... Troponin Troponin is a complex of three proteins that is integral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle. ...


Physical examination

The general appearance of patients may vary according to the experienced symptoms; the patient may be comfortable, or restless and in severe distress with an increased respiratory rate. A cool and pale skin is common and points to vasoconstriction. Some patients have low-grade fever (38–39 °C). Blood pressure may be elevated or decreased, and the pulse can be become irregular.[42][43] It has been suggested that this article or section be merged with Minute volume. ... This article does not cite any references or sources. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... A sphygmomanometer, a device used for measuring arterial pressure. ... ËŒ For other uses, see Pulse (disambiguation). ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ...


If heart failure ensues, elevated jugular venous pressure and hepatojugular reflux, or swelling of the legs due to peripheral edema may be found on inspection. Rarely, a cardiac bulge with a pace different from the pulse rhythm can be felt on precordial examination. Various abnormalities can be found on auscultation, such as a third and fourth heart sound, systolic murmurs, paradoxical splitting of the second heart sound, a pericardial friction rub and rales over the lung.[42][44] The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system. ... The abdominojugular test, also known as hepatojugular reflux, is used as an alternate test for measuring jugular venous pressure (JVP) through the distension or swelling of the jugular vein. ... This page is about the condition called edema. ... This article does not cite any references or sources. ... Auscultation is the technical term for listening to the internal sounds of the body, usually using a stethoscope. ... Front of thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline). ... Murmurs are abnormal heart sounds that are produced as a result of turbulent blood flow which is sufficient to produce audible noise. ... The pericardium is a double-walled sac that contains the heart and the roots of the great vessels. ... Rales,crackles or crepitation, are the clicking, rattling, or crackling noises heard on auscultation of the lungs with a stethescope during inhalation. ...

12-lead electrocardiogram (ECG) showing acute inferior ST segment elevation MI (STEMI). Note the ST segment elevation in leads II, III, and aVF along with reciprocal ST segment depression in leads I and aVL.
12-lead electrocardiogram (ECG) showing acute inferior ST segment elevation MI (STEMI). Note the ST segment elevation in leads II, III, and aVF along with reciprocal ST segment depression in leads I and aVL.

Download high resolution version (1664x896, 342 KB)12 Lead Electrocardiogram (ECG) with ST segment elevation in Leads II, III and aVF for an inferior Acute Myocardial Infarction (AMI). ... Download high resolution version (1664x896, 342 KB)12 Lead Electrocardiogram (ECG) with ST segment elevation in Leads II, III and aVF for an inferior Acute Myocardial Infarction (AMI). ... “QRS” redirects here. ...

Electrocardiogram

Main article: Electrocardiogram

The primary purpose of the electrocardiogram is to detect ischemia or acute coronary injury in broad, symptomatic emergency department populations. However, the standard 12 lead ECG has several limitations. An ECG represents a brief sample in time. Because unstable ischemic syndromes have rapidly changing supply versus demand characteristics, a single ECG may not accurately represent the entire picture.[45] It is therefore desirable to obtain serial 12 lead ECGs, particularly if the first ECG is obtained during a pain-free episode. Alternatively, many emergency departments and chest pain centers use computers capable of continuous ST segment monitoring.[46] It should also be appreciated that the standard 12 lead ECG does not directly examine the right ventricle, and does a relatively poor job of examining the posterior basal and lateral walls of the left ventricle. In particular, acute myocardial infarction in the distribution of the circumflex artery is likely to produce a nondiagnostic ECG.[45] The use of non-standard ECG leads like right-sided lead V4R and posterior leads V7, V8, and V9 may improve sensitivity for right ventricular and posterior myocardial infarction. In spite of these limitations, the 12 lead ECG stands at the center of risk stratification for the patient with suspected acute myocardial infarction. Mistakes in interpretation are relatively common, and the failure to identify high risk features has a negative effect on the quality of patient care.[47] The 12 lead ECG is used to classify patients into one of three groups: “QRS” redirects here. ... “QRS” redirects here. ... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and... “QRS” redirects here. ... “QRS” redirects here. ... “QRS” redirects here. ... ECG may also refer to the East Coast Greenway Lead II An Electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ... “QRS” redirects here. ... The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and... “QRS” redirects here. ... The right ventricle is one of four chambers (two atria and two ventricles) in the human heart. ... In the heart, a ventricle is a chamber which collects blood from an atrium (another heart chamber) and pumps it out of the heart. ... “QRS” redirects here. ... “QRS” redirects here. ... “QRS” redirects here. ...

1. those with ST segment elevation or new bundle branch block (suspicious for acute injury and a possible candidate for acute reperfusion therapy with thrombolytics or primary PCI),
2. those with ST segment depression or T wave inversion (suspicious for ischemia), and
3. those with a so-called non-diagnostic or normal ECG.[48]

A normal ECG does not rule out acute myocardial infarction. Sometimes the earliest presentation of acute myocardial infarction is the hyperacute T wave, which is treated the same as ST segment elevation.[49] In practice this is rarely seen, because it only exists for 2-30 minutes after the onset of infarction.[50] Hyperacute T waves need to be distinguished from the peaked T waves associated with hyperkalemia.[51] The current guidelines for the ECG diagnosis of acute myocardial infarction require at least 1 mm (0.1 mV) of ST segment elevation in 2 or more anatomically contiguous leads.[48] This criterion is problematic, however, as acute myocardial infarction is not the most common cause of ST segment elevation in chest pain patients.[52] In addition, over 90% of healthy men have at least 1 mm (0.1 mV) of ST segment elevation in at least one precordial lead.[53] The clinician must therefore be well versed in recognizing the so-called ECG mimics of acute myocardial infarction, which include left ventricular hypertrophy, left bundle branch block, paced rhythm, benign early repolarization, pericarditis, hyperkalemia, and ventricular aneurysm.[54][55][53] Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... Percutaneous coronary intervention is an invasive cardiologic therapeutic procedure to treat narrowed coronary arteries (artery stenosis). ... Hyperkalemia is an elevated blood level (above 5. ... In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... Left ventricular hypertrophy (LVH) is the thickening of the myocardium (muscle) of the left ventricle of the heart. ... ECG characteristics of a typical LBBB showing wide QRS complexes with abnormal morphology in leads V1 and V6. ... A pacemaker, scale in centimeters A pacemaker (or artificial pacemaker, so as not to be confused with the hearts natural pacemaker) is a medical device which uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Hyperkalemia is an elevated blood level (above 5. ...


Left bundle branch block and pacing can interfere with the electrocardiographic diagnosis of acute myocadial infarction. The GUSTO investigators Sgarbossa et al. developed a set of criteria for identifying acute myocardial infarction in the presence of left bundle branch block and paced rhythm. They include concordant ST segment elevation > 1 mm (0.1 mV), discordant ST segment elevation > 5 mm (0.5 mV), and concordant ST segment depression in the left precordial leads.[56] The presence of reciprocal changes on the 12 lead ECG may help distinguish true acute myocardial infarction from the mimics of acute myocardial infarction. The contour of the ST segment may also be helpful, with a straight or upwardly convex (non-concave) ST segment favoring the diagnosis of acute myocardial infarction.[57] ECG characteristics of a typical LBBB showing wide QRS complexes with abnormal morphology in leads V1 and V6. ... A pacemaker, scale in centimeters A pacemaker (or artificial pacemaker, so as not to be confused with the hearts natural pacemaker) is a medical device which uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart. ...


The constellation of leads with ST segment elevation enables the clinician to identify what area of the heart is injured, which in turn helps predict the so-called culprit artery.

Wall Affected Leads Showing ST Segment Elevation Leads Showing Reciprocal ST Segment Depression Suspected Culprit Artery
Septal V1, V2 None Left Anterior Descending (LAD)
Anterior V3, V4 None Left Anterior Descending (LAD)
Anteroseptal V1, V2, V3, V4 None Left Anterior Descending (LAD)
Anterolateral V3, V4, V5, V6, I, aVL II, III, aVF Left Anterior Descending (LAD), Circumflex (LCX), or Obtuse Marginal
Extensive anterior (Sometimes called Anteroseptal with Lateral extension) V1,V2,V3, V4, V5, V6, I, aVL II, III, aVF Left main coronary artery (LCA)
Inferior II, III, aVF I, aVL Right Coronary Artery (RCA) or Circumflex (LCX)
Lateral I, aVL, V5, V6 II, III, aVF Circumflex (LCX) or Obtuse Marginal
Posterior (Usually associated with Inferior or Lateral but can be isolated) V7, V8, V9 V1,V2,V3, V4 Posterior Descending (PDA) (branch of the RCA or Circumflex (LCX))
Right ventricular (Usually associated with Inferior) II, III, aVF, V1, V4R I, aVL Right Coronary Artery (RCA)

As the myocardial infarction evolves, there may be loss of R wave height and development of pathological Q waves. T wave inversion may persist for months or even permanently following acute myocardial infarction.[58] Typically, however, the T wave recovers, leaving a pathological Q wave as the only remaining evidence that an acute myocardial infarction has occurred. The LAD, or left anterior descending artery (or anterior interventricular branch of the left coronary artery, or anterior descending branch) passes at first behind the pulmonary artery and then comes forward between that vessel and the left auricula to reach the anterior interventricular sulcus, along which it descends to the... The LAD, or left anterior descending artery (or anterior interventricular branch of the left coronary artery, or anterior descending branch) passes at first behind the pulmonary artery and then comes forward between that vessel and the left auricula to reach the anterior interventricular sulcus, along which it descends to the... The LAD, or left anterior descending artery (or anterior interventricular branch of the left coronary artery, or anterior descending branch) passes at first behind the pulmonary artery and then comes forward between that vessel and the left auricula to reach the anterior interventricular sulcus, along which it descends to the... The LAD, or left anterior descending artery (or anterior interventricular branch of the left coronary artery, or anterior descending branch) passes at first behind the pulmonary artery and then comes forward between that vessel and the left auricula to reach the anterior interventricular sulcus, along which it descends to the... The LCX, or left circumflex artery (or circumflex artery, or circumflex branch of the left coronary artery) follows the left part of the coronary sulcus, running first to the left and then to the right, reaching nearly as far as the posterior longitudinal sulcus. ... The left marginal artery (or obtuse marginal artery) is a branch of the circumflex artery, originating at the posterior interventricular sulcus, traveling along the left margin of heart towards the apex of the heart. ... The left coronary artery, also abbreviated LCA, arises from the aorta above the left cusp of the aortic valve. ... The diaphragmatic surface of the heart, directed downward and slightly backward, is formed by the ventricles, and rests upon the central tendon and a small part of the left muscular portion of the diaphragm. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... The LCX, or left circumflex artery (or circumflex artery, or circumflex branch of the left coronary artery) follows the left part of the coronary sulcus, running first to the left and then to the right, reaching nearly as far as the posterior longitudinal sulcus. ... The left marginal artery (or obtuse marginal artery) is a branch of the circumflex artery, originating at the posterior interventricular sulcus, traveling along the left margin of heart towards the apex of the heart. ... The Right coronary artery passes at first between the conus arteriosus and the right auricula and then runs in the right portion of the coronary sulcus, coursing at first from the left to right and then on the diaphragmatic surface of the heart from right to left as far as... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... The circumflex artery, also known as the circumflex branch, is an artery that comes off of the left coronary artery. ... The right ventricle is one of four chambers (two atria and two ventricles) in the human heart. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ...


Cardiac markers

Main article: Cardiac marker

Cardiac markers or cardiac enzymes are proteins from cardiac tissue found in the blood. These proteins are released into the bloodstream when damage to the heart occurs, as in the case of a myocardial infarction. Until the 1980s, the enzymes SGOT and LDH were used to assess cardiac injury. Then it was found that disproportional elevation of the MB subtype of the enzyme creatine kinase (CK) was very specific for myocardial injury. Current guidelines are generally in favor of troponin sub-units I or T, which are very specific for the heart muscle and are thought to rise before permanent injury develops.[59] Elevated troponins in the setting of chest pain may accurately predict a high likelihood of a myocardial infarction in the near future.[60] Medical tests that are often referred to as cardiac markers include: cardiac troponin (the most sensitive and specific test for myocardial damage) creatine kinase (CK, also known as phosphocreatine kinase or creatine phosphokinase) Aspartate transaminase (AST, also called Glutamic Oxaloacetic Transaminase (GOT/SGOT) or aspartate aminotransferase (ASAT)) lactate dehydrogenase (LDH... Aspartate transaminase (AST) also called Serum Glutamic Oxaloacetic Transaminase (SGOT) or aspartate aminotransferase (ASAT) (EC 2. ... Lactate dehydrogenase (LDH) is an enzyme (EC 1. ... Creatine Kinase Creatine kinase (CK), also known as phosphocreatine kinase or creatine phosphokinase (CPK) is an enzyme (EC 2. ... Troponin Troponin is a complex of three proteins that is integral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle. ...


The diagnosis of myocardial infarction requires two out of three components (history, ECG, and enzymes). When damage to the heart occurs, levels of cardiac markers rise over time, which is why blood tests for them are taken over a 24 hour period. Because these enzyme levels are not elevated immediately following a heart attack, patients presenting with chest pain are generally treated with the assumption that a myocardial infarction has occurred and then evaluated for a more precise diagnosis.[61] Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ...


Angiography

Angiogram of the coronary arteries.
Angiogram of the coronary arteries.

In difficult cases or in situations where intervention to restore blood flow is appropriate, coronary angiography can be performed. A catheter is inserted into an artery (usually the femoral artery) and pushed to the vessels supplying the heart. Obstructed or narrowed arteries can be identified, and angioplasty applied as a therapeutic measure (see below). Angioplasty requires extensive skill, especially in emergency settings, and may not always be available out of hours. It is commonly performed by interventional cardiologists. Angioplasty Owned by and taken of Bleiglass File links The following pages link to this file: Myocardial infarction Angioplasty Categories: GFDL images ... Angioplasty Owned by and taken of Bleiglass File links The following pages link to this file: Myocardial infarction Angioplasty Categories: GFDL images ... Patient about to undergo an angiogram, image courtesy of WHO. Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... Coronary angiogram A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ... Femoral artery and its major branches - right thigh, anterior view. ... This article does not cite any references or sources. ... Interventional cardiology is a branch of the medical specialty of cardiology that deals specifically with the mechanical treatment of heart diseases. ...


Histopathology

Microscopy image (magn. ca 100x, H&E stain) from autopsy specimen of myocardial infarct (7 days post-infarction).
Microscopy image (magn. ca 100x, H&E stain) from autopsy specimen of myocardial infarct (7 days post-infarction).

Histopathological examination of the heart may reveal infarction at autopsy. Under the microscope, myocardial infarction presents as a circumscribed area of ischemic, coagulative necrosis (cell death). On gross examination, the infarct is not identifiable within the first 12 hours.[62] Image File history File links Download high resolution version (800x607, 795 KB) Summary Microscopy image (magn. ... Image File history File links Download high resolution version (800x607, 795 KB) Summary Microscopy image (magn. ... H&E stained lung tissue sample from an end-stage emphysema patient. ... Anatomic pathology is a medical specialty (a branch of pathology) that is concerned with the diagnosis of disease based on the gross, microscopic, and molecular examination of cells and tissues. ... Necrosis (in Greek Νεκρός = Dead) is the name given to accidental death of cells and living tissue. ...


Although earlier changes can be discerned using electron microscopy, one of the earliest changes under a normal microscope are so-called wavy fibers.[63] Subsequently, the myocyte cytoplasm becomes more eosinophilic (pink) and the cells lose their transversal striations, with typical changes and eventually loss of the cell nucleus.[64] The interstitium at the margin of the infarcted area is initially infiltrated with neutrophils, then with lymphocytes and macrophages, who phagocytose ("eat") the myocyte debris. The necrotic area is surrounded and progressively invaded by granulation tissue, which will replace the infarct with a fibrous (collagenous) scar (which are typical steps in wound healing). The interstitial space (the space between cells outside of blood vessels) may be infiltrated with red blood cells.[62] The electron microscope is a microscope that can magnify very small details with high resolving power due to the use of electrons rather than light to scatter off material, magnifying at levels up to 500,000 times. ... Organelles. ... Eosinophilic is a technical term used by histologists. ... HeLa cells stained for DNA with the Blue Hoechst dye. ... Neutrophil granulocytes (commonly referred to as neutrophils) are a class of white blood cells and are part of the immune system. ... A scanning electron microscope (SEM) image of a single human lymphocyte. ... A macrophage of a mouse stretching its arms to engulf two particles, possibly pathogens Macrophages (Greek: big eaters, from makros large + phagein eat) are cells within the tissues that originate from specific white blood cells called monocytes. ... Steps of a macrophage ingesting a pathogen: a. ... Granulation tissue is the perfused, fibrous connective tissue that replaces a fibrin clot in healing wounds. ... Tropocollagen triple helix. ... This article does not cite any references or sources. ... Wound healing, or wound repair, is the bodys natural process of regenerating dermal and epidermal tissue. ... “Red cell” redirects here. ...


These features can be recognized in cases where the perfusion was not restored; reperfused infarcts can have other hallmarks, such as contraction band necrosis.[65]


First aid

As myocardial infarction is a common medical emergency, the signs are often part of first aid courses. The emergency action principles also apply in the case of myocardial infarction. First aid is a series of simple, life-saving medical techniques that a non-doctor or layman can be trained to perform. ... This article includes how-to sections and may need to be edited to encyclopedic style. ...


Immediate care

When symptoms of myocardial infarction occur, people wait an average of three hours, instead of doing what is recommended: calling for help immediately.[66][67] Acting immediately by calling the emergency services can prevent sustained damage to the heart ("time is muscle").[68] It has been suggested that this article or section be merged with Distress call. ...


Certain positions allow the patient to rest in a position which minimizes breathing difficulties. A half-sitting position with knees bent is often recommended. Access to more oxygen can be given by opening the window and widening the collar for easier breathing.


Aspirin can be given quickly (if the patient is not allergic to aspirin); but taking aspirin before calling the emergency medical services may be associated with unwanted delay.[69] Aspirin has an antiplatelet effect which inhibits formation of further thrombi (blood clots) that clog arteries. Non-enteric coated or soluble preparations are preferred. If chewed or dissolved, respectively, they can be absorbed by the body even quicker. If the patient cannot swallow, the aspirin can be used sublingually. U.S. guidelines recommend a dose of 162 – 325 mg.[70] Australian guidelines recommend a dose of 150 – 300 mg.[71] This article is about the drug. ... Allergy is an abnormal reaction to a substance foreign to the body that is acquired, predictable and rapid. ... The examples and perspective in this article or section may not represent a worldwide view. ... An antiplatelet drug is a member of a class of pharmaceuticals that decreases platelet aggregation and inhibits thrombus formation. ... For Trombe wall (used in solar homes), see Trombe wall. ... An enteric coating is a barrier applied to oral medication that controls the location in the digestive system where it is absorbed. ... In pharmacology (and more specifically pharmacokinetics), absorption is the movement of a drug into the bloodstream. ...


Glyceryl trinitrate (nitroglycerin) sublingually (under the tongue) can be given if it has been prescribed for the patient. Glyceryl trinitrate (GTN) has been used to treat angina and heart failure since at least 1880. ... Sublingual, literally under the tongue, from Latin, refers to a pharmacological route of administration in which certain drugs are entered directly into the bloodstream via absorption under the tongue. ...


If an Automated External Defibrillator (AED) is available the rescuer should immediately bring the AED to the patient's side and be prepared to follow its instructions should the victim lose consciousness.


If possible the rescuer should obtain basic information from the victim, in case the patient is unable to answer questions once emergency medical technicians arrive (if the patient becomes unconscious). The victim's name and any information regarding the nature of the victims pain will useful to health care providers. Also the exact time that these symptoms started, what the patient was doing at the onset of symptoms, and anything else that might give clues to the pathology of the chest pain. It is also very important to relay any actions that have been taken, such as the number or dose of aspirin or nitroglycerin given, to the EMS personnel. An emergency medical technician (EMT) is an emergency responder trained to provide emergency medical services (EMS) to the critically ill and injured. ...


Other general first aid principles include monitoring pulse, breathing, level of consciousness and, if possible, the blood pressure of the patient. In case of cardiac arrest, cardiopulmonary resuscitation (CPR) can be administered. CPR redirects here. ...


Automatic external defibrillation (AED)

Since the publication of data showing that the availability of automated external defibrillators (AEDs) in public places may significantly increase chances of survival, many of these have been installed in public buildings, public transport facilities, and in non-ambulance emergency vehicles (e.g. police cars and fire engines). AEDs analyze the heart's rhythm and determine whether the rhythm is amenable to defibrillation ("shockable"), as in ventricular tachycardia and ventricular fibrillation. An automated external defibrillator, open and ready for pads to be attached An Automated External Defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient,[1] and is able to treat them by application... Bangkok Skytrain. ... Ford Crown Victoria Police Interceptor of the United States Federal Protective Service. ... A fire engine of the Greater Manchester Fire and Rescue Service, England. ... Typical view of defibrillation in progress, with the operator at the head, but clear of contact with the patient Defibrillation is the definitive treatment for the life-threatening cardiac arrhythmias ventricular fibrillation and pulseless ventricular tachycardia. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ...


Emergency services

Emergency Medical Services (EMS) Systems vary considerably in their ability to evaluate and treat patients with suspected acute myocardial infarction. Some provide as little as first aid and early defibrillation. Others employ highly trained paramedics with sophisticated technology and advanced protocols.[72] Early access to EMS is promoted by a 9-1-1 system currently available to 90% of the population in the United States.[72] Most are capable of providing oxygen, IV access, sublingual nitroglycerine, morphine, and aspirin. Some are capable of providing thrombolytic therapy in the prehospital setting.[73][74] The examples and perspective in this article or section may not represent a worldwide view. ... The examples and perspective in this article or section may not represent a worldwide view. ... General Name, symbol, number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, period, block 16, 2, p Appearance colorless (gas) pale blue (liquid) Standard atomic weight 15. ... Nitroglycerin (also nitroglycerine, trinitroglycerin, or glyceryl trinitrate) is a chemical compound, a heavy, colorless, poisonous, oily, explosive liquid obtained by nitrating glycerol. ... This article is about the drug. ... This article is about the drug. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ...


With primary PCI emerging as the preferred therapy for ST segment elevation myocardial infarction, EMS can play a key role in reducing door to balloon intervals (the time from presentation to a hospital ER to the restoration of coronary artery blood flow) by performing a 12 lead ECG in the field and using this information to triage the patient to the most appropriate medical facility.[75][76][77][78] In addition, the 12 lead ECG can be transmitted to the receiving hospital, which enables time saving decisions to be made prior to the patient's arrival. This may include a "cardiac alert" or "STEMI alert" that calls in off duty personnel in areas where the cardiac cath lab is not staffed 24 hours a day.[79] Even in the absence of a formal alerting program, prehospital 12 lead ECGs are independently associated with reduced door to treatment intervals in the emergency department.[80] Percutaneous coronary intervention is an invasive cardiologic therapeutic procedure to treat narrowed coronary arteries (artery stenosis). ... The examples and perspective in this article or section may not represent a worldwide view. ... Door to balloon is a time measurement in emergency cardiac care (ECC), specifically in the treatment of ST segment elevation myocardial infarction. ... The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and... ECG may also refer to the East Coast Greenway Lead II An Electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ... Coronary angiogram A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. ...


Wilderness first aid

In wilderness first aid, a possible heart attack justifies evacuation by the fastest available means, including MEDEVAC, even in the earliest or precursor stages. The patient will rapidly be incapable of further exertion and have to be carried out. Wilderness first aid is the provision of first aid under conditions where the arrival of emergency responders or the patient evacuation may be delayed due to constraints of terrain, weather, and available persons or equipment. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... A [PC-12] of the Royal Flying Doctor Service of Australia. ...


Air travel

Certified personnel traveling by commercial aircraft may be able to assist an MI patient by using the on-board first aid kit, which may contain some cardiac drugs (such as glyceryl trinitrate spray, aspirin, or opioid painkillers) and oxygen. Pilots may divert the flight to land at a nearby airport. Cardiac monitors are being introduced by some airlines, and they can be used by both on-board and ground-based physicians.[81] First aid kit of the French Army A first aid kit is a collection of supplies and equipment for use in giving first aid, particularly in a medical emergency. ... Glyceryl trinitrate (GTN) is the pharmaceutical name for nitroglycerin. ... This article is about the drug. ... An opioid is a chemical substance that has a morphine-like action in the body. ... General Name, symbol, number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, period, block 16, 2, p Appearance colorless (gas) pale blue (liquid) Standard atomic weight 15. ... Lead II An electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ...


Treatment

A heart attack is a medical emergency which demands both immediate attention and activation of the emergency medical services. The ultimate goal of the management in the acute phase of the disease is to salvage as much myocardium as possible and prevent further complications. As time passes, the risk of damage to the heart muscle increases; hence the phrase that in myocardial infarction, "time is muscle," and time wasted is muscle lost.[68] {{Otheruses4|the medical term|the Australian television series|Medical Emergenc an immediate threat to a persons life or long term health. ... The examples and perspective in this article or section may not represent a worldwide view. ...


The treatments itself may have complications. If attempts to restore the blood flow are initiated after a critical period of only a few hours, the result is reperfusion injury instead of amelioration.[82] Other treatment modalities may also cause complications; the use of antithrombotics for example carries an increased risk of bleeding. Reperfusion injury refers to damage to tissue caused when blood supply returns to the tissue after a period of ischemia. ... For other uses, see Bleeding (disambiguation). ...


First line

Oxygen, aspirin, glyceryl trinitrate (nitroglycerin) and analgesia (usually morphine, hence the popular mnemonic MONA, morphine, oxygen, nitro, aspirin) are administered as soon as possible. In many areas, first responders can be trained to administer these prior to arrival at the hospital. Morphine is the preferred pain relief drug due to its ability to dilate blood vessels, which aids in blood flow to the heart as well as its pain relief properties. Oxygen first aid kit showing a demand valve and a constant flow mask Oxygen first aid or oxygen administration is a first aid treatment for many medical emergencies involving the organs of respiration and circulation such as heart attack, drowning, carbon monoxide poisoning, decompression illness, lung barotrauma and gas embolism. ... This article is about the drug. ... Glyceryl trinitrate (GTN) has been used to treat angina and heart failure since at least 1880. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ... This article is about the drug. ... For other uses, see Mnemonic (disambiguation). ...


Of the first line agents, only aspirin has been proven to decrease mortality.[83]


Once the diagnosis of myocardial infarction is confirmed, other pharmacologic agents are often given. These include beta blockers,[84][85] anticoagulation (typically with heparin),[70] and possibly additional antiplatelet agents such as clopidogrel.[70] These agents are typically not started until the patient is evaluated by an emergency room physician or under the direction of a cardiologist. These agents can be used regardless of the reperfusion strategy that is to be employed. While these agents can decrease mortality in the setting of an acute myocardial infarction, they can lead to complications and potentially death if used in the wrong setting. Beta blockers or beta-adrenergic blocking agents are a class of drugs used to treat a variety of cardiovascular conditions and some other diseases. ... Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ... A box of Plavix Clopidogrel is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. ...


Reperfusion

The concept of reperfusion has become so central to the modern treatment of acute myocardial infarction, that we are said to be in the reperfusion era.[86][87] Patients who present with suspected acute myocardial infarction and ST segment elevation (STEMI) or new bundle branch block on the 12 lead ECG are presumed to have an occlusive thrombosis in an epicardial coronary artery. They are therefore candidates for immediate reperfusion, either with thrombolytic therapy, percutaneous coronary intervention (PCI) or when these therapies are unsuccessful, bypass surgery. ECG may also refer to the East Coast Greenway Lead II An Electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... Percutaneous coronary intervention is an invasive cardiologic therapeutic procedure to treat narrowed coronary arteries (artery stenosis). ... Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ...


Individuals without ST segment elevation are presumed to be experiencing either unstable angina (UA) or non-ST segment elevation myocardial infarction (NSTEMI). They receive many of the same initial therapies and are often stabilized with antiplatelet drugs and anticoagulated. If their condition remains (hemodynamically) stable, they can be offered either late coronary angiography with subsequent restoration of blood flow (revascularization), or non-invasive stress testing to determine if there is significant ischemia that would benefit from revascularization. If hemodynamic instability develops in individuals with NSTEMIs, they may undergo urgent coronary angiography and subsequent revascularization. The use of thrombolytic agents is contraindicated in this patient subset, however.[88] An antiplatelet drug is a member of a class of pharmaceuticals that decreases platelet aggregation and inhibits thrombus formation. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... Hemodynamics is concerned with the forces generated by the heart and the motion of blood through the cardiovascular system. ... Coronary angiogram A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. ... Minimally invasive surgical procedures avoid open invasive surgery in favor of closed or local surgery with less trauma. ... A cardiac stress test is a medical test performed to evaluate relative arterial blood flow increases to the left ventricular heart muscle during exercise, as compared to resting blood flow rates (i. ...


The basis for this distinction in treatment regimens is that ST segment elevations on an ECG are typically due to complete occlusion of a coronary artery. On the other hand, in NSTEMIs there is typically a sudden narrowing of a coronary artery with preserved (but diminished) flow to the distal myocardium. Anticoagulation and antiplatelet agents are given to prevent the narrowed artery from occluding.


At least 10% of patients with STEMI don't develop myocardial necrosis (as evidenced by a rise in cardiac markers) and subsequent q waves on EKG after reperfusion therapy. Such a successful restoration of flow to the infarct-related artery during an acute myocardial infarction is known as "aborting" the myocardial infarction. If treated within the hour, about 25% of STEMIs can be aborted.[89]


Thrombolytic therapy

Main article: Thrombolysis

Thrombolytic therapy is indicated for the treatment of STEMI if the drug can be administered within 12 hours of the onset of symptoms, the patient is eligible based on exclusion criteria, and primary PCI is not immediately available.[70] The effectiveness of thrombolytic therapy is highest in the first 2 hours. After 12 hours, the risk associated with thrombolytic therapy outweighs any benefit.[88][90] Because irreversible injury occurs within 2–4 hours of the infarction, there is a limited window of time available for reperfusion to work. Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ...


Thrombolytic drugs are contraindicated for the treatment of unstable angina and NSTEMI[88][91] and for the treatment of individuals with evidence of cardiogenic shock.[92] Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively. ...


Although no perfect thrombolytic agent exists, an ideal thrombolytic drug would lead to rapid reperfusion, have a high sustained patency rate, be specific for recent thrombi, be easily and rapidly administered, create a low risk for intra-cerebral and systemic bleeding, have no antigenicity, adverse hemodynamic effects, or clinically significant drug interactions, and be cost effective.[93] Currently available thrombolytic agents include streptokinase, urokinase, and alteplase (recombinant tissue plasminogen activator, rtPA). More recently, thrombolytic agents similar in structure to rtPA such as reteplase and tenecteplase have been used. These newer agents boast efficacy at least as good as rtPA with significantly easier administration. The thrombolytic agent used in a particular individual is based on institution preference and the age of the patient. Streptokinase is an extracellular metallo-enzyme produced by beta-haemolytic streptococcus and is used as an effective and cheap clot-dissolving medication in some cases of myocardial infarction (heart attack) and pulmonary embolism. ... Urokinase, also called urokinase-type Plasminogen Activator (uPA) is an enzyme (EC 3. ... In blood coagulation, tissue plasminogen activator (tPA) is an enzyme (EC 3. ... In blood coagulation, tissue plasminogen activator (tPA) is an enzyme (EC 3. ... Reteplase (Retavase®) is a thrombolytic drug, used to treat heart attacks by breaking up the clots that cause them. ... Tenecteplase is an enzyme used as a thrombolytic drug. ...


Depending on the thrombolytic agent being used, adjuvant anticoagulation with heparin or low molecular weight heparin may be of benefit.[94][95] With tPA and related agents (reteplase and tenecteplase), heparin is needed to maintain coronary artery patency. Because of the anticoagulant effect of fibrinogen depletion with streptokinase[96] and urokinase[97][98][99] treatment, it is less necessary there.[94] In medicine, adjuvants are agents which modify the effect of other agents while having few if any direct effects when given by themselves. ... Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ... In medicine, low molecular weight heparin (LMWH) is a class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis. ...


Intracranial bleeding (ICB) and subsequent cerebrovascular accident (CVA) is a serious side effect of thrombolytic use. The risk of ICB is dependent on a number of factors, including a previous episode of intracranial bleed, age of the individual, and the thrombolytic regimen that is being used. In general, the risk of ICB due to thrombolytic use for the treatment of an acute myocardial infarction is between 0.5 and 1 percent.[94] A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion (an ischemic stroke- approximately 90% of strokes), by hemorrhage (a hemorrhagic stroke - less than 10% of strokes) or other causes. ...


Thrombolytic therapy to abort a myocardial infarction is not always effective. The degree of effectiveness of a thrombolytic agent is dependent on the time since the myocardial infarction began, with the best results occurring if the thrombolytic agent is used within two hours of the onset of symptoms.[100][74] If the individual presents more than 12 hours after symptoms commenced, the risk of intracranial bleed are considered higher than the benefits of the thrombolytic agent.[101] Failure rates of thrombolytics can be as high as 20% or higher.[102] In cases of failure of the thrombolytic agent to open the infarct-related coronary artery, the patient is then either treated conservatively with anticoagulants and allowed to "complete the infarction" or percutaneous coronary intervention (PCI, see below) is then performed. Percutaneous coronary intervention in this setting is known as "rescue PCI" or "salvage PCI". Complications, particularly bleeding, are significantly higher with rescue PCI than with primary PCI due to the action of the thrombolytic agent. Percutaneous coronary intervention is an invasive cardiologic therapeutic procedure to treat narrowed coronary arteries (artery stenosis). ...


Percutaneous coronary intervention

Thrombus material (in a cup, upper left corner) removed from a coronary artery during a percutaneous coronary intervention to abort a myocardial infarction. Five pieces of thrombus are shown (arrow heads).
Thrombus material (in a cup, upper left corner) removed from a coronary artery during a percutaneous coronary intervention to abort a myocardial infarction. Five pieces of thrombus are shown (arrow heads).

The benefit of prompt, expertly performed primary percutaneous coronary intervention over thrombolytic therapy for acute ST elevation myocardial infarction is now well established.[103][104][105] Logistic and economic obstacles seem to hinder a more widespread application of percutaneous coronary intervention (PCI) via cardiac catheterization,[106] although the feasibility of regionalized PCI for STEMI is currently being explored in the United States.[107] The use of percutaneous coronary intervention as a therapy to abort a myocardial infarction is known as primary PCI. The goal of primary PCI is to open the artery as soon as possible, and preferably within 90 minutes of the patient presenting to the emergency room. This time is referred to as the door-to-balloon time. Few hospitals can provide PCI within the 90 minute interval,[108] which prompted the American College of Cardiology (ACC) to launch a national Door to Balloon (D2B) Initiative in November of 2006. Over 800 hospitals have joined the D2B Alliance as of March 16, 2007.[109] Percutaneous coronary intervention is an invasive cardiologic therapeutic procedure to treat narrowed coronary arteries (artery stenosis). ... Image File history File links Download high-resolution version (1198x693, 897 KB) This page is a candidate to be copied to the Wikimedia Commons using the Transwiki process. ... Image File history File links Download high-resolution version (1198x693, 897 KB) This page is a candidate to be copied to the Wikimedia Commons using the Transwiki process. ... For Trombe wall (used in solar homes), see Trombe wall. ... Percutaneous coronary intervention is an invasive cardiologic therapeutic procedure to treat narrowed coronary arteries (artery stenosis). ... This article does not cite any references or sources. ... Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. ... Door to balloon is a time measurement in emergency cardiac care (ECC), specifically in the treatment of ST segment elevation myocardial infarction. ...


The current guidelines in the United States restrict primary PCI to hospitals with available emergency bypass surgery as a backup,[70] but this is not the case in other parts of the world.[110]


Primary PCI involves performing a coronary angiogram to determine the anatomical location of the infarcting vessel, followed by balloon angioplasty (and frequently deployment of an intracoronary stent) of the thrombosed arterial segment. In some settings, an extraction catheter may be used to attempt to aspirate (remove) the thrombus prior to balloon angioplasty. While the use of intracoronary stents do not improve the short term outcomes in primary PCI, the use of stents is widespread because of the decreased rates of procedures to treat restenosis compared to balloon angioplasty.[111] Patient about to undergo an angiogram, image courtesy of WHO. Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... This article does not cite any references or sources. ... Endoscopic image of self-expanding metallic stent in esophagus, which was used to palliatively treat esophageal cancer. ...


Adjuvant therapy during primary PCI include intravenous heparin, aspirin, and clopidogrel. The use of glycoprotein IIb/IIIa inhibitors are often used in the setting of primary PCI to reduce the risk of ischemic complications during the procedure.[112][113] Due to the number of antiplatelet agents and anticoagulants used during primary PCI, the risk of bleeding associated with the procedure are higher than during an elective PCI.[citation needed] Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ... This article is about the drug. ... A box of Plavix Clopidogrel is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. ... In medicine, a glycoprotein IIb/IIIa inhibitors, also GpIIb/IIIa inhibitors, is class of antiplatelet agents. ...


Coronary artery bypass surgery

Coronary artery bypass surgery during mobilization (freeing) of the right coronary artery from its surrounding tissue, adipose tissue (yellow). The tube visible at the bottom is the aortic cannula (returns blood from the HLM). The tube above it (obscured by the surgeon on the right) is the venous cannula (receives blood from the body). The patient's heart is stopped and the aorta is cross-clamped. The patient's head (not seen) is at the bottom.
Coronary artery bypass surgery during mobilization (freeing) of the right coronary artery from its surrounding tissue, adipose tissue (yellow). The tube visible at the bottom is the aortic cannula (returns blood from the HLM). The tube above it (obscured by the surgeon on the right) is the venous cannula (receives blood from the body). The patient's heart is stopped and the aorta is cross-clamped. The patient's head (not seen) is at the bottom.

Despite the guidelines, emergency bypass surgery for the treatment of an acute myocardial infarction (MI) is less common then PCI or medical management. In an analysis of patients in the U.S. National Registry of Myocardial Infarction (NRMI) from January 1995 to May 2004, the percentage of patients with cardiogenic shock treated with primary PCI rose from 27.4% to 54.4%, while the increase in CABG treatment was only from 2.1% to 3.2%.[114] Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ... Image File history File links Download high resolution version (6066x4067, 1748 KB) http://fmp. ... Image File history File links Download high resolution version (6066x4067, 1748 KB) http://fmp. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... Adipose tissue is one of the main types of connective tissue. ... A heart-lung machine (upper right) in a coronary artery bypass surgery. ... Cardiac Surgeon is a surgeon who performs operative procedure on the Heart and also on Great vessels of the body. ... The heart and lungs, from an older edition of Grays Anatomy. ... The aorta (generally pronounced [eɪˈɔːtə] or ay-orta) is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation. ... Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively. ...


Emergency coronary artery bypass graft surgery (CABG) is usually undertaken to simultaneously treat a mechanical complication, such as a ruptured papillary muscle, or a ventricular septal defect, with ensueing cardiogenic shock.[115] In uncomplicated MI, the mortality rate can be high when the surgery is performed immediately following the infarction.[116] If this option is entertained, the patient should be stabilized prior to surgery, with supportive interventions such as the use of an intra-aortic balloon pump.[117] In patients developing cardiogenic shock after a myocardial infarction, both PCI and CABG are satisfactory treatment options, with similar survival rates.[118][119] Crude death rate by country Mortality rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of that population, per unit time. ... The Intra-aortic balloon pump (IABP) is a mechanical device that is used to increase myocardial oxygen supply and decrease myocardial oxygen demand as well as increase cardiac output. ...


Coronary artery bypass surgery involves an artery or vein from the patient being implanted to bypass narrowings or occlusions on the coronary arteries. Several arteries and veins can be used, however internal mammary artery grafts have demonstrated significantly better long-term patency rates than great saphenous vein grafts.[120] In patients with two or more coronary arteries affected, bypass surgery is associated with higher long-term survival rates compared to percutaneous interventions.[121] In patients with single vessel disease, surgery is comparably safe and effective, and may be a treatment option in selected cases.[122] Bypass surgery has higher costs initially, but becomes cost-effective in the long term.[123] A surgical bypass graft is more invasive initially but bears less risk of recurrent procedures (but these may be again minimally invasive).[122] A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... In human anatomy, the internal thoracic artery (ITA) (previously known as the internal mammary artery) is a vessel that supplies the chest wall and mamma, a term used for breast in anatomy. ... Great saphenous vein and its tributaries. ... In biostatistics, survival rate is a part of the the survival analysis, indicating the percentage of people in a study or treatment group who are alive for a given period of time after diagnosis. ... Cost-effectiveness In economics, comparison of the relative expenditure (costs) and outcomes (effects) associated with two or more courses of action. ... The term invasive in Medicine has two meanings: A medical procedure which penetrates or breaks the skin or a body cavity, i. ... Minimally invasive surgical procedures avoid open invasive surgery in favor of closed or local surgery with less trauma. ...


Monitoring for arrhythmias

Additional objectives are to prevent life-threatening arrhythmias or conduction disturbances. This requires monitoring in a coronary care unit and protocolised administration of antiarrhythmic agents. Antiarrhythmic agents are typically only given to individuals with life-threatening arrhythmias after a myocardial infarction and not to suppress the ventricular ectopy that is often seen after a myocardial infarction.[124][125][126] A coronary care unit (CCU) is a hospital ward specialised in the care of patients with heart attacks, unstable angina and (in practice) various other cardiac conditions that require continuous monitoring and treatment. ... Antiarrhythmic agents are a group of pharmaceuticals that are used to suppress fast rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation. ... This article does not cite any references or sources. ...


Rehabilitation

Cardiac rehabilitation aims to optimize function and quality of life in those afflicted with a heart disease. This can be with the help of a physician, or in the form of a cardiac rehabilitation program.[127] The well-being or quality of life of a population is an important concern in economics and political science. ...


Physical exercise is an important part of rehabilitation after a myocardial infarction, with beneficial effects on cholesterol levels, blood pressure, weight, stress and mood.[127] Some patients become afraid of exercising because it might trigger another infarct.[128] Patients are stimulated to exercise, and should only avoid certain exerting activities such as shovelling. Local authorities may place limitations on driving motorised vehicles.[129] Some people are afraid to have sex after a heart attack. Most people can resume sexual activities after 3 to 4 weeks. The amount of activity needs to be dosed to the patients possibilities.[130] U.S. Marine emerging from the swim portion of a triathlon. ... Physical medicine and rehabilitation (PM&R) or physiatry is a branch of medicine dealing with functional restoration of a person affected by physical disability. ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... A mood is a relatively lasting emotional or affective state. ... For other uses, see Driving (disambiguation). ... A motor vehicle is a machine which incorporates a motor (sometimes known as an engine), and which is used for transportation on land. ... This article is about sexual practices (i. ...


Secondary prevention

The risk of a recurrent myocardial infarction decreases with strict blood pressure management and lifestyle changes, chiefly smoking cessation, regular exercise, a sensible diet for patients with heart disease, and limitation of alcohol intake. A No Smoking sign Smoking cessation (commonly known as quitting, or kicking the habit) is the effort to stop smoking tobacco products. ... U.S. Marine emerging from the swim portion of a triathlon. ... Diet may play an important role in causing or preventing heart disease. ... This article summarizes the recommended maximum intake (or safe limits) of alcohol as recommended by the health agencies of various governments. ...


Patients are usually commenced on several long-term medications post-MI, with the aim of preventing secondary cardiovascular events such as further myocardial infarctions, congestive heart failure or cerebrovascular accident (CVA). Unless contraindicated, such medications may include:[131][71] Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ... A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion (an ischemic stroke- approximately 90% of strokes), by hemorrhage (a hemorrhagic stroke - less than 10% of strokes) or other causes. ...

  • Antiplatelet drug therapy such as aspirin and/or clopidogrel should be continued to reduce the risk of plaque rupture and recurrent myocardial infarction. Aspirin is first-line, owing to its low cost and comparable efficacy, with clopidogrel reserved for patients intolerant of aspirin. The combination of clopidogrel and aspirin may further reduce risk of cardiovascular events, however the risk of hemorrhage is increased.[132]
  • Beta blocker therapy such as metoprolol or carvedilol should be commenced.[133] These have been particularly beneficial in high-risk patients such as those with left ventricular dysfunction and/or continuing cardiac ischaemia.[134] β-Blockers decrease mortality and morbidity. They also improve symptoms of cardiac ischemia in NSTEMI.
  • ACE inhibitor therapy should be commenced 24–48 hours post-MI in hemodynamically-stable patients, particularly in patients with a history of MI, diabetes mellitus, hypertension, anterior location of infarct (as assessed by ECG), and/or evidence of left ventricular dysfunction. ACE inhibitors reduce mortality, the development of heart failure, and decrease ventricular remodelling post-MI.[135]
  • Statin therapy has been shown to reduce mortality and morbidity post-MI.[136][137] The effects of statins may be more than their LDL lowering effects. The general consensus is that statins have plaque stabilization and multiple other ("pleiotropic") effects that may prevent myocardial infarction in addition to their effects on blood lipids.[138]
  • The aldosterone antagonist agent eplerenone has been shown to further reduce risk of cardiovascular death post-MI in patients with heart failure and left ventricular dysfunction, when used in conjunction with standard therapies above.[139]
  • Omega-3 fatty acids, commonly found in fish, have been shown to reduce mortality post-MI.[140] While the mechanism by which these fatty acids decrease mortality is unknown, it has been postulated that the survival benefit is due to electrical stabilization and the prevention of ventricular fibrillation.[141] However, further studies in a high-risk subset have not shown a clear-cut decrease in potentially fatal arrhythmias due to omega-3 fatty acids.[142][143]

An antiplatelet drug is a member of a class of pharmaceuticals that decreases platelet aggregation and inhibits thrombus formation. ... This article is about the drug. ... A box of Plavix Clopidogrel is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Beta blockers or beta-adrenergic blocking agents are a class of drugs used to treat a variety of cardiovascular conditions and some other diseases. ... “Minax” redirects here. ... Carvedilol is a non-selective beta blocker indicated in the treatment of mild to moderate congestive heart failure (CHF). ... In the heart, a ventricle is a chamber which collects blood from an atrium (another heart chamber) and pumps it out of the heart. ... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... Captopril, the first ACE inhibitor ACE inhibitors, or inhibitors of Angiotensin-Converting Enzyme, are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure, in most cases as the drugs of first choice. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... For other forms of hypertension, see Hypertension (disambiguation). ... In zootomy, several terms are used to describe the location of organs and other structures in the body of bilateral animals. ... Lovastatin, the first statin to be marketed The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic agents, used as pharmaceutical agents to lower cholesterol levels in people with or at risk for cardiovascular disease. ... In pathology, an atheroma (plural: atheromata) is an accumulation and swelling (-oma) in artery walls that is made up of cells, or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue. ... Aldosterone antagonist refers to drugs which antagonise the action of aldosterone at mineralocorticoid receptors. ... Eplerenone (INN) (IPA: ) is an aldosterone antagonist used as an adjunct in the management of chronic heart failure. ... Omega-3 fatty acids are a family of polyunsaturated fatty acids which have in common a carbon-carbon double bond in the ω-3 position. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ...

New therapies under investigation

Patients who receive stem cell treatment by coronary artery injections of stem cells derived from their own bone marrow after a myocardial infarction (MI) show improvements in left ventricular ejection fraction and end-diastolic volume not seen with placebo. The larger the initial infarct size, the greater the effect of the infusion. Clinical trials of progenitor cell infusion as a treatment approach to ST elevation MI are proceeding.[144] Medical researchers believe that stem cell treatments have the potential to change the face of human disease and alleviate suffering. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... Stem cell division and differentiation. ... This article does not cite any references or sources. ... In cardiovascular physiology, ejection fraction (Ef) is the fraction of blood pumped out of a ventricle with each heart beat. ... End-diastolic volume is the volume of blood in the ventricles just before systole. ... For other uses, see Placebo (disambiguation). ... In health care, including medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a process in which a medicine or other medical treatment is tested for its safety and effectiveness, often in comparison to existing treatments. ... The term progenitor cell is used in cell biology and developmental biology to refer to immature or undifferentiated cells, typically found in post-natal animals. ...


There are currently 3 biomaterial and tissue engineering approaches for the treatment of MI, but these are in an even earlier stage of medical research, so many questions and issues need to be addressed before they can be applied to patients. The first involves polymeric left ventricular restraints in the prevention of heart failure. The second utilizes in vitro engineered cardiac tissue, which is subsequently implanted in vivo. The final approach entails injecting cells and/or a scaffold into the myocardium to create in situ engineered cardiac tissue.[145] In surgery, a biomaterial is a synthetic or natural material used to replace part of a living system or to function in intimate contact with living tissue. ... Tissue engineering is the use of a combination of cells, engineering and materials methods, and suitable biochemical and physio-chemical factors to improve or replace biological functions. ... Medical research (or experimental medicine) is basic research and applied research conducted to aid the body of knowledge in the field of medicine. ... A polymer (from Greek: πολυ, polu, many; and μέρος, meros, part) is a substance composed of molecules with large molecular mass composed of repeating structural units, or monomers, connected by covalent chemical bonds. ... Wiktionary has a definition of: In vitro In vitro (Latin: within glass) means within a test tube, or, more generally, outside a living organism or cell. ... In vivo (Latin for (with)in the living). ... In situ is a Latin phrase meaning in the place. ...


Complications

Complications may occur immediately following the heart attack (in the acute phase), or may need time to develop (a chronic problem). After an infarction, an obvious complication is a second infarction, which may occur in the domain of another atherosclerotic coronary artery, or in the same zone if there are any live cells left in the infarct. In medicine, an acute disease is a disease with either or both of: a rapid onset; a short course (as opposed to a chronic course). ... In medicine, a chronic disease is a disease that is long-lasting or recurrent. ...


Congestive heart failure

A myocardial infarction may compromise the function of the heart as a pump for the circulation, a state called heart failure. There are different types of heart failure; left- or right-sided (or bilateral) heart failure may occur depending on the affected part of the heart, and it is a low-output type of failure. If one of the heart valves is affected, this may cause dysfunction, such as mitral regurgitation in the case of left-sided MI. The incidence of heart failure is particularly high in patients with diabetes and requires special management strategies.[146] Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ... For transport in plants, see Vascular tissue. ... Mitral regurgitation (MR), also known as mitral insufficiency, is the abnormal leaking of blood through the mitral valve, from the left ventricle into the left atrium of the heart. ...


Myocardial rupture

Main article: Myocardial rupture

Myocardial rupture is most common three to five days after myocardial infarction, commonly of small degree, but may occur one day to three weeks later. In the modern era of early revascularization and intensive pharmacotherapy as treatment for MI, the incidence of myocardial rupture is about 1% of all MIs.[147] This may occur in the free walls of the ventricles, the septum between them, the papillary muscles, or less commonly the atria. Rupture occurs because of increased pressure against the weakened walls of the heart chambers due to heart muscle that cannot pump blood out effectively. The weakness may also lead to ventricular aneurysm, a localized dilation or ballooning of the heart chamber. Myocardial rupture is a laceration or tearing of the walls of the ventricles or atria of the heart, of the interatrial or interventricular septum, of the papillary muscles or chordae tendineae or of one of the valves of the heart. ... Myocardial rupture is a laceration or tearing of the walls of the ventricles or atria of the heart, of the interatrial or interventricular septum, of the papillary muscles or chordae tendineae or of one of the valves of the heart. ... In anatomy, a ventricle is a part of the body filled with fluid. ... Look up septum in Wiktionary, the free dictionary. ... Papillary muscles: attached to chordae tendineae, their function is to open and close both the bicuspid and the tricuspid valves, which are located between the atrias and their respective ventricles. ... Atria may refer to: Atria is an alternative spelling for the Etruscan city that is now Adria in the Veneto region of Northern Italy. ... Post surgical photo of brain aneurysm survivor. ...


Risk factors for myocardial rupture include completion of infarction (no revascularization performed), female sex, advanced age, and a lack of a previous history of myocardial infarction.[147] In addition, the risk of rupture is higher in individuals who are revascularized with a thrombolytic agent than with PCI.[148][149] The shear stress between the infarcted segment and the surrounding normal myocardium (which may be hypercontractile in the post-infarction period) makes it a nidus for rupture.[150]


Rupture is usually a catastrophic event that may result a life-threatening process known as cardiac tamponade, in which blood accumulates within the pericardium or heart sac, and compresses the heart to the point where it cannot pump effectively. Rupture of the intraventricular septum (the muscle separating the left and right ventricles) causes a ventricular septal defect with shunting of blood through the defect from the left side of the heart to the right side of the heart. Rupture of the papillary muscle may also lead to acute mitral regurgitation and subsequent pulmonary edema and possibly even cardiogenic shock. Cardiac tamponade, also known as pericardial tamponade, is a medical emergency condition where liquid accumulates in the pericardium in a relatively short time. ... The pericardium is a double-walled sac that contains the heart and the roots of the great vessels. ... A ventricular septal defect (or VSD) is a defect in the ventricular septum (the wall dividing the left and right ventricles of the heart). ... In medicine, a shunt is a device designed to drain excess cerebrospinal fluid from the brain and carry it to other parts of the body. ... Mitral regurgitation (MR), also known as mitral insufficiency, is the abnormal leaking of blood through the mitral valve, from the left ventricle into the left atrium of the heart. ... Pulmonary edema is swelling and/or fluid accumulation in the lungs. ... Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively. ...


Life-threatening arrhythmia

A 12 lead electrocardiogram showing ventricular tachycardia.
A 12 lead electrocardiogram showing ventricular tachycardia.

Since the electrical characteristics of the infarcted tissue change (see pathophysiology section), arrhythmias are a frequent complication.[citation needed] The re-entry phenomenon may cause too fast heart rates (ventricular tachycardia and even ventricular fibrillation),[citation needed] and ischemia in the electrical conduction system of the heart may cause a complete heart block (when the impulse from the sinoatrial node, the normal cardiac pacemaker, doesn't reach the heart chambers any more).[citation needed] Image File history File links Download high-resolution version (1088x570, 474 KB) 12 lead electrocardiogram of ventricular tachycardia. ... Image File history File links Download high-resolution version (1088x570, 474 KB) 12 lead electrocardiogram of ventricular tachycardia. ... “QRS” redirects here. ... Heart attack redirects here. ... A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to (and stimulate) the myocardium (Cardiac muscle). ... Third degree heart block, also known as complete heart block or third degree AV block, is a defect of the electrical system of the heart, in which the impulse generated in the atria (typically the SA node on top of the right atrium) does not propagate to the ventricles. ... The sinoAtrial node (abbreviated SA node or SAN, also called the sinus node) is the impulse generating (pacemaker) tissue located in the right atrium of the heart, and thus the generator of sinus rhythm. ...


Pericarditis

Main article: Pericarditis

As a reaction to the damage of the heart muscle, inflammatory cells are attracted. The inflammation may reach out and affect the heart sac. This is called pericarditis. In Dressler's syndrome, this occurs several weeks after the initial event. Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Dresslers syndrome is a form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). ...


Cardiogenic shock

A complication that may occur in the acute setting soon after a myocardial infarction or in the weeks following it is cardiogenic shock. Cardiogenic shock is defined as a hemodynamic state in which the heart cannot produce enough of a cardiac output to supply an adequate amount of oxygenated blood to the tissues of the body. Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively. ... Cardiac output (CO) is the volume of blood being pumped by the heart, in particular by a ventricle in a minute. ...


While the data on performing interventions on individuals with cardiogenic shock is sparse, trial data suggests a long-term mortality benefit in undergoing revascularization if the individual is less than 75 years old and if the onset of the acute myocardial infarction is less than 36 hours and the onset of cardiogenic shock is less than 18 hours.[92] If the patient with cardiogenic shock is not going to be revascularized, aggressive hemodynamic support is warranted, with insertion of an intra-aortic balloon pump if not contraindicated.[92] If diagnostic coronary angiography does not reveal a culprit blockage that is the cause of the cardiogenic shock, the prognosis is poor.[92] The Intra-aortic balloon pump (IABP) is a mechanical device that is used to increase myocardial oxygen supply and decrease myocardial oxygen demand as well as increase cardiac output. ...


Prognosis

The prognosis for patients with myocardial infarction varies greatly, depending on the patient, the condition itself and the given treatment. Using simple variables which are immediately available in the emergency room, patients with a higher risk of adverse outcome can be identified. For example, one study found that 0.4% of patients with a low risk profile had died after 90 days, whereas the mortality rate in high risk patients was 21.1%.[151] In computer science and mathematics, a variable (IPA pronunciation: ) (sometimes called a pronumeral) is a symbolic representation denoting a quantity or expression. ... The emergency room is the American English term for a room, or group of rooms, within a hospital that is designed for the treatment of urgent and medical emergencies. ... Crude death rate by country Mortality rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of that population, per unit time. ...


Although studies differ in the identified variables, some of the more reproduced risk stratifiers 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 concentration, peripheral vascular disease and elevation of cardiac markers.[151][152][153] This article is in need of attention from an expert on the subject. ... Hemodynamics is concerned with the forces generated by the heart and the motion of blood through the cardiovascular system. ... Ventricular systole The parts of a QRS complex. ... A sphygmomanometer, a device used for measuring arterial pressure. ... The Killip classification is a classification system used in individuals with an acute myocardial infarction (heart attack), in order to risk stratify them. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Blood plasma is the liquid component of blood, in which the blood cells are suspended. ... Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass). ... In medicine, peripheral artery occlusive disease (PAOD, also known as peripheral vascular disease (PVD) and peripheral artery disease (PAD) is a collator for all diseases caused by the obstruction of large peripheral arteries, which can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism or thrombus formation. ...


Assesment of left ventricular ejection fraction may increase the predictive power of some risk stratification models.[154] The prognostic importance of Q-waves is debated.[155] Prognosis is significantly worsened if a mechanical complication (papillary muscle rupture, myocardial free wall rupture, and so on) were to occur.[148] In the heart, a ventricle is a chamber which collects blood from an atrium (another heart chamber) and pumps it out of the heart. ... In cardiovascular physiology, ejection fraction (Ef) is the fraction of blood pumped out of a ventricle with each heart beat. ... In anatomy, the papillary muscles of the heart serve to limit the movements of the mitral and tricuspid valves. ...


There is evidence that case fatality of myocardial infarction has been improving over the years in all ethnicities.[156]


Legal implications

At common law, a myocardial infarction is generally a disease, but may sometimes be an injury. This has implications for no-fault insurance schemes such as workers' compensation. A heart attack is generally not covered;[157] however, it may be a work-related injury if it results, for example, from unusual emotional stress or unusual exertion.[158] Additionally, 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 who has suffered from a myocardial infarction may be prevented from participating in activity that puts other people's lives at risk, for example driving a car, taxi or airplane.[129] This article concerns the common-law legal system, as contrasted with the civil law legal system; for other meanings of the term, within the field of law, see common law (disambiguation). ... This article is about the medical term. ... Injury is damage or harm caused to the structure or function of the body caused by an outside agent or force, which may be physical or chemical. ... Workers compensation (colloquially known as workers comp in North American English or compo in Australian English) provides insurance to cover medical care and compensation for employees who are injured in the course of employment, in exchange for mandatory relinquishment of the employees right to sue their employer for the... An industrial injury is any disease or bodily damage resulting from working. ... Police officers in South Australia A police officer (or policeman/policewoman) is a warranted worker of a police force. ...


See also

An acute coronary syndrome (ACS) is a set of signs and symptoms suggestive of sudden cardiac ischemia, usually caused by disruption of atherosclerotic plaque in an epicardial coronary artery. ... angina tonsillaris see tonsillitis. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... In cardiology hibernating myocardium is a state when some segments of the myocardium exhibit abnormalities of contractile function. ... In cardiology stunned myocardium is a state when some section of the myocardium (corresponding to area of a major coronary occlusion) shows a form of contractile abnormality. ... This article needs to be wikified. ...

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  • 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 of resources from MedlinePlus.
  • Heart Attack Warning Signals from the Heart and Stroke Foundation of Canada
  • Regional PCI for STEMI Resource Center - Evidence based online resource center for the development of regional PCI networks for acute STEMI
  • STEMI Systems - Articles, profiles, and reviews of the latest publications involved in STEMI care. Quarterly newsletter.
  • American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.
  • American Heart Association's Heart Attack web site - Information and resources for preventing, recognizing and treating heart attack.

  Results from FactBites:
 
Myocardial Infarction (11222 words)
The traditional concept that myocardial infarctions can be classified as transmural or nontransmural on the basis of the presence or absence of Q waves is misleading, since autopsy studies have demonstrated convincingly that pathologic Q waves may be associated with nontransmural infarction and may be absent with transmural infarction.
Reference:Montalescot,G. and others,Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction,N.Engl.J.Med.,Vol.344,No.25.June 21,2001,PP.1895-903.
Myocardial necrosis (i.e.MI) is said to be present if the maximal concentration of cTnT or cTnI exceeds the decision limit (99 percent of the values for a reference control group) on at least one occasion during the 24 hours after the index clinical event.
Acute Myocardial Infarction (5049 words)
Myocardial infarction occurs when myocardial ischemia exceeds a critical threshold and overwhelms myocardial cellular repair mechanisms that are designed to maintain normal operating function and hemostasis.
Myocardial infarction is the leading cause of death in the United States (US) as well as in most industrialized nations throughout the world.
As the duration of the occlusion increases, the area of myocardial cell death enlarges, extending from the endocardium to the myocardium and ultimately to the epicardium.
  More results at FactBites »

 
 

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