Myocardial infarction
A myocardial infarction, or "heart attack", is defined as "gross necrosis of the myocardium, as a result of interruption of the blood supply to the area".[1] The coronary arteries are the blood vessels that supply the heart muscle.
Pathophysiology
Most myocardial infarctions are due to atherosclerosis.
Stunned myocardium
The area of damage in the heart that results from decreased blood supply is usually larger than the infarct.[2] In other words, when the blood supply becomes inadequate (Ischemia) and the hard-working cardiac muscle cells are deprived of oxygen and nutrients, at least some of the affected muscle cells may be impaired by this loss rather than killed. By definition, if an infarct has occurred, at least some of these muscle cell have died- but many others may have become swollen or injured and yet, with restoration of the blood supply, are able to eventually recover.
Classification
Non-ST segment elevation myocardial infarction (NSTEMI)
ST segment elevation myocardial infarction (STEMI)
Treatment
NSTEMI
Clinical practice guidelines address the treatment of NSTEMI.[3] Primary angioplasty is "indicated for patients with UA/NSTEMI who have no serious comorbidity and who have coronary lesions amenable to PCI and any of the high-risk features."[3]
STEMI
Primary angioplasty is better than thrombolysis if the angioplasty can be performed with less than a 90 minute delay.[4]
Complications
Dysrhythmia
Pump Failure
References
- ↑ National Library of Medicine. Myocardial infarction. Retrieved on 2007-10-28.
- ↑ Solomon SD, Glynn RJ, Greaves S, et al (2001). "Recovery of ventricular function after myocardial infarction in the reperfusion era: the healing and early afterload reducing therapy study". Ann. Intern. Med. 134 (6): 451–8. PMID 11255520. [e]
- ↑ 3.0 3.1 Anderson JL, Adams CD, Antman EM, et al (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". J. Am. Coll. Cardiol. 50 (7): e1–e157. DOI:10.1016/j.jacc.2007.02.013. PMID 17692738. Research Blogging.
- ↑ Asseburg C, Vergel YB, Palmer S, et al (2007). "Assessing the effectiveness of primary angioplasty compared with thrombolysis and its relationship to time delay: a Bayesian evidence synthesis". Heart 93 (10): 1244–50. DOI:10.1136/hrt.2006.093336. PMID 17277350. Research Blogging.