Cardiovascular Medicine Book

Circulatory Disorders

Electrocardiogram

Myocardial Infarction

Symptoms

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Acute Coronary SyndromeAka: Myocardial Infarction, Coronary Artery Disease, Atherosclerotic Heart Disease

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  1. See Also
    1. Immediate Myocardial Infarction Management
    2. Myocardial Infarction
  2. Tags
    1. C0010054
    2. C0151744
    3. C0027051
    4. C0948089
  3. Risk Factors
    1. See Cardiac Risk Factors
  4. Epidemiology
    1. Prevalence of CAD in U.S.: 64 million (2001)
    2. Incidence of acute MI in U.S.: 1.2 million yearly
    3. No prior coronary symptoms in >50% with fatal acute MI
    4. Coronary deaths account for 20% of all deaths in U.S.
  5. Pathophysiology: Atherosclerotic Plaque
    1. Form over 10-15 years in response to vascular injury
      1. Significant Plaque present in 75% of age >25 years
    2. Lipid core (atheroma)
      1. Injured endothelium attracts Macrophages
      2. Macrophages resorb LDL Cholesterol fatty streaks
      3. Lipids transform Macrophages into foam cells
    3. Surrounding wall (fibroatheroma)
      1. Surrounds lipid core
      2. Composed of fibroblasts and smooth muscle cells
    4. Acute MI or Acute Coronary Syndrome
      1. Occurs on Plaque rupture; results in vessel occlusion
  6. Symptoms
    1. See Angina Diagnosis
      1. Reviews the likelihood that Chest Pain due to heart
    2. Asymptomatic in 25% of Myocardial Infarctions
    3. MI Chest Pain similar to Angina
      1. Deep, poorly localize chest ache
        1. Worse with activity
        2. Better with rest and Nitroglycerin
      2. Radiation
        1. Arm, shoulder, hand or upper back
        2. Neck, jaw or throat
    4. Distinguishing features of MI Chest Pain
      1. More intense than Angina
      2. More persistent than Angina (>30 minutes)
      3. Not fully relieved by palliative measures
        1. Rest
        2. Nitroglycerin (3 consecutive doses)
      4. Accompanied by systemic symptoms
        1. Nausea
        2. Sweating
        3. Apprehension
  7. Signs
    1. Pallor
    2. Diaphoresis
    3. Tachycardia
    4. S4 Gallup Rhythm
    5. Signs of Congestive Heart Failure may also be present
      1. Rales on lung examination
      2. S3 Gallup Rhythm
    6. Jugular Venous Distention
      1. Seen in Right Ventricular Infarction
  8. Differential Diagnosis
    1. See Chest Pain
    2. Pericarditis
    3. Aortic Dissection
    4. Cholecystitis
    5. Cholelithiasis
  9. Diagnosis
    1. Serum Cardiac Markers
    2. Electrocardiogram in Myocardial Infarction
    3. Echocardiogram in Myocardial Infarction
  10. Management
    1. See Immediate Myocardial Infarction Management
    2. Myocardial Infarction Stabilization
    3. Cardiac Rehabilitation
  11. Complications
    1. Arrhythmia
      1. Ventricular Fibrillation
      2. Accelerated Idioventricular Rhythm
      3. Bradyarrhythmia
      4. Atrioventricular Block
    2. Congestive Heart Failure
    3. Cardiogenic Shock
    4. Acute Mechanical Complications
      1. Ventricular Septal Rupture
      2. Acute Mitral Regurgitation
    5. Pericarditis
    6. Ventricular aneurysm
    7. Recurrent Angina
    8. Dressler's Syndrome

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