Cardiovascular Medicine Book

Circulatory Disorders

Electrocardiogram

Myocardial Infarction

Symptoms

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

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  1. See Also
    1. Immediate Myocardial Infarction Management
    2. Myocardial Infarction
  2. Risk Factors
    1. See Cardiac Risk Factors
  3. 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.
  4. 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
  5. 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
  6. 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
  7. Differential Diagnosis
    1. See Chest Pain
    2. Pericarditis
    3. Aortic Dissection
    4. Cholecystitis
    5. Cholelithiasis
  8. Diagnosis
    1. Serum Cardiac Markers
    2. Electrocardiogram in Myocardial Infarction
    3. Echocardiogram in Myocardial Infarction
  9. Management
    1. See Immediate Myocardial Infarction Management
    2. Myocardial Infarction Stabilization
    3. Cardiac Rehabilitation
  10. 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

Coronary Arteriosclerosis (C0010054)

Definition (MSH)Thickening and loss of elasticity of the CORONARY ARTERIES, leading to progressive arterial insufficiency (CORONARY DISEASE).
ConceptsDisease or Syndrome (T047)
ICD9414.0, 414.0
MSHD003324
EnglishARTERIOSCLEROSIS CORONARY ARTERY, Arteriosclerotic heart disease, ASHD, ASHD - Atherosclerotic heart disease, ATHEROSCLEROTIC CORONARY VASCULAR DISEASE, Atherosclerotic heart disease, Coronary Arterioscleroses, Coronary Arteriosclerosis, Coronary artery arteriosclerosis, Coronary artery sclerosis, Coronary Atheroscleroses, Coronary Atherosclerosis, Coronary sclerosis
Spanisharteriosclerosis coronaria, ateroesclerosis coronaria, enfermedad ateroesclerotica cardiaca, enfermedad aterosclerotica cardiaca, esclerosis coronaria
Parent ConceptsCoronary atherosclerosis and other heart disease (C0810003), Cardiovascular Diseases (C0007222), [X]Other forms of chronic ischemic heart disease (C0155669), Atherosclerosis (C0004153), Arteriosclerosis (C0003850), Coronary heart disease (C0010068), Structural disorder of heart (C1290384), Coronary Artery Disease (C1956346), Ambiguous concept (C1274012)
SourcesCCS, COSTAR, CST, DXP, ICD9CM, LNC, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Myocardial Infarction (C0027051)

Definition (MSH)NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION).
Definition (CSP)gross necrosis of the myocardium, as a result of interruption of the blood supply to the area.
Definition (NCI)Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis.
Definition (NCI)Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis.
ConceptsDisease or Syndrome (T047)
ICD9410.9
MSHD009203
EnglishAMI, Attack - heart, ATTACK CORONARY, Cardiac infarction, HEART ATTACK, HEART INFARCTION, INFARCT MYOCARDIAL, Infarction of heart, MI, MI - Myocardial infarction, Myocardial Infarct, Myocardial Infarction, Myocardial Infarctions, Myocardial Infarcts
Spanishataque al corazon, infarto cardiaco, infarto de corazon, infarto de miocardio
Parent ConceptsHeart (C0018787), Cardio-vascular Findings: Heart (C0150873), Myocardial Ischemia (C0151744), Coronary Arteriosclerosis (C0010054), Cardiomyopathies (C0878544), Injury of anatomical site (C1264235), Structural disorder of heart (C1290384), Ambiguous concept (C1274012)
SourcesAIR, AOD, COSTAR, CSP, CST, DXP, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Myocardial Ischemia (C0151744)

Definition (MSH)A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (CORONARY ARTERY DISEASE), to obstruction by a thrombus (CORONARY THROMBOSIS), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (MYOCARDIAL INFARCTION).
Definition (NCI)A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries, to obstruction by a thrombus, or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction).
Definition (CSP)blood deficiency in the myocardium caused by a constriction or obstruction of its blood vessels; frequently occurs in conjunction with hypoxia, which is reduction in oxygen supply.
ConceptsDisease or Syndrome (T047)
ICD9410-414.99, 414.8, 414.9
MSHD017202
EnglishCardiac ischaemia, Cardiac ischemia, HEART DIS ISCHEMIC, IHD, IHD - Ischaemic heart disease, IHD - Ischemic heart disease, Ischaemic heart disease, ISCHEMIA MYOCARDIAL, ISCHEMIC HEART DIS, Ischemic heart disease, Ischemic Heart Diseases, MYOCARDIAL ISCHAEMIA, myocardial ischemia, myocardial ischemia/hypoxia, Myocardial Ischemias
Spanishcardiopatia isquemica, enfermedad cardiaca isquemica, enfermedad isquemica del corazon, isquemia miocardica
Parent Conceptsvascular ischemia (C0679395), Heart Diseases (C0018799), Ischemia (C0022116), Coronary Arteriosclerosis (C0010054), Arterial and Arteriolar Disorders (C0549520), Circulatory system disease NOS (C0728936), Vascular Diseases (C0042373), Non-Neoplastic Heart Disorder (C1335015), Myocardial Ischemia (C0151744), Cardiomyopathies (C0878544), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CSP, CST, DXP, ICD9CM, LNC, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Acute Coronary Syndrome (C0948089)

Definition (MSH)An episode of MYOCARDIAL ISCHEMIA that generally lasts longer than a transient anginal episode but that does not usually result in MYOCARDIAL INFARCTION.
ConceptsDisease or Syndrome (T047)
MSHD054058
EnglishACS - Acute coronary syndrome, Acute Coronary Syndrome, Acute Coronary Syndromes
Spanishsindrome coronario agudo
Parent ConceptsMyocardial Ischemia (C0151744), Syndrome (C0039082), Cardiomyopathies (C0878544), Acute ischemic heart disease (C1510446), Duplicate concept (C1274013)
SourcesMSH, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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