Cardiovascular Medicine Book

Circulatory Disorders

Electrocardiogram

Myocardial Infarction

Symptoms

Endocrinology Chapter related topics

Gynecology Chapter related topics

Pathology and Laboratory Medicine Chapter related topics

Pediatrics Chapter related topics

Pharmacology Chapter related topics

Prevention Chapter related topics

Procedure Chapter related topics

Radiology Chapter related topics

Surgery Chapter related topics

http://www.fpnotebook.com/

Acute Coronary Syndrome Immediate ManagementAka: Myocardial Infarction Assessment, Ischemic Chest Pain Management, Immediate Myocardial Infarction Management, Immediate MI Management

Advertisement

  1. History: Targeted Brief
    1. Duration of pain
    2. Prior Myocardial Infarction
    3. Cardiac Risk Factors
    4. Thrombolytic Contraindications
  2. Exam: Targeted Brief
    1. Signs of right or left sided Heart Failure
    2. New murmur or pericardial rub
    3. Assess tissue perfusion, systemic Blood Pressure
    4. Asymmetry of peripheral pulses
  3. Diagnosis
    1. EKG in Acute MI within 5 minutes
    2. Consider Echocardiogram in Acute MI if no delay
    3. Portable Chest XRay within 30 minutes
    4. Labs
      1. Electrolytes
      2. ProTime
      3. Partial Thromboplastin Time (PTT)
    5. Serum Cardiac Markers
      1. Troponin I
  4. Immediate Assessment
    1. ABC Management
    2. Mnemonic: IV-O2-Monitor
      1. Vitals with Oxygen Saturation
      2. Start Intravenous Access
      3. Cardiopulmonary monitor
    3. Consider Differential Diagnosis
      1. See Chest Pain
  5. Management: Immediate
    1. Mnemonic: "MONA" greets all patients
      1. Morphine Sulfate IV 2-5 mg every 5-30 min prn
        1. Pain not relieved with 3 Sublingual Nitroglycerins
      2. Oxygen by Nasal cannula at 4 liters per minute
      3. Nitroglycerin
        1. Sublingual Nitroglycerin 0.4 mg
        2. Nitroglycerin paste (start with 1/2 inch)
        3. Low threshold to switch to Nitroglycerin Drip
      4. Non-enteric coated Aspirin 325 mg PO
        1. Dipyridamole (Persantine) for Aspirin sensitivity
    2. Cardiology Consultation
  6. Management: Evaluate 12 lead Electrocardiogram (EKG)
    1. High Risk Indications: Myocardial Infarction Protocol
      1. ST Elevation MI (Q-Wave MI)
      2. New (or presumed new) Left Bundle Branch Block
    2. Moderate Risk Indications: Myocardial Ischemia Protocol
      1. Non-ST elevation MI (Non-Q-Wave MI)
      2. ST depression or dynamic T Wave inversion
      3. High Unstable Angina Risk
    3. Low Risk: Non-diagnostic Electrocardiogram Protocol
      1. Absent ST segment or T Wave changes on EKG
      2. Low Unstable Angina Risk
  7. References
    1. (2000) Circulation 102(suppl I):I

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)



Navigation Tree