Cardiovascular Medicine Book

http://www.fpnotebook.com/

Myocardial Infarction Stabilization

Aka: Myocardial Infarction Stabilization
  1. Course: Hospital
    1. Cardiac Intensive Care Unit Admission
      1. Move from Emergency Department within 1-2 hours
      2. Observe on Critical Care Unit for 24 hours
    2. Heparin for 48-72 hours
      1. Coumadin if indicated
    3. Telemetry (Step Down Unit)
      1. Observe rhythm with activity for 2-4 days
    4. Cardiac Rehabilitation
      1. Education on day 1
      2. Ambulatory on day 2
    5. Evaluation prior to discharge
      1. Echocardiogram prior to discharge
      2. Consider sub-maximal stress test prior to discharge
      3. See Post Myocardial Infarction Evaluation
    6. Discharge
      1. Day 4-5 in Uncomplicated Myocardial Infarction
  2. Discharge Planning
    1. See Activity after Myocardial Infarction
    2. See Post Myocardial Infarction Evaluation
    3. See Post Myocardial Infarction Medications
  3. Complications
    1. Pericarditis (common)
  4. Prognosis: Serum markers for worse prognosis
    1. C-Reactive Protein (CRP) increased
    2. White Blood Cell count increased (Leukocytosis)
      1. Sabatine (2002) J Am Coll Cardiol 40:1761-8
  5. Prognosis: Risk of subsequent infarction or death
    1. Age over 70 years
    2. Left Ventricular Ejection Fraction under 40%
    3. Congestive Heart Failure
    4. Residual ischemia
      1. Post-infarct Angina
      2. Exercise-induced ischemia by EKG or Imaging
    5. Ventricular ectopy (>10 PVCs per minute)
    6. Non Q-wave infarction
    7. Diabetes Mellitus
    8. Anterior Myocardial Infarction
    9. Hypertension
    10. Major Depression increases mortality within 4 months
      1. Beck Depression Inventory Score <4: 2.6% mortality
      2. Beck Depression Inventory Score 4-9: 17.1% mortality
      3. Beck Depression Inventory Score >10: 23.3% mortality
      4. Bush (2001) Am J Cardiol 88:337-41

Myocardial Infarction (C0027051)

Definition (NCI) A disorder characterized by gross necrosis of the myocardium; this is due to an interruption of 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 (MEDLINEPLUS)

Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don't get help immediately. It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include

  • Chest discomfort - pressure, squeezing, or pain
  • Shortness of breath
  • Discomfort in the upper body - arms, shoulder, neck, back
  • Nausea, vomiting, dizziness, lightheadedness, sweating

These symptoms can sometimes be different in women.

What exactly is a heart attack? Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat – called an arrhythmia - that causes a severe decrease in the pumping function of the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die.

NIH: National Heart, Lung, and Blood Institute

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 (MSH) NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION).
Concepts Disease or Syndrome (T047)
MSH D009203
ICD10 I22, I21
SnomedCT 233824008, 22298006, 155304006, 266288001, 66514008, 194796000
English Myocardial Infarct, Infarctions, Myocardial, Myocardial Infarction, Myocardial Infarctions, Infarcts, Myocardial, Myocardial Infarcts, HEART ATTACK, HEART INFARCTION, INFARCT MYOCARDIAL, Infarct, Myocardial, Infarction, Myocardial, MYOCARDIAL INFARCT, MYOCARDIAL INFARCTION, Cardiac infarction, NOS, Heart attack, NOS, Infarction of heart, NOS, Myocardial infarction, NOS, MI, ATTACK CORONARY, ATTACK HEART (NOS), Myocardial infarction syndrome, Myocardial infarction (MI), mi, Attack heart (NOS), Infarct myocardial, Heart Attack, INFARCTION (MI), MYOCARDIAL, MYOCARDIAL INFARCTION, (MI), MI, MYOCARDIAL INFARCTION, cardiac infarction, Myocardial Infarction [Disease/Finding], AMI, attacking heart, heart attacks, attack hearts, infarctions myocardial, infarcts myocardial, myocardial infarctions, Infarction;heart, myocardial infarcts, Infarction;myocardial, attacks coronary, attacks hearts, coronary attack, disorder infarction myocardial, mied, myocardial necrosis, syndrome myocardial infarction, mies, Myocardial infarct, Myocardial infarction, Heart attack, MI - Myocardial infarction, Cardiac infarction, Infarction of heart, Myocardial infarction (disorder), cardiac; infarction, infarction; myocardial, Attack - heart, Heart Attacks, Infarctions (Myocardial), Myocardial infarction NOS, Attack coronary, myocardial infarction, heart attack, heart infarction
German MYOKARDINFARKT, Koronarattacke, Herzanfall, MI, Herzanfall (NNB), HERZANFALL, Herzinfarkt, Myokardinfarkt
Dutch hartaanval, hartinfarct, hartaanval (NAO), MI, cardiaal; infarct, infarct; myocard, myocardinfarct, Hartinfarct, Infarct, myocard-, Myocardinfarct
French Crise coronaire, IM, Crise cardiaque SAI, Crise cardiaque, CRISE CARDIAQUE, INFARCTUS DU MYOCARDE, IDM (Infarctus Du Myocarde), Infarctus du myocarde, Infarctus myocardique
Italian MI, Attacco cardiaco, Attacco coronarico, Attacco cardiaco (NAS), Infarto del miocardio, Infarto miocardico
Portuguese Ataque coronário, Ataque do coração, Ataque cardíaco NE, EM, ATAQUE CARDIACO, ENFARTO DO MIOCARDIO, Enfarte do miocárdio, Infarto do Miocárdio
Spanish IM, Crisis coronaria, Ataque al corazón, Ataque al corazón (NEOM), Infarto miocárdico, Heart attack, Attack - heart, Myocardial infarct, Myocardial infarction, ATAQUE CARDIACO, INFARTO DE MIOCARDIO, Infarto al Miocardio, ataque al corazón, infarto cardíaco, infarto de corazón, infarto de miocardio (trastorno), infarto de miocardio, Infarto de miocardio, Infarto del Miocardio
Japanese 心臓発作(NOS), 冠発作, 心臓発作, カンホッサ, シンゾウホッサNOS, シンゾウホッサ, シンキンコウソク, 冠状動脈梗塞, 心筋梗塞, 冠動脈梗塞, 心筋梗塞症
Swedish Hjärtinfarkt
Czech infarkt myokardu, Srdeční záchvat, Srdeční záchvat (NOS), IM, Koronární záchvat, Infarkt myokardu
Finnish Sydäninfarkti
Russian INFARKT MIOKARDA, ИНФАРКТ МИОКАРДА
Croatian SRČANI INFARKT
Polish Świeży zawał serca, Zawał serca świeży, Zawał mięśnia sercowego, Zawał serca
Hungarian Coronaria roham, Szívroham (k.m.n.), Szívroham, Infarctus myocardii, Szívizom infarctus, MI
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Navigation Tree