ST elevation Miocardial infarction

Regions of the Myocardium

Lateral
I, AVL,V5V6

Inferior
II, III, aVF

Anterior /
Septal
V1-V4

Definition

Myocardial infarction (MI) rapid

development
of
myocardial
necrosis caused by a critical
imbalance between the oxygen
supply and demand of the
myocardium.
This usually results from plaque
rupture with thrombus formation in
a coronary vessels, resulting in an
acute reduction of blood supply to
a portion of the myocardium

Unstable
Angina
Non
occlusive
thrombus
Non specific
ECG
Normal
cardiac
enzymes

NSTEMI

Occluding
thrombus
sufficient to cause
tissue damage &
mild
myocardial
necrosis
ST depression +/T wave inversion
on
ECG
Elevated cardiac
enzymes

STEMI
Complete thrombus
occlusion
ST elevations on
ECG or new LBBB
Elevated cardiac
enzymes
More severe
symptoms

PATHOPHYSIOLOGY

Occurs when coronary blood

flow
decreases
abruptly
after a thrombotic occlusion
of
a
coronary
artery
previously
affected
by
atherosclerosis.

In most cases, infarction

occurs
when
an
atherosclerotic
plaque
fissures,
ruptures,
or
ulcerates

Pathophysiologi

Pathophysiologi

PATHOPHYSIOLOGY

American Heart Association: http://watchlearnlive.heart.org

American Heart Association: http://watchlearnlive.heart.org

American Heart Association: http://watchlearnlive.heart.org

American Heart Association: http://watchlearnlive.heart.org

American Heart Association: http://watchlearnlive.heart.org

American Heart Association: http://watchlearnlive.heart.org

RISK FACTORS
Non-Modifiable
Gender and Age
Men, increased risk > age

Modifiable
Smoking

Hypertension

Women, increased risk >

Diabetes

age 55

Dyslipidemia

Obesity

Lack of physical

45

Family History
CAD diagnosed before age
55 in father or brother
CAD disease diagnosed
before age 65 in mother or

activity

Mellitus

DIAGNOSIS OF ACS
At least 2 of the following
Ischemic symptoms
Diagnostic ECG
changes
Serum cardiac marker
elevations

DIAGNOSIS OF ACS
Ischemic symptoms
Prolonged pain (usually >20 mins) may also be described
as a dull pain, constricting, crushing, squeezing
Usually retrosternal location, radiating to left chest, left
arm; can be
epigastric
Dyspnea
Diaphoresis
Palpitations
Nausea/vomiting
Light headedness

DIAGNOSIS OF ACS
At least 2 of the following
Ischemic symptoms
Diagnostic ECG
changes
Serum cardiac marker
elevations

DIAGNOSIS OF ACS
At least 2 of the following
Ischemic symptoms

Troponin T

Diagnostic ECG changes

CK-MB

Serum cardiac marker

CK

elevations

Myoglobin

ECG IN AMI

CHANGES IN ECG

MANAGEMENT

TIMI RISK SCORE FOR

STEMI
Risk of
Risk Factor
Age > 65 years old
Age > 75 years old
History of
angina/hipertension/D
M
Systolic BP <100
Heart rate > 100
Killip II-IV
Weight > 67kg
Anterior MI or LBBB
Delay treatment

Score
2
3
1
3
2
2
1
1
1

Total
Death in 30
Score
days
0
0.8%
1
1.6%
2
2.2%
3
4.4%
4
7.3%
5
12.4%
6
16.1%
7
23.4%
8
26.8%
9-14
35.9%

KILLIP CLASSIFICATION
Class
Description
I
no clinical signs of heart
failure
II
rales or crackles in the
lungs, an S3, and
elevated jugular venous
pressure
III
acute pulmonary edema
IV
cardiogenic shock or
hypotension (systolic BP
< 90 mmHg), and
evidence of peripheral
vasoconstriction

Mortality Rate (%)

6

17

30 - 40
60 80

SECONDARY PREVENTIONS FOR

PATIENTS WITH STEMI
Weight management (BMI 18.5 to 24.9 kg per m 2; waist
circumference
less than 40 inches in men, less than 35 inches in women)
Diabetes management (A1C less than 7 percent)
Antiplatelet and anticoagulant therapy
Renin-angiotensin-aldosterone system blocker therapy
Beta blocker therapy

Than
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