Myocard Infarction

 Myocardial infarction (MI) (ie, heart attack) is the irreversible death

(necrosis) of heart muscle secondary to prolonged lack of oxygen
supply (ischemia). 
Patients with typical MI may have the following symptoms in the days or even weeks
preceding the event (although typical STEMI may occur suddenly, without warning):
 Fatigue
 Chest discomfort
 Malaise

Typical chest pain in acute MI has the following characteristics:

 Intense and unremitting for 30-60 minutes
 Substernal, and often radiates up to the neck, shoulder, and jaw, and down the
left arm
 Usually described as a substernal pressure sensation that also may be
characterized as squeezing, aching, burning, or even sharp
 In some patients, the symptom is epigastric, with a feeling of indigestion or of
fullness and gas
The patient’s vital signs may demonstrate the following in MI:
 The patient’s heart rate is often increased (tachycardic) secondary to a high
sympathoadrenal discharge
 The pulse may be irregular because of ventricular ectopy, an accelerated
idioventricular rhythm, ventricular tachycardia, atrial fibrillation or flutter, or other
supraventricular arrhythmias; bradyarrhythmias may be present
 In general, the patient's blood pressure is initially elevated because of peripheral
arterial vasoconstriction resulting from an adrenergic response to pain and
ventricular dysfunction
 However, with right ventricular MI or severe left ventricular dysfunction,
hypotension and cardiogenic shock can be seen
 The respiratory rate may be increased in response to pulmonary congestion or
anxiety
 Coughing, wheezing, and the production of frothy sputum may occur

Diagnosis
Laboratory studies
Laboratory tests used in the diagnosis of MI include the following:
 Cardiac biomarkers/enzymes: The American College of Cardiology/American
Heart Association (ACC/AHA) and the European Society of Cardiology (ESC)
guidelines recommend that cardiac biomarkers should be measured at
presentation in patients with suspected MI, and that the only biomarker that is
recommended to be used for the diagnosis of acute MI at this time is cardiac
troponin due to its superior sensitivity and accuracy.  [1, 2, 3, 4]
  Troponin levels: Troponin is a contractile protein that normally is not found in
serum; it is released only when myocardial necrosis occurs
 Complete blood cell count
 Comprehensive metabolic panel
 Lipid profile
Electrocardiography
The ECG is the most important tool in the initial evaluation and triage of patients in
whom an acute coronary syndrome (ACS), such as MI, is suspected. It is confirmatory
of the diagnosis in approximately 80% of cases.
Cardiac imaging
For individuals with highly probable or confirmed acute MI, coronary angiography can
be used to definitively diagnose or rule out coronary artery disease

Myocardial infarction (MI), commonly known as a heart attack, is defined

pathologically as the irreversible death of myocardial cells caused by
ischemia. Clinically, MI is a syndrome that can be recognized by a set of
symptoms, chest pain being the hallmark of these symptoms in most cases,
supported by biochemical laboratory changes, electrocardiographic (ECG)
changes, or findings on imaging modalities able to detect myocardial injury
and necrosis.
. Detection of an increase or decrease in cardiac biomarker values (preferably using
cardiac troponin [cTn]) with at least one value above the 99th percentile of the upper
reference limit (URL) and with at least one of the following findings:
 Symptoms of ischemia
 New or presumed new significant ST-segment-T wave (ST-T) changes or new
left bundle branch block (LBBB)
 Development of pathologic Q waves on the ECG
 Imaging evidence of new loss of viable myocardium or a new regional wall
motion abnormality
 Identification of an intracoronary thrombus by angiography or autopsy
2. Cardiac death with symptoms suggestive of myocardial ischemia and presumed new
ischemic changes or injury or new BBB on ECG, but death occurred before cardiac
biomarker levles were obtained, or before cardiac biomarker values would be increased.