DEFINITION

Acute Myocardial
Infarction

Clinical Setting
Evidence of
Consistent w/
Myocardial injury
Myocardial Ischemia

↑ cardiac trop1 Persistent Chest

value above the discomfort
Or
99th percentile Other suggestive
URL ischemic symptoms

STEMI
NSTEMI
INITIAL DIAGNOSIS
IIa C

NEW
 Atypical electrocardiographic presentations
that should prompt a primary percutaneous coronary
intervention strategy in patients with ongoing symptoms
consistent with myocardial ischaemia
2012
Urgent angiography in 2 Hours
Consider neurological outcome
time constraint
ECG Evolution
Reperfusion Therapy
2012 2017
Procedural Aspect of PCI Strategy
2012
 prevent platelets from
Anti platelet clumping and also
prevent clots from
forming and growing

Anti thrombotic
drugs

slow down clotting,

thereby reducing fibrin
Anti coagulant formation and
preventing clots from
forming and growing
Classification
Mechanism of Action
Mechanism of Action
in haemodynamically stable patients, oral beta-blocker
initiation should be considered within the first 24 h
 Nitrates
• The routine use of nitrates in STEMI was of no
benefit & not recommended
• IV nitrates may be useful during the acute
phase in patients with hypertension or heart
failure
• Following the acute phase, nitrates remain
valuable agents to control residual angina
symptoms
 Calcium Antagonist
• no beneficial effect on death or reinfarction
• routine use of calcium antagonists in the acute
phase is not indicated.
• in patients with contraindications to beta-
blockersreasonable option
• Routine use of dihydropyridines has failed to
show benefit after STEMIprescribed for
clear additional indications such as
hypertension or residual angina
“DO NOT FORGET”
INTERVENTIONS
Myocardial Infarction with Non-Obsructive
Coronary Arteries

MINOCA
No stenosis ???
Thank You