MYOCARDIAL

INFARCTION
Kaveesha Sachini Perera
ADNS232PEN
INTRODUCTION

• Myocardial Infarction (MI) is a medical term for a heart attack

• MI’s occur when an atherosclerotic plaque gradually builds up in

the inner lining of a coronary artery and then suddenly ruptures

• This leads to the formation of a thrombus, totally occluding the

artery and preventing blood flow to the heart muscle.

• Symptoms include chest pain, shortness of breath, and sweating

CASE PRESENTATION

Biographic data History of Present Illness Past Medical/ Surgical History

 Name: Somapala
 Known case of hypertension.
 Site-Chest
 Age:60 years  Onset-Sudden Social History
 Gender: Male  Character-Crushing, heavy
 Radiation - chest to the left jaw and
 Chronic Smoker
arm.
 Alcohol: no history
Chief Complaint  Alleviating Factors- diaphoresis
 Severe chest pain(2hrs ago) Time course-2 hours ago
 Exacerbating factors- non
 Shortness of breath
 Severity-Severe
Physical Examination
Vitals
Blood Pressure:160/90mmHg
Pulse: 95bmp
Body Temperature: 37.0oC
Respirations:20 breaths/min
General Physical Examination
Diaphoresis
SOB
Pallor
Auscultation: Systolic murmur
EKG: ST segment elevation in leads V2 to V5
Which imaging modality provides further diagnostic
information in this patient?

 An Electrocardiogram (EKG) is an important test in

the early diagnosis and evaluation of individuals with
chest discomfort and provides further diagnostic data.

 Certain changes in the heart's electrical activity may

signify heart damage.

 The classic ECG changes are:

• ST segment elevation or depression

• Abnormal Q wave

• T wave inversion
 Cont.
• ST-segment changes on a 12-lead EKG indicate ischemia or

infarction (death of the muscle tissue) of the myocardium.

• This indicates a total blockage of one or more coronary arteries

and ultimately leads to myocardial necrosis.

• ST segment elevation in leads V1-V6 suggests an infarction

involving the anterior wall of the left ventricle.

• This is caused by the occlusion of the left anterior descending

coronary artery.
What specific finding on the apical echocardiogram
would be consistent with a myocardial infarction?
• An echocardiogram uses sound waves (ultrasound) to create real-
time images of the heart’s chambers and walls.

• One of the key indicators on an apical echocardiogram is

abnormal wall motion due to reduced movement, indicating
damage to the muscle tissue.

• In some cases, only a specific segment of the wall may exhibit

reduced movement, known as segmental hypokinesis. This
provides information about the location and extent of the MI.

• In certain cases, an apical echocardiogram may reveal the

presence of a thrombus formation.
What laboratory test can be used to confirm the
diagnosis of a myocardial infarction?

• When diagnosing a myocardial infarction , a particular laboratory

test called a cardiac troponin test, is commonly used due to its high
sensitivity and specificity.

• Particularly Troponin T and Troponin I are released into the

bloodstream when there is damage to the heart muscle

• Therefore there is an elevation of Troponin in blood during a

myocardial infarction.

• Measuring these enzymes, such as troponin and other enzymes such

as creatine kinase-MB (CK-MB), helps confirm a MI diagnosis and
assess its severity.
How long after the onset of symptoms should the troponin I
levels become elevated?

• Troponin I is highly sensitive and specific to cardiac muscle

injury. It is released into the blood stream within 3-6 hours from
the onset of MI symptoms.

• Peak levels are reached with 12-24 hours and may remain elevated
for upto 7-10 days.

• The timing of troponin I elevation is influenced by factors such as:

I. extent of myocardial injury

II. size of the infarction

III. characteristics specific to individual patients

Given the patient’s presentation, EKG findings, and elevated
troponin I levels, what is the most likely diagnosis?

• These findings suggest a deviation of blood flow to a section of the myocardium

and is consistent with the pathophysiology of a myocardial infarction.

• According to Mr. Somapala’s medical history, physical examination findings and

diagnostic findings, including ST segment and troponin I level elevation , a

myocardial infarction emerges as the most likely diagnosis.

• MI’s require prompt treatments, including oxygen and drug therapy and surgical

interventions to prevent further blockage and minimize damage.

References
• Mayo Clinic (2018). Heart attack - Diagnosis and treatment - Mayo Clinic. [online] Mayoclinic.org.
Available at: https://www.mayoclinic.org/diseases-conditions/heart-attack/diagnosis-treatment/drc-
20373112.

• ‌Yi-Jin Kuok (2019). Myocardial infarction | Radiology Reference Article | Radiopaedia.org. [online]
Radiopaedia.org. Available at: https://radiopaedia.org/articles/myocardial-infarction?lang=us.

• Esmaeilzadeh, M., Parsaee, M. and Maleki, M. (2013). The role of echocardiography in coronary
artery disease and acute myocardial infarction. The journal of Tehran Heart Center, [online] 8(1),
pp.1–13. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587668/.

• Abubakkar Raheel (2015). Myocardial Infarction - Case Presentation and an Overview. [online]
Available at: https://www.slideshare.net/ALPHAROMEO93/myocardial-infarction-case-presentation-
and-an-overview.
Thank you