ST elevation myocardial infarction causes

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Acute Coronary Syndrome Main Page

ST Elevation Myocardial Infarction Microchapters


Patient Information



Pathophysiology of Vessel Occlusion
Pathophysiology of Reperfusion
Gross Pathology


Differentiating ST elevation myocardial infarction from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History and Complications

Risk Stratification and Prognosis



Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings


EKG Examples

Chest X Ray

Cardiac MRI


Coronary Angiography


Pre-Hospital Care

Initial Care

Beta Blockers
The coronary care unit
The step down unit
STEMI and Out-of-Hospital Cardiac Arrest
Pharmacologic Reperfusion
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Reperfusion at a Non–PCI-Capable Hospital:Recommendations
Mechanical Reperfusion
The importance of reducing Door-to-Balloon times
Primary PCI
Adjunctive and Rescue PCI
Rescue PCI
Facilitated PCI
Adjunctive PCI
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy
Antithrombin therapy
Unfractionated heparin
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Factor Xa Inhibition
DVT prophylaxis
Long term anticoagulation
Antiplatelet Agents
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Other Initial Therapy
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
Lipid Management

Pre-Discharge Care

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post Hospitalization Plan of Care

Long-Term Medical Therapy and Secondary Prevention

Inhibition of the Renin-Angiotensin-Aldosterone System
Cardiac Rehabilitation
Pacemaker Implantation
Long Term Anticoagulation
Implantable Cardioverter Defibrillator
ICD implantation within 40 days of myocardial infarction
ICD within 90 days of revascularization

Case Studies

Case #1

Case #2

Case #3

Case #4

Case #5

ST elevation myocardial infarction causes On the Web

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CDC on ST elevation myocardial infarction causes

ST elevation myocardial infarction causes in the news

Blogs on ST elevation myocardial infarction causes

Directions to Hospitals Treating ST elevation myocardial infarction

Risk calculators and risk factors for ST elevation myocardial infarction causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]


The most common proximate cause of ST elevation myocardial infarction is plaque rupture. There are risk factors for plaque rupture and triggers of plaque rupture. A full discussion regarding the chronic risk factors and acute triggers of ST elevation MI can be found in other chapters. While plaque rupture is the most common cause of ST segment elevation MI, other conditions can cause ST elevation and myocardial necrosis. In order to expeditiously treat an alternate underlying cause of myonecrosis, it is important to rapidly identify conditions other than plaque rupture that may also cause ST elevation and myonecrosis. Indeed, the management of some of these conditions might differ substantially from that of plaque rupture: cocaine induced STEMI would not be treated with beta-blockers, and myocardial contusion would not be treated with an antithrombin.


Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Acute coronary syndrome, amyloidosis, anaphylactic shock, aortic dissection, aortic stenosis, arrhythmias, atherosclerosis, bradyarrhythmias, broken heart syndrome, commotio cordis, coronary artery aneurysm, coronary artery dissection, coronary artery vasospasm, coronary heart disease, coronary stent thrombosis, coronary thrombosis, dissecting aortic aneurysm, dyslipidemia, Hurler disease hypertension, hypotension, idiopathic hypertrophic subaortic stenosis, infectious endocarditis, Kawasaki disease, malignant hypertension, myocardial contusion,plaque rupture, prinzmetal angina, Progesterone, pseudoxanthoma elasticum, stress cardiomyopathy, tachyarrhythmias, Takayasu arteritis, Takotsubo cardiomyopathy
Chemical / poisoning Carbon monoxide poisoning
Dermatologic Kawasaki disease, pseudoxanthoma elasticum
Drug Side Effect Aldesleukin, almotriptan, alvimopan, Amlodipine besylate and Valsartan, amphetamines, anabolic steroids, cocaine, combined oral contraceptive pill, caspofungin acetate, desmopressin, desogestrel and ethinyl estradiol, diclofenac (patch), diflunisal, disulfiram, eletriptan, ephedrine, Estropipate, erythropoietin, ergonovine, estramustine, ethynodiol diacetate and ethinyl estradiol, etravirine, etonogestrel, fibrinogen,goserelin, idarubicin hydrochloride, indinavir, interferon alfacon-1, interferon gamma, letrozole, leuprolide, levothyroxine, marijuana, sudden withdrawal of beta blockers, meclofenamate, medroxyprogesterone, mefenamic acid, meloxicam, meropenem, methoxy polyethylene glycol-epoetin beta, naratriptan, niacin, Norgestimate and Ethinyl estradiol, Norgestrel and Ethinyl estradiol, sudden withdrawal of nitrates, nitroglycerin, oxaprozin, pegylated interferon alfa-2b, pergolide, piroxicam, pramipexole, ramucirumab, Repaglinide and Metformin hydrochloride, Rubidium Rb 82, sertraline, sumatriptan, testosterone, thalidomide, tiagabine, toremifene
Ear Nose Throat Thyrotoxicosis
Endocrine Amyloidosis, diabetes mellitus, pheochromocytoma, thyrotoxicosis
Environmental Air pollution, earthquakes, fine particulate matter
Gastroenterologic Hurler disease, pseudoxanthoma elasticum
Genetic Fabry's disease, familial hypercholesterolemia, homocystinuria, Hurler disease, mucopolysaccharidoses
Hematologic Disseminated intravascular coagulation, hypercoagulable states, polycythemia vera, thrombocytosis
Iatrogenic Coronary stent thrombosis, sudden withdrawal of beta blockers, sudden withdrawal of nitrates, transluminal percutaneous coronary angioplasty
Infectious Disease Infectious endocarditis
Musculoskeletal / Ortho Homocystinuria
Neurologic No underlying causes
Nutritional / Metabolic Amyloidosis, dyslipidemia, electrolyte imbalance, Fabry's disease, familial hypercholesterolemia, heavy meal, homocystinuria, Hurler disease, mucopolysaccharidoses, thiamine deficiency
Obstetric/Gynecologic Combined oral contraceptive pill, nuvaring
Oncologic Pheochromocytoma
Opthalmologic Homocystinuria
Overdose / Toxicity Cocaine, epinephrine overdose, marijuana
Psychiatric Anxiety, bereavement, broken heart syndrome, Hurler disease, psychological stress, stress cardiomyopathy,
Pulmonary Anaphylactic shock, respiratory failure, upper respiratory tract infection
Renal / Electrolyte Electrolyte imbalance
Rheum / Immune / Allergy Amyloidosis, anaphylactic shock, polyarteritis nodosa
Sexual Sexual activity
Trauma Electrocution, myocardial contusion, sports injury, trauma
Urologic No underlying causes
Miscellaneous Anger, electrocution, physical exertion, wartime bombing/missile attacks

Causes in Alphabetical Order


  1. Peters A, Dockery DW, Muller JE, Mittleman MA (2001). "Increased particulate air pollution and the triggering of myocardial infarction". Circulation. 103 (23): 2810–5. PMID 11401937. Unknown parameter |month= ignored (help)
  2. Peters A, Döring A, Wichmann HE, Koenig W (1997). "Increased plasma viscosity during an air pollution episode: a link to mortality?". Lancet. 349 (9065): 1582–7. doi:10.1016/S0140-6736(97)01211-7. PMID 9174559. Unknown parameter |month= ignored (help)
  3. Peters A, Fröhlich M, Döring A; et al. (2001). "Particulate air pollution is associated with an acute phase response in men; results from the MONICA-Augsburg Study". Eur. Heart J. 22 (14): 1198–204. doi:10.1053/euhj.2000.2483. PMID 11440492. Unknown parameter |month= ignored (help)
  4. Pope CA3rd, Dockery DW, Kanner RE, Villegas GM, Schwartz J (1999). "Oxygen saturation, pulse rate, and particulate air pollution: A daily time-series panel study". Am. J. Respir. Crit. Care Med. 159 (2): 365–72. PMID 9927345. Unknown parameter |month= ignored (help)
  5. Peters A, Perz S, Döring A, Stieber J, Koenig W, Wichmann HE (1999). "Increases in heart rate during an air pollution episode". Am. J. Epidemiol. 150 (10): 1094–8. PMID 10568625. Unknown parameter |month= ignored (help)
  6. 6.0 6.1 Mittleman MA, Maclure M, Sherwood JB; et al. (1995). "Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators". Circulation. 92 (7): 1720–5. PMID 7671353. Unknown parameter |month= ignored (help)
  7. Möller J, Hallqvist J, Diderichsen F, Theorell T, Reuterwall C, Ahlbom A (1999). "Do episodes of anger trigger myocardial infarction? A case-crossover analysis in the Stockholm Heart Epidemiology Program (SHEEP)". Psychosom Med. 61 (6): 842–9. PMID 10593637.
  8. Koton S, Tanne D, Bornstein NM, Green MS (2004). "Triggering risk factors for ischemic stroke: a case-crossover study". Neurology. 63 (11): 2006–10. PMID 15596741. Unknown parameter |month= ignored (help)
  9. Mittleman MA, Mintzer D, Maclure M, Tofler GH, Sherwood JB, Muller JE (1999). "Triggering of myocardial infarction by cocaine". Circulation. 99 (21): 2737–41. PMID 10351966. Unknown parameter |month= ignored (help)
  10. Leor J, Kloner RA (1996). "The Northridge earthquake as a trigger for acute myocardial infarction". Am. J. Cardiol. 77 (14): 1230–2. PMID 8651102. Unknown parameter |month= ignored (help)
  11. Leor J, Poole WK, Kloner RA (1996). "Sudden cardiac death triggered by an earthquake". N. Engl. J. Med. 334 (7): 413–9. PMID 8552142. Unknown parameter |month= ignored (help)
  12. Brown DL (1999). "Disparate effects of the 1989 Loma Prieta and 1994 Northridge earthquakes on hospital admissions for acute myocardial infarction: importance of superimposition of triggers". Am. Heart J. 137 (5): 830–6. PMID 10220631. Unknown parameter |month= ignored (help)
  13. Liao D, Creason J, Shy C, Williams R, Watts R, Zweidinger R (1999). "Daily variation of particulate air pollution and poor cardiac autonomic control in the elderly". Environ. Health Perspect. 107 (7): 521–5. PMC 1566669. PMID 10378998. Unknown parameter |month= ignored (help)
  14. Pope CA, Verrier RL, Lovett EG; et al. (1999). "Heart rate variability associated with particulate air pollution". Am. Heart J. 138 (5 Pt 1): 890–9. PMID 10539820. Unknown parameter |month= ignored (help)
  15. Gold DR, Litonjua A, Schwartz J; et al. (2000). "Ambient pollution and heart rate variability". Circulation. 101 (11): 1267–73. PMID 10725286. Unknown parameter |month= ignored (help)
  16. Peters A, Liu E, Verrier RL; et al. (2000). "Air pollution and incidence of cardiac arrhythmia". Epidemiology. 11 (1): 11–7. PMID 10615837. Unknown parameter |month= ignored (help)
  17. Lipovetzky N, Hod H, Roth A, Kishon Y, Sclarovsky S, Green MS (2004). "Heavy meals as a trigger for a first event of the acute coronary syndrome: a case-crossover study". Isr. Med. Assoc. J. 6 (12): 728–31. PMID 15609883. Unknown parameter |month= ignored (help)
  18. Vogel RA, Corretti MC, Plotnick GD (1997). "Effect of a single high-fat meal on endothelial function in healthy subjects". Am. J. Cardiol. 79 (3): 350–4. PMID 9036757. Unknown parameter |month= ignored (help)
  19. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE (2001). "Triggering myocardial infarction by marijuana". Circulation. 103 (23): 2805–9. PMID 11401936. Unknown parameter |month= ignored (help)
  20. Allegra JR, Mostashari F, Rothman J, Milano P, Cochrane DG (2005). "Cardiac events in New Jersey after the September 11, 2001, terrorist attack". J Urban Health. 82 (3): 358–63. doi:10.1093/jurban/jti087. PMID 16000653. Unknown parameter |month= ignored (help)
  21. Meisel SR, Kutz I, Dayan KI; et al. (1991). "Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians". Lancet. 338 (8768): 660–1. PMID 1679475. Unknown parameter |month= ignored (help)
  22. Subramanyam S, Kreisberg RA (2012). "Pheochromocytoma: a cause of ST-segment elevation myocardial infarction, transient left ventricular dysfunction, and takotsubo cardiomyopathy". Endocr Pract. 18 (4): e77–80. doi:10.4158/EP11346.CR. PMID 22441003.
  23. Willich SN, Lewis M, Löwel H, Arntz HR, Schubert F, Schröder R (1993). "Physical exertion as a trigger of acute myocardial infarction. Triggers and Mechanisms of Myocardial Infarction Study Group". N. Engl. J. Med. 329 (23): 1684–90. PMID 8232457. Unknown parameter |month= ignored (help)
  24. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (1998). "Prediction of coronary heart disease using risk factor categories". Circulation. 97 (18): 1837–47. PMID 9603539. Unknown parameter |month= ignored (help)
  25. 25.0 25.1 25.2 Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE (1993). "Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators". N. Engl. J. Med. 329 (23): 1677–83. PMID 8232456. Unknown parameter |month= ignored (help)
  26. 26.0 26.1 Hallqvist J, Möller J, Ahlbom A, Diderichsen F, Reuterwall C, de Faire U (2000). "Does heavy physical exertion trigger myocardial infarction? A case-crossover analysis nested in a population-based case-referent study". Am. J. Epidemiol. 151 (5): 459–67. PMID 10707914. Unknown parameter |month= ignored (help)
  27. Giri S, Thompson PD, Kiernan FJ; et al. (1999). "Clinical and angiographic characteristics of exertion-related acute myocardial infarction". JAMA. 282 (18): 1731–6. PMID 10568645. Unknown parameter |month= ignored (help)
  28. Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE (2000). "Triggering of sudden death from cardiac causes by vigorous exertion". N. Engl. J. Med. 343 (19): 1355–61. PMID 11070099. Unknown parameter |month= ignored (help)
  29. Whang W, Manson JE, Hu FB; et al. (2006). "Physical exertion, exercise, and sudden cardiac death in women". JAMA. 295 (12): 1399–403. doi:10.1001/jama.295.12.1399. PMID 16551711. Unknown parameter |month= ignored (help)
  30. Siscovick DS, Weiss NS, Fletcher RH, Lasky T (1984). "The incidence of primary cardiac arrest during vigorous exercise". N. Engl. J. Med. 311 (14): 874–7. PMID 6472399. Unknown parameter |month= ignored (help)
  31. Muller JE, Mittleman MA, Maclure M, Sherwood JB, Tofler GH (1996). "Triggering myocardial infarction by sexual activity. Low absolute risk and prevention by regular physical exertion. Determinants of Myocardial Infarction Onset Study Investigators". JAMA. 275 (18): 1405–9. PMID 8618365. Unknown parameter |month= ignored (help)
  32. Möller J, Ahlbom A, Hulting J; et al. (2001). "Sexual activity as a trigger of myocardial infarction. A case-crossover analysis in the Stockholm Heart Epidemiology Programme (SHEEP)". Heart. 86 (4): 387–90. PMC 1729949. PMID 11559674. Unknown parameter |month= ignored (help)
  33. Witte DR, Bots ML, Hoes AW, Grobbee DE (2000). "Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study". BMJ. 321 (7276): 1552–4. PMC 27557. PMID 11124170.
  34. Akashi YJ, Barbaro G, Sakurai T, Nakazawa K, Miyake F (2007). "Cardiac autonomic imbalance in patients with reversible ventricular dysfunction takotsubo cardiomyopathy". QJM. 100 (6): 335–43. doi:10.1093/qjmed/hcm028. PMID 17483198.
  35. Kawano H, Koide Y, Toda G, Yano K (2005). "ST-segment elevation of electrocardiogram in a patient with Shoshin beriberi". Intern. Med. 44 (6): 578–85. PMID 16020883. Unknown parameter |month= ignored (help)
  36. Hundley JM, Ashburn LL, Sebrell WH. The electrocardiogram in chronic thiamine deficiency in rats. Am J Physiol 144: 404–414, 1954.
  37. Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P (2004). "Risk of myocardial infarction and stroke after acute infection or vaccination". N. Engl. J. Med. 351 (25): 2611–8. doi:10.1056/NEJMoa041747. PMID 15602021. Unknown parameter |month= ignored (help)
  38. Saikku P, Leinonen M, Tenkanen L, Linnanmaki E, Ekman MR, Manninen V, Manttari M, Frick MH, Huttunen JK. (1992). "Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study". Ann Intern Med. 116 (4): 273–8. PMID 1733381.

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