ST elevation myocardial infarction: Difference between revisions

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{{ST elevation myocardial infarction}}
{{ST elevation myocardial infarction}}


{{CMG}}; '''Associate Editor(s)-In-Chief:'''  Anne-Marie Anagnostopoulos, M.D.; Debanik Chaudhuri, M.D.; Robert Salazar, M.D.
{{CMG}}; '''Associate Editor(s)-In-Chief:'''  Anne-Marie Anagnostopoulos, M.D.; Debanik Chaudhuri, M.D.; Robert Salazar, M.D.


'''''Keywords and synonyms:''''' <small>AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis </small>
'''''Keywords and synonyms:''''' AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis
 
== [[ST elevation myocardial infarction overview|Overview]] ==
 
== [[ST elevation myocardial infarction pathophysiology|Pathophysiology]] ==


==[[ST elevation myocardial infarction overview|Overview]]==
[[ST elevation myocardial infarction pathophysiology|Pathophysiology of Vessel Occlusion]] | [[ST Elevation Myocardial Infarction: Pathophysiology of Reperfusion|Pathophysiology of Reperfusion]]


==[[ST elevation myocardial infarction pathophysiology|Pathophysiology]]==
== [[ST elevation myocardial infarction causes|Causes]] ==
[[ST elevation myocardial infarction pathophysiology|Pathophysiology of Vessel Occlusion]] | [[ST Elevation Myocardial Infarction: Pathophysiology of Reperfusion |Pathophysiology of Reperfusion]]


==[[ST elevation myocardial infarction causes|Causes]]==
== [[ST elevation myocardial infarction differential diagnosis|Differential Diagnosis of ST Elevation Myocardial Infarction]] ==


==[[ST elevation myocardial infarction risk factors|Risk Factors]]==
== [[ST elevation myocardial infarction epidemiology and demographics|Epidemiology and Demographics]] ==


==[[ST elevation myocardial infarction triggers|Triggers]]==
== [[ST elevation myocardial infarction risk factors|Risk Factors]] ==


==[[ST elevation myocardial infarction differential diagnosis|Differential Diagnosis of ST Elevation Myocardial Infarction]]==
== [[ST elevation myocardial infarction triggers|Triggers]] ==
==[[ST elevation myocardial infarction epidemiology and demographics | Epidemiology and Demographics]]==


==Diagnosis==
== Diagnosis ==


[[ST elevation myocardial infarction diagnostic criteria|Diagnostic Criteria]] | [[ST elevation myocardial infarction history and symptoms|History & Symptoms]] | [[ST elevation myocardial infarction physical examination|Physical Examination]] | [[ST elevation myocardial infarction electrocardiogram|Electrocardiogram]] | [[ST elevation myocardial infarction coronary angiography|Coronary Angiography]] | [[ST elevation myocardial infarction gross pathology|Gross Pathology]] | [[ST elevation myocardial infarction histopathology|Histopathology]]
[[ST elevation myocardial infarction diagnostic criteria|Diagnostic Criteria]] | [[ST elevation myocardial infarction history and symptoms|History & Symptoms]] | [[ST elevation myocardial infarction physical examination|Physical Examination]] | [[ST elevation myocardial infarction electrocardiogram|Electrocardiogram]] | [[ST elevation myocardial infarction coronary angiography|Coronary Angiography]] | [[ST elevation myocardial infarction gross pathology|Gross Pathology]] | [[ST elevation myocardial infarction histopathology|Histopathology]]


==Treatment==
== Treatment ==


===[[ST elevation myocardial infarction pre-hospital care|Pre-Hospital Care]]===
=== [[ST elevation myocardial infarction pre-hospital care|Pre-Hospital Care]] ===


===[[ST elevation myocardial infarction initial care|Initial Care]]===
=== [[ST elevation myocardial infarction initial care|Initial Care]] ===


[[ST elevation myocardial infarction oxygen therapy|Oxygen]] | [[ST elevation myocardial infarction nitrate therapy|Nitrates]] | [[ST elevation myocardial infarction analgesic therapy|Analgesics]] | [[ST elevation myocardial infarction aspirin therapy|Aspirin]] | [[ST elevation myocardial infarction beta blocker therapy|Beta Blockers]] | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombins]] | [[Coronary care unit|The coronary care unit]] |  [[Step Down Unit|The step down unit]]
[[ST elevation myocardial infarction oxygen therapy|Oxygen]] | [[ST elevation myocardial infarction nitrate therapy|Nitrates]] | [[ST elevation myocardial infarction analgesic therapy|Analgesics]] | [[ST elevation myocardial infarction aspirin therapy|Aspirin]] | [[ST elevation myocardial infarction beta blocker therapy|Beta Blockers]] | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombins]] | [[Coronary care unit|The coronary care unit]] |  [[Step Down Unit|The step down unit]]


'''Pharmacologic Reperfusion''' | [[ST elevation myocardial infarction reperfusion therapy|Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)]] | [[ST elevation myocardial infarction fibrinolytic therapy|Fibrinolysis]]  
'''Pharmacologic Reperfusion''' | [[ST elevation myocardial infarction reperfusion therapy|Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)]] | [[ST elevation myocardial infarction fibrinolytic therapy|Fibrinolysis]]


'''Mechanical Reperfusion''' | [[Door-to-Balloon| The importance of reducing Door-to-Balloon times]] | [[ST elevation myocardial infarction primary percutaneous coronary intervention|Primary PCI]] | [[ST elevation myocardial infarction percutaneous coronary intervention following fibrinolytic administration|Adjunctive and Rescue PCI]] | [[ST elevation myocardial infarction rescue percutaneous coronary intervention|Rescue PCI]]  |
'''Mechanical Reperfusion''' | [[Door-to-Balloon|The importance of reducing Door-to-Balloon times]] | [[ST elevation myocardial infarction primary percutaneous coronary intervention|Primary PCI]] | [[ST elevation myocardial infarction percutaneous coronary intervention following fibrinolytic administration|Adjunctive and Rescue PCI]] | [[ST elevation myocardial infarction rescue percutaneous coronary intervention|Rescue PCI]]  |
[[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Facilitated PCI]] |  
[[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Facilitated PCI]] |
[[ST Elevation Myocardial Infarction Adjunctive Percutaneous Coronary Intervention|Adjunctive PCI]] |  
[[ST Elevation Myocardial Infarction Adjunctive Percutaneous Coronary Intervention|Adjunctive PCI]] |
[[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] | [[ST elevation myocardial infarction management of patients who were not reperfused|Management of Patients Who Were Not Reperfused]] | [[ST elevation myocardial infarction assessing success of reperfusion|Assessing Success of Reperfusion]]
[[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] | [[ST elevation myocardial infarction management of patients who were not reperfused|Management of Patients Who Were Not Reperfused]] | [[ST elevation myocardial infarction assessing success of reperfusion|Assessing Success of Reperfusion]]


'''Antithrombin Therapy'''  • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombin therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Unfractionated Heparin|Unfractionated heparin]]  • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Enoxaparin| Low Molecular Weight Heparinoid Therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Bivalirudin| Direct Thrombin Inhibitor Therapy]] •  [[ ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Fondaparinux|Factor Xa Inhibition]] • [[ST elevation myocardial infarction deep vein thrombosis prophylaxis and anticoagulation|DVT prophylaxis]] •  [[ST elevation myocardial infarction deep vein thrombosis prophylaxis and anticoagulation|Long term anticoagulation]]
'''Antithrombin Therapy'''  • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombin therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Unfractionated Heparin|Unfractionated heparin]]  • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Enoxaparin|Low Molecular Weight Heparinoid Therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Bivalirudin|Direct Thrombin Inhibitor Therapy]] •  [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Fondaparinux|Factor Xa Inhibition]] • [[ST elevation myocardial infarction deep vein thrombosis prophylaxis and anticoagulation|DVT prophylaxis]] •  [[ST elevation myocardial infarction deep vein thrombosis prophylaxis and anticoagulation|Long term anticoagulation]]


'''Antiplatelet Agents''' | [[ST elevation myocardial infarction aspirin therapy|Aspirin]] | [[ST elevation myocardial infarction thienopyridine therapy|Thienopyridine Therapy]] | [[ST elevation myocardial infarction glycoprotein IIbIIIa inhibition|Glycoprotein IIbIIIa Inhibition]]
'''Antiplatelet Agents''' | [[ST elevation myocardial infarction aspirin therapy|Aspirin]] | [[ST elevation myocardial infarction thienopyridine therapy|Thienopyridine Therapy]] | [[ST elevation myocardial infarction glycoprotein IIbIIIa inhibition|Glycoprotein IIbIIIa Inhibition]]
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'''Other Initial Therapy'''  |  [[ST elevation myocardial infarction inhibition of the renin-angiotensin-aldosterone system at discharge|Inhibition of the Renin-Angiotensin-Aldosterone System]] | [[ST elevation myocardial infarction magnesium therapy|Magnesium Therapy]] |  [[ST elevation myocardial infarction glucose control|Glucose Control]] | [[ST elevation myocardial infarction calcium channel blocker therapy|Calcium Channel Blocker Therapy]]
'''Other Initial Therapy'''  |  [[ST elevation myocardial infarction inhibition of the renin-angiotensin-aldosterone system at discharge|Inhibition of the Renin-Angiotensin-Aldosterone System]] | [[ST elevation myocardial infarction magnesium therapy|Magnesium Therapy]] |  [[ST elevation myocardial infarction glucose control|Glucose Control]] | [[ST elevation myocardial infarction calcium channel blocker therapy|Calcium Channel Blocker Therapy]]


==Discharge Care==
== Discharge Care ==
[[ST elevation myocardial infarction secondary prevention|Secondary Prevention]] | [[ST elevation myocardial infarction inhibition of the renin-angiotensin-aldosterone system at discharge|Inhibition of the Renin-Angiotensin-Aldosterone System]]  |
 
[[ST elevation myocardial infarction cardiac rehabilitation|Cardiac Rehabilitation]] | [[ST elevation myocardial infarction prognosis|Prognosis]] | [[ST elevation myocardial infarction pacemaker implantation|Pacemaker Implantation]] | [[ST elevation myocardial infarction deep vein thrombosis prophylaxis and anticoagulation| Long term anticoagulation]]
[[ST elevation myocardial infarction secondary prevention|Secondary Prevention]] | [[ST elevation myocardial infarction inhibition of the renin-angiotensin-aldosterone system at discharge|Inhibition of the Renin-Angiotensin-Aldosterone System]]  |
[[ST elevation myocardial infarction cardiac rehabilitation|Cardiac Rehabilitation]] | [[ST elevation myocardial infarction prognosis|Prognosis]] | [[ST elevation myocardial infarction pacemaker implantation|Pacemaker Implantation]] | [[ST elevation myocardial infarction deep vein thrombosis prophylaxis and anticoagulation|Long term anticoagulation]]


==Complications==
== Complications ==


===[[ST elevation myocardial infarction complications|Overview]]===
=== [[ST elevation myocardial infarction complications|Overview]] ===


'''Ischemic Complications:''' [[Reinfarction]]
'''Ischemic Complications:''' [[Reinfarction]]


'''Mechanical Complications:'''[[Cardiogenic shock]]  |  [[Left ventricular aneurysm]]  |  [[Myocardial rupture]]  |  [[Left ventricular aneurysm|Pseudoaneurysm]]  |  [[Papillary muscle rupture]]  |  
'''Mechanical Complications:'''[[Cardiogenic shock]]  |  [[Left ventricular aneurysm]]  |  [[Myocardial rupture]]  |  [[Left ventricular aneurysm|Pseudoaneurysm]]  |  [[Papillary muscle rupture]]  |
[[Rupture of the ventricular septum]]
[[Rupture of the ventricular septum]]


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'''Pericarditis:'''  [[Post myocardial infarction pericarditis]]  |  [[Dressler's syndrome]]
'''Pericarditis:'''  [[Post myocardial infarction pericarditis]]  |  [[Dressler's syndrome]]


==Related Chapters==
== Related Chapters ==
 
* [[The Living Guidelines: STEMI]]
* [[The Living Guidelines: STEMI]]
*In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme used by the ACC / AHA guidelines. [[ACC AHA Guidelines Classification Scheme|Read more about the classification scheme used by the ACC / AHA Guidelines Committee here]].
* In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme used by the ACC / AHA guidelines. [[ACC AHA Guidelines Classification Scheme|Read more about the classification scheme used by the ACC / AHA Guidelines Committee here]].
 
== Disclaimer ==


==Disclaimer==
Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the [[wikidoc:General disclaimer|disclaimers]] page for important information regarding limitations of the information found here.
Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the [[wikidoc:General disclaimer|disclaimers]] page for important information regarding limitations of the information found here.


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Revision as of 19:12, 15 August 2012

For patient information click here

Myocardial infarction
ICD-10 I21-I22
ICD-9 410
DiseasesDB 8664
MedlinePlus 000195

Acute Coronary Syndrome Main Page

ST Elevation Myocardial Infarction Microchapters

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Patient Information

Overview

Pathophysiology

Pathophysiology of Vessel Occlusion
Pathophysiology of Reperfusion
Gross Pathology
Histopathology

Causes

Differentiating ST elevation myocardial infarction from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History and Complications

Risk Stratification and Prognosis

Pregnancy

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Chest X Ray

Cardiac MRI

Echocardiography

Coronary Angiography

Treatment

Pre-Hospital Care

Initial Care

Oxygen
Nitrates
Analgesics
Aspirin
Beta Blockers
Antithrombins
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)
Fibrinolysis
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
CABG
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
Aspirin
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

Overview
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 On the Web

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US National Guidelines Clearinghouse

NICE Guidance

FDA on ST elevation myocardial infarction

CDC on ST elevation myocardial infarction

ST elevation myocardial infarction in the news

Blogs on ST elevation myocardial infarction

Directions to Hospitals Treating ST elevation myocardial infarction

Risk calculators and risk factors for ST elevation myocardial infarction

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Anne-Marie Anagnostopoulos, M.D.; Debanik Chaudhuri, M.D.; Robert Salazar, M.D.

Keywords and synonyms: AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis

Overview

Pathophysiology

Pathophysiology of Vessel Occlusion | Pathophysiology of Reperfusion

Causes

Differential Diagnosis of ST Elevation Myocardial Infarction

Epidemiology and Demographics

Risk Factors

Triggers

Diagnosis

Diagnostic Criteria | History & Symptoms | Physical Examination | Electrocardiogram | Coronary Angiography | Gross Pathology | Histopathology

Treatment

Pre-Hospital Care

Initial Care

Oxygen | Nitrates | Analgesics | Aspirin | Beta Blockers | Antithrombins | The coronary care unit | The step down unit

Pharmacologic Reperfusion | Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI) | Fibrinolysis

Mechanical Reperfusion | The importance of reducing Door-to-Balloon times | Primary PCI | Adjunctive and Rescue PCI | Rescue PCI | Facilitated PCI | Adjunctive PCI | CABG | Management of Patients Who Were Not Reperfused | Assessing Success of Reperfusion

Antithrombin TherapyAntithrombin therapyUnfractionated heparinLow Molecular Weight Heparinoid TherapyDirect Thrombin Inhibitor TherapyFactor Xa InhibitionDVT prophylaxisLong term anticoagulation

Antiplatelet Agents | Aspirin | Thienopyridine Therapy | Glycoprotein IIbIIIa Inhibition

Other Initial Therapy | Inhibition of the Renin-Angiotensin-Aldosterone System | Magnesium Therapy | Glucose Control | Calcium Channel Blocker Therapy

Discharge Care

Secondary Prevention | Inhibition of the Renin-Angiotensin-Aldosterone System | Cardiac Rehabilitation | Prognosis | Pacemaker Implantation | Long term anticoagulation

Complications

Overview

Ischemic Complications: Reinfarction

Mechanical Complications:Cardiogenic shock | Left ventricular aneurysm | Myocardial rupture | Pseudoaneurysm | Papillary muscle rupture | Rupture of the ventricular septum

Arrhythmic Complications: Sudden cardiac death

Embolic Complications: Stroke | DVT

Pericarditis: Post myocardial infarction pericarditis | Dressler's syndrome

Related Chapters

Disclaimer

Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the disclaimers page for important information regarding limitations of the information found here.


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