Acute coronary syndrome

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(Redirected from Myocardial infarction)

Background

Definition

  • Spectrum of syndromes resulting from myocardial ischemia
    • Unstable angina: no biochemical or EKG abnormalities, but increasing anginal symptoms
      • New-onset, severe angina
      • Angina at rest
      • Early post-MI angina
      • Post-revascularization angina
    • NSTEMI: biochemical abnormalities with or without EKG abnormalities
    • STEMI: biochemical abnormalities with ST elevation in 2 or more contiguous leads

Consensus Classification of Myocardial Infarction (MI)

  • Type 1: spontaneous MI from plaque rupture, dissection, etc
  • Type 2: demand ischemia
  • Type 3: likely MI but patient died before biomarkers were drawn
  • Type 4
    • Type 4a: PCI-related MI
    • Type 4b: stent thrombosis
  • Type 5: CABG-related MI

Etiology

  • Thrombosis: rupture of atherosclerotic plaque resulting in thrombus formation that occludes the lumen
  • Stenosis: luminal narrowing from progressive atherosclerotic disease

Clinical Manifestations

  • Angina
  • RV infarct will present with

Complications

Investigations

  • EKG
    • If concern for inferior STEMI, get a 15-lead to rule out RV infarct
  • Labs
    • Troponin
    • CK
    • AST
  • Imaging
    • Coronary angiogram
    • Myocardial perfusion (MIBI)

Management

  • TNK 0.53mg/kg IV bolus then transfer to PCI centre
  • If RV infarct
    • Fluids and fluids
    • Consider inotropes