Pathogenesis and Treatment of ST Elevation Myocardial Infarction

1. Pathogenesis and Treatment of ST
Elevation Myocardial Infarction
By Suryansh Pandey
Group 1325

2. Introduction
• STEMI are caused by atherosclerotic plaque
rupture with vessel occlusion due to secondary
thrombosis, with the extent of subsequent
myocardial injury dependent on the area of
myocardium subtended by the culprit vessel,
duration of occlusion and presence of
collaterals.

3. Pathogenesis of ST Elevation
Myocardial Infarction
• STEMI occurs when there is a rupture of a
plaque in the coronary artery.
• The rupture leads to the formation of a blood
clot that completely blocks blood flow.
• The blockage results in ischemia and damage
to the heart muscle.

4. Risk Factors
• Smoking
• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Family history of heart disease
• Age

5. Clinical Presentation
• Chest pain or discomfort
• Shortness of breath
• Nausea
• Lightheadedness
• Cold sweats

6. Diagnostic Evaluation
• Electrocardiogram (ECG): A primary tool
used to diagnose ST Elevation Myocardial
Infarction (STEMI) .
• Cardiac enzymes (troponin): Elevated levels
of cardiac enzymes, specifically troponin,
indicate damage to the heart muscle. Serial
measurements are taken to assess the extent
of the damage and monitor the progression
of the condition.
• Cardiac catheterization: Also known as
coronary angiography, this invasive
procedure involves the insertion of a catheter
into the coronary arteries to visualize any
blockages or narrowing. It helps determine
the need for revascularization procedures
such as angioplasty or stenting.

7. Treatment Options
• Reperfusion Therapy: This treatment aims to
restore blood flow to the heart by either using
thrombolytic therapy or percutaneous coronary
intervention (PCI). PCI, also known as angioplasty,
involves the use of a catheter with a balloon on
the tip to open up the blocked artery and restore
blood flow.
• Pharmacological Therapy: This treatment
involves the use of medications to reduce pain,
prevent blood clot formation, and manage other
risk factors.

8. Reperfusion Therapy
• Percutaneous Coronary Intervention (PCI):
 Minimally invasive procedure performed in
a cardiac catheterization lab.
 A catheter with a balloon at the tip is
inserted into the blocked artery and inflated
to open the artery.
 A stent may be placed to keep the artery
open and improve blood flow.
• Fibrinolytic Therapy:
 Administered intravenously to dissolve the
blood clot causing the blockage.
 Can be used when PCI is not readily
available or there are contraindications for
the procedure.

9. Pharmacological Therapy
• Antiplatelet Medications
 Aspirin: Reduces the risk of blood clot formation by
inhibiting platelet aggregation.
 P2Y12 inhibitors (e.g., clopidogrel, prasugrel, ticagrelor):
Prevent platelet activation and aggregation.
• Anticoagulant Medications
 Heparin: Prevents blood clot formation by inhibiting the
activity of clotting factors.
 Direct thrombin inhibitors (e.g., bivalirudin): Inhibit the
activity of thrombin, a key enzyme in the clotting
process.
• Beta Blockers: Reduce heart rate and blood
pressure, relieving the workload on the heart.
• ACE Inhibitors: Inhibit the activity of angiotensin-
converting enzyme, reducing the production of
angiotensin II and promoting vasodilation.

10. Secondary Prevention
• Quit Smoking
• Adopt a Healthy Diet
• Regular Exercise
• Take Medications as Prescribed