- Myocardial infarction is caused by inadequate oxygen supply to the heart muscle, usually due to blockage of a coronary artery.
- The classic symptom is chest pain or discomfort that may radiate to the shoulder, neck or arm.
- An electrocardiogram (ECG) within 10 minutes of symptoms can help diagnose myocardial infarction and determine prognosis. ST segment elevations on ECG strongly indicate acute ischemia.
- Biomarkers of cardiac injury like cardiac troponins and creatine kinase MB fraction rise in the bloodstream following myocardial infarction and can help with diagnosis.
This document provides an overview of myocardial infarction (MI), also known as a heart attack. It defines MI as the death of heart muscle caused by a blockage of the coronary arteries that limits blood flow. The document discusses the epidemiology and symptoms of MI and outlines the criteria for diagnosis. It describes the role of laboratory tests like cardiac troponins and electrocardiograms in diagnosis. Early management includes oxygen, aspirin, nitroglycerin, and morphine for pain relief. Reperfusion strategies like percutaneous coronary intervention (PCI) or thrombolytics are discussed. Complications and classifications of MIs are also reviewed.
will help you in understanding myocardial infarction in more detail with its management and therapy with complications and with graphical knowledge you can understand it better and some laboratry test are also included in it .
This document provides an overview of acute myocardial infarction (MI), also known as a heart attack. It discusses the definition, causes, risk factors, pathogenesis, classification, diagnosis and management of MI. The diagnosis involves taking a patient history, examining signs and symptoms, electrocardiography, serum analysis and echocardiography. Management is staged and involves pre-hospital, emergency department and post-discharge care, with a focus on reperfusing the blocked artery as quickly as possible, such as through percutaneous coronary intervention or thrombolytic therapy. The goal is to correctly identify the type of MI, treat the patient according to guidelines and manage any complications.
The patient presented with symptoms of chest pain, shortness of breath, and sweating. ECG and blood tests showed elevated cardiac markers. This is consistent with a diagnosis of myocardial infarction (MI). MI occurs when blood flow to the heart is blocked, causing heart muscle cell death. On pathology, MI presents as areas of necrosis and inflammation. Laboratory tests for MI diagnosis include cardiac troponins, CK-MB, and myoglobin, which are more specific and sensitive than total CK or LDH. Together, the presentation and test results make the diagnosis of MI likely in this case.
This document discusses STEMI (ST-elevation myocardial infarction) in young patients. It covers the diagnosis of STEMI using ECG and cardiac biomarkers. Investigations discussed include echocardiography, coronary angiography, and cardiac imaging tests. Treatment focuses on rapid reperfusion through medications, PCI, or CABG. Complications and long-term management are also outlined. The document provides an overview of evaluating and treating STEMI in the young.
Acute coronary syndrome (ACS) refers to unstable angina and myocardial infarction and is usually caused by rupture of an atherosclerotic plaque leading to coronary artery thrombosis. It is characterized by prolonged chest pain and cardiac enzyme elevations. Diagnosis involves electrocardiogram showing ST segment changes and elevated troponin levels. Treatment focuses on reperfusion therapy, antiplatelets, anticoagulants, and lifestyle modifications to prevent future events. Prognosis depends on extent of myocardial damage, with in-hospital mortality over 10% and 5-year survival rates around 75% for those who survive the initial event.
This document summarizes guidelines for the classification, diagnosis, and management of acute coronary syndromes (ACS). It discusses:
1) ACS are classified as STEMI or NSTE-ACS including NSTEMI and UA based on biomarkers and ECG findings. STEMI criteria require ST elevation and often indicates coronary artery occlusion.
2) Risk factors, pathophysiology, presentation, diagnostic testing and goals of initial therapy are outlined for STEMI. Diagnosis relies on ECG changes, cardiac biomarkers and imaging. Management focuses on rapid reperfusion via fibrinolysis or primary PCI to limit infarct size.
3) Reperfusion therapy options of PCI versus fibrinolysis are compared, with PCI preferred when performed
This document provides an overview of myocardial infarction (MI), also known as a heart attack. It defines MI as the death of heart muscle caused by a blockage of the coronary arteries that limits blood flow. The document discusses the epidemiology and symptoms of MI and outlines the criteria for diagnosis. It describes the role of laboratory tests like cardiac troponins and electrocardiograms in diagnosis. Early management includes oxygen, aspirin, nitroglycerin, and morphine for pain relief. Reperfusion strategies like percutaneous coronary intervention (PCI) or thrombolytics are discussed. Complications and classifications of MIs are also reviewed.
will help you in understanding myocardial infarction in more detail with its management and therapy with complications and with graphical knowledge you can understand it better and some laboratry test are also included in it .
This document provides an overview of acute myocardial infarction (MI), also known as a heart attack. It discusses the definition, causes, risk factors, pathogenesis, classification, diagnosis and management of MI. The diagnosis involves taking a patient history, examining signs and symptoms, electrocardiography, serum analysis and echocardiography. Management is staged and involves pre-hospital, emergency department and post-discharge care, with a focus on reperfusing the blocked artery as quickly as possible, such as through percutaneous coronary intervention or thrombolytic therapy. The goal is to correctly identify the type of MI, treat the patient according to guidelines and manage any complications.
The patient presented with symptoms of chest pain, shortness of breath, and sweating. ECG and blood tests showed elevated cardiac markers. This is consistent with a diagnosis of myocardial infarction (MI). MI occurs when blood flow to the heart is blocked, causing heart muscle cell death. On pathology, MI presents as areas of necrosis and inflammation. Laboratory tests for MI diagnosis include cardiac troponins, CK-MB, and myoglobin, which are more specific and sensitive than total CK or LDH. Together, the presentation and test results make the diagnosis of MI likely in this case.
This document discusses STEMI (ST-elevation myocardial infarction) in young patients. It covers the diagnosis of STEMI using ECG and cardiac biomarkers. Investigations discussed include echocardiography, coronary angiography, and cardiac imaging tests. Treatment focuses on rapid reperfusion through medications, PCI, or CABG. Complications and long-term management are also outlined. The document provides an overview of evaluating and treating STEMI in the young.
Acute coronary syndrome (ACS) refers to unstable angina and myocardial infarction and is usually caused by rupture of an atherosclerotic plaque leading to coronary artery thrombosis. It is characterized by prolonged chest pain and cardiac enzyme elevations. Diagnosis involves electrocardiogram showing ST segment changes and elevated troponin levels. Treatment focuses on reperfusion therapy, antiplatelets, anticoagulants, and lifestyle modifications to prevent future events. Prognosis depends on extent of myocardial damage, with in-hospital mortality over 10% and 5-year survival rates around 75% for those who survive the initial event.
This document summarizes guidelines for the classification, diagnosis, and management of acute coronary syndromes (ACS). It discusses:
1) ACS are classified as STEMI or NSTE-ACS including NSTEMI and UA based on biomarkers and ECG findings. STEMI criteria require ST elevation and often indicates coronary artery occlusion.
2) Risk factors, pathophysiology, presentation, diagnostic testing and goals of initial therapy are outlined for STEMI. Diagnosis relies on ECG changes, cardiac biomarkers and imaging. Management focuses on rapid reperfusion via fibrinolysis or primary PCI to limit infarct size.
3) Reperfusion therapy options of PCI versus fibrinolysis are compared, with PCI preferred when performed
The document discusses coronary artery anatomy and acute myocardial infarction. It describes:
- The main coronary arteries that supply the heart and the regions each artery perfuses.
- How atherosclerosis leads to plaque buildup in arteries, reducing blood flow to the heart.
- How a plaque rupture can cause a clot that fully occludes a coronary artery, causing cell death in the myocardial region supplied by that artery - known as a myocardial infarction.
Acute coronary syndrome presentation with bivalirudinRaleifoot Chisolm
This document summarizes the key steps in treating a patient experiencing an ST-elevation myocardial infarction (STEMI). It describes how inflammatory processes can destabilize atherosclerotic plaques and potentially cause rupture. It then outlines the symptoms, diagnostic criteria, treatment options including percutaneous coronary intervention, and goals for rapid treatment times for STEMI patients.
Acute chest pain is one of the most common reason for seeking care in the emergency department (10% of all visits)
Only 10-15% of patients with chest pain actually have ACS.
Myocardial Infarction Pathogenesis and TreatmentPUDI CHIRANJEEVI
Myocardial infarction, or heart attack, occurs when blood flow to the heart is blocked, damaging heart muscle. There are two main types - STEMI caused by a complete blockage, and NSTEMI from a partial blockage. Risk factors include age, smoking, high cholesterol, diabetes, and family history. Diagnosis involves history, cardiac biomarkers like troponin that indicate heart damage, ECG showing elevated ST segments, and imaging tests. Treatment focuses on restoring blood flow through medications, angioplasty, or bypass surgery, along with long term preventative medications like aspirin, statins, and beta blockers.
Myocardial infarction, also known as a heart attack, occurs when blood flow to the heart is blocked, depriving heart muscle cells of oxygen and nutrients and causing cell death. It is a leading cause of death and can cause complications like heart failure, arrhythmias, or cardiac rupture if left untreated. Treatment focuses on restoring blood flow, reducing workload on the heart, managing pain, and preventing further complications.
Myocardial infarction, also known as a heart attack, occurs when blood flow to the heart is blocked, depriving heart muscle cells of oxygen and nutrients and causing cell death. It is a leading cause of death and can cause complications like heart failure, arrhythmias, or cardiac rupture if left untreated. Treatment focuses on restoring blood flow, reducing workload on the heart, and managing pain and complications through medications, oxygen, and monitoring for arrhythmias.
Myocardial infarction, or heart attack, results from ischemia and hypoxia causing irreversible damage to heart muscle. It is a leading cause of death in the US. Risk factors include atherosclerosis, hypertension, smoking, diabetes, and family history. Diagnosis involves cardiac biomarkers like troponin and CK-MB which are released from damaged heart tissue. Electrocardiograms and echocardiograms can also help detect heart muscle damage and complications from a heart attack.
This document defines myocardial infarction and provides epidemiological data. It begins by defining myocardial infarction as the irreversible necrosis of heart muscle due to prolonged ischemia resulting from a blockage in a coronary artery. It then notes that over 735,000 Americans have heart attacks each year. Risk factors include increasing age, male sex, hypertension, dyslipidemia, diabetes, smoking, obesity, physical inactivity, and excessive alcohol consumption. The pathophysiology involves rupture of an atheromatous plaque leading to thrombus formation and coronary artery occlusion, causing ischemia and eventual cell death.
1. ST elevation myocardial infarction (STEMI) occurs when there is ST elevation or new left bundle branch block on ECG due to acute coronary artery occlusion.
2. Diagnosis is based on symptoms, elevated cardiac biomarkers, and ECG changes showing ST elevation. Treatment involves stabilization, pain control, and reperfusion therapy.
3. Prognosis depends on factors like age, previous MI history, infarct location and size, and presence of heart failure or hypotension. Early reperfusion, beta-blockers, ACE inhibitors and risk factor modification can limit damage.
This document discusses myocardial infarction (MI), also known as a heart attack. It provides details on:
1. The criteria for diagnosing an MI, including the rise and fall of biochemical markers and characteristic ECG changes.
2. Common risk factors for MI such as high blood cholesterol, diabetes, hypertension, smoking, male gender, and family history of heart disease.
3. The pathophysiology of an MI, including how atherosclerotic plaque can rupture and cause a thrombus to form, blocking blood flow to heart muscle.
4. How an ECG can be used to detect patterns of ischemia, injury, and infarction during an MI.
Myocardial infarction, commonly known as a heart attack, results from abrupt reduction in coronary blood flow causing ischemic myocardial necrosis. In over 90% of cases, an acute thrombus forms in an artery previously partially obstructed by atherosclerosis, blocking blood flow. Release of cardiac enzymes like troponins and CK-MB are diagnostic of myocardial infarction. Symptoms include chest pain and ECG changes like ST elevation or new left bundle branch block. Treatment focuses on reperfusion through medications or angioplasty to restore blood flow.
Myocarditis is inflammation of the heart muscle that can lead to dilated cardiomyopathy. It has infectious, toxic, or autoimmune causes. Patients may be asymptomatic or experience cardiac symptoms
Myocardial infarction, or heart attack, occurs when blood flow to the heart is blocked, damaging heart muscle. It is usually caused by a blood clot forming in one of the coronary arteries. A heart attack can lead to damage or death of heart muscle depending on how much of the heart is affected and for how long. Diagnosis involves assessing symptoms, electrocardiogram changes, and cardiac enzyme levels. Treatment focuses on restoring blood flow through clot-busting drugs or angioplasty, along with medications, monitoring, and lifestyle changes to prevent future heart attacks.
The document summarizes a seminar on ST-elevation myocardial infarction (STEMI). It discusses the objectives and epidemiology of STEMI and describes the pathophysiology, clinical presentations, investigations, management, and complications. It provides details on defining STEMI, investigating patients, treating the condition through reperfusion therapies or bypass surgery, managing complications, and providing secondary prevention after STEMI. The seminar aimed to define STEMI, understand its assessment and management, diagnose and treat complications early, and ensure appropriate long-term care of patients after STEMI.
- Takatsubo cardiomyopathy (TTC), also known as stress cardiomyopathy or broken heart syndrome, is a reversible form of heart failure caused by transient left ventricular dysfunction.
- It is typically triggered by periods of intense emotional or physical stress and is characterized by EKG changes and chest pain similar to a heart attack despite an absence of coronary artery blockages.
- The leading theories for its pathophysiology include high catecholamine levels from stress overwhelming the heart muscle or coronary microvascular dysfunction impairing blood flow. The heart regains normal function within weeks with supportive care.
The document discusses myocardial infarction and acute coronary syndrome, providing definitions, causes, risk factors, types, pathophysiology, clinical manifestations, diagnostic measures, management, and nursing management of MI. It covers topics such as the epidemiology of MI/ACS, diagnostic criteria and biomarkers for diagnosis, treatments including percutaneous coronary intervention and fibrinolytic therapy, and complications of MI.
This document provides an overview of acute coronary syndrome (ACS). It begins with a review of coronary artery anatomy and variations. It then discusses the presentations of ACS, including ischemic chest pain and equivalents. The main types of ACS - unstable angina, NSTEMI, and STEMI - are defined based on symptoms, electrocardiogram findings, and cardiac biomarker levels. Diagnosis and management strategies are outlined, including reperfusion therapies and drug treatments. Follow-up care after ACS and indications for procedures like cardiac catheterization and ICD placement are also summarized.
1. A myocardial infarction occurs when blood flow to the heart is blocked, damaging heart muscle.
2. It is caused most often by atherosclerosis and plaque buildup that obstruct coronary arteries.
3. Symptoms include chest pain and other signs of reduced blood supply to the heart. Diagnosis is based on symptoms, electrocardiogram changes, and blood tests showing cardiac enzyme levels.
1) STEMI/acute coronary syndrome occurs when blood supply to the heart is disrupted, damaging heart muscle. It is caused by blockages in the coronary arteries from clot formations.
2) Symptoms include chest pain that may radiate to the back, neck, or arms along with shortness of breath, nausea and weakness.
3) Risk factors include age over 45, smoking, high blood pressure, high cholesterol, diabetes and obesity.
An acute myocardial infarction (AMI) occurs when blood flow to an area of the heart is suddenly blocked, causing death of heart muscle cells due to lack of oxygen. The most common cause is rupture of an atherosclerotic plaque in a coronary artery. Treatment aims to restore blood flow as quickly as possible through fibrinolytic drugs, angioplasty, or bypass surgery. Complications include heart failure, cardiogenic shock, arrhythmias, or cardiac wall rupture. Aggressive management is needed to restore perfusion and support cardiac function.
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The document discusses coronary artery anatomy and acute myocardial infarction. It describes:
- The main coronary arteries that supply the heart and the regions each artery perfuses.
- How atherosclerosis leads to plaque buildup in arteries, reducing blood flow to the heart.
- How a plaque rupture can cause a clot that fully occludes a coronary artery, causing cell death in the myocardial region supplied by that artery - known as a myocardial infarction.
Acute coronary syndrome presentation with bivalirudinRaleifoot Chisolm
This document summarizes the key steps in treating a patient experiencing an ST-elevation myocardial infarction (STEMI). It describes how inflammatory processes can destabilize atherosclerotic plaques and potentially cause rupture. It then outlines the symptoms, diagnostic criteria, treatment options including percutaneous coronary intervention, and goals for rapid treatment times for STEMI patients.
Acute chest pain is one of the most common reason for seeking care in the emergency department (10% of all visits)
Only 10-15% of patients with chest pain actually have ACS.
Myocardial Infarction Pathogenesis and TreatmentPUDI CHIRANJEEVI
Myocardial infarction, or heart attack, occurs when blood flow to the heart is blocked, damaging heart muscle. There are two main types - STEMI caused by a complete blockage, and NSTEMI from a partial blockage. Risk factors include age, smoking, high cholesterol, diabetes, and family history. Diagnosis involves history, cardiac biomarkers like troponin that indicate heart damage, ECG showing elevated ST segments, and imaging tests. Treatment focuses on restoring blood flow through medications, angioplasty, or bypass surgery, along with long term preventative medications like aspirin, statins, and beta blockers.
Myocardial infarction, also known as a heart attack, occurs when blood flow to the heart is blocked, depriving heart muscle cells of oxygen and nutrients and causing cell death. It is a leading cause of death and can cause complications like heart failure, arrhythmias, or cardiac rupture if left untreated. Treatment focuses on restoring blood flow, reducing workload on the heart, managing pain, and preventing further complications.
Myocardial infarction, also known as a heart attack, occurs when blood flow to the heart is blocked, depriving heart muscle cells of oxygen and nutrients and causing cell death. It is a leading cause of death and can cause complications like heart failure, arrhythmias, or cardiac rupture if left untreated. Treatment focuses on restoring blood flow, reducing workload on the heart, and managing pain and complications through medications, oxygen, and monitoring for arrhythmias.
Myocardial infarction, or heart attack, results from ischemia and hypoxia causing irreversible damage to heart muscle. It is a leading cause of death in the US. Risk factors include atherosclerosis, hypertension, smoking, diabetes, and family history. Diagnosis involves cardiac biomarkers like troponin and CK-MB which are released from damaged heart tissue. Electrocardiograms and echocardiograms can also help detect heart muscle damage and complications from a heart attack.
This document defines myocardial infarction and provides epidemiological data. It begins by defining myocardial infarction as the irreversible necrosis of heart muscle due to prolonged ischemia resulting from a blockage in a coronary artery. It then notes that over 735,000 Americans have heart attacks each year. Risk factors include increasing age, male sex, hypertension, dyslipidemia, diabetes, smoking, obesity, physical inactivity, and excessive alcohol consumption. The pathophysiology involves rupture of an atheromatous plaque leading to thrombus formation and coronary artery occlusion, causing ischemia and eventual cell death.
1. ST elevation myocardial infarction (STEMI) occurs when there is ST elevation or new left bundle branch block on ECG due to acute coronary artery occlusion.
2. Diagnosis is based on symptoms, elevated cardiac biomarkers, and ECG changes showing ST elevation. Treatment involves stabilization, pain control, and reperfusion therapy.
3. Prognosis depends on factors like age, previous MI history, infarct location and size, and presence of heart failure or hypotension. Early reperfusion, beta-blockers, ACE inhibitors and risk factor modification can limit damage.
This document discusses myocardial infarction (MI), also known as a heart attack. It provides details on:
1. The criteria for diagnosing an MI, including the rise and fall of biochemical markers and characteristic ECG changes.
2. Common risk factors for MI such as high blood cholesterol, diabetes, hypertension, smoking, male gender, and family history of heart disease.
3. The pathophysiology of an MI, including how atherosclerotic plaque can rupture and cause a thrombus to form, blocking blood flow to heart muscle.
4. How an ECG can be used to detect patterns of ischemia, injury, and infarction during an MI.
Myocardial infarction, commonly known as a heart attack, results from abrupt reduction in coronary blood flow causing ischemic myocardial necrosis. In over 90% of cases, an acute thrombus forms in an artery previously partially obstructed by atherosclerosis, blocking blood flow. Release of cardiac enzymes like troponins and CK-MB are diagnostic of myocardial infarction. Symptoms include chest pain and ECG changes like ST elevation or new left bundle branch block. Treatment focuses on reperfusion through medications or angioplasty to restore blood flow.
Myocarditis is inflammation of the heart muscle that can lead to dilated cardiomyopathy. It has infectious, toxic, or autoimmune causes. Patients may be asymptomatic or experience cardiac symptoms
Myocardial infarction, or heart attack, occurs when blood flow to the heart is blocked, damaging heart muscle. It is usually caused by a blood clot forming in one of the coronary arteries. A heart attack can lead to damage or death of heart muscle depending on how much of the heart is affected and for how long. Diagnosis involves assessing symptoms, electrocardiogram changes, and cardiac enzyme levels. Treatment focuses on restoring blood flow through clot-busting drugs or angioplasty, along with medications, monitoring, and lifestyle changes to prevent future heart attacks.
The document summarizes a seminar on ST-elevation myocardial infarction (STEMI). It discusses the objectives and epidemiology of STEMI and describes the pathophysiology, clinical presentations, investigations, management, and complications. It provides details on defining STEMI, investigating patients, treating the condition through reperfusion therapies or bypass surgery, managing complications, and providing secondary prevention after STEMI. The seminar aimed to define STEMI, understand its assessment and management, diagnose and treat complications early, and ensure appropriate long-term care of patients after STEMI.
- Takatsubo cardiomyopathy (TTC), also known as stress cardiomyopathy or broken heart syndrome, is a reversible form of heart failure caused by transient left ventricular dysfunction.
- It is typically triggered by periods of intense emotional or physical stress and is characterized by EKG changes and chest pain similar to a heart attack despite an absence of coronary artery blockages.
- The leading theories for its pathophysiology include high catecholamine levels from stress overwhelming the heart muscle or coronary microvascular dysfunction impairing blood flow. The heart regains normal function within weeks with supportive care.
The document discusses myocardial infarction and acute coronary syndrome, providing definitions, causes, risk factors, types, pathophysiology, clinical manifestations, diagnostic measures, management, and nursing management of MI. It covers topics such as the epidemiology of MI/ACS, diagnostic criteria and biomarkers for diagnosis, treatments including percutaneous coronary intervention and fibrinolytic therapy, and complications of MI.
This document provides an overview of acute coronary syndrome (ACS). It begins with a review of coronary artery anatomy and variations. It then discusses the presentations of ACS, including ischemic chest pain and equivalents. The main types of ACS - unstable angina, NSTEMI, and STEMI - are defined based on symptoms, electrocardiogram findings, and cardiac biomarker levels. Diagnosis and management strategies are outlined, including reperfusion therapies and drug treatments. Follow-up care after ACS and indications for procedures like cardiac catheterization and ICD placement are also summarized.
1. A myocardial infarction occurs when blood flow to the heart is blocked, damaging heart muscle.
2. It is caused most often by atherosclerosis and plaque buildup that obstruct coronary arteries.
3. Symptoms include chest pain and other signs of reduced blood supply to the heart. Diagnosis is based on symptoms, electrocardiogram changes, and blood tests showing cardiac enzyme levels.
1) STEMI/acute coronary syndrome occurs when blood supply to the heart is disrupted, damaging heart muscle. It is caused by blockages in the coronary arteries from clot formations.
2) Symptoms include chest pain that may radiate to the back, neck, or arms along with shortness of breath, nausea and weakness.
3) Risk factors include age over 45, smoking, high blood pressure, high cholesterol, diabetes and obesity.
An acute myocardial infarction (AMI) occurs when blood flow to an area of the heart is suddenly blocked, causing death of heart muscle cells due to lack of oxygen. The most common cause is rupture of an atherosclerotic plaque in a coronary artery. Treatment aims to restore blood flow as quickly as possible through fibrinolytic drugs, angioplasty, or bypass surgery. Complications include heart failure, cardiogenic shock, arrhythmias, or cardiac wall rupture. Aggressive management is needed to restore perfusion and support cardiac function.
Similar to Analysis of various investigations in myocardial infarction.pptx (20)
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. • The most common serious cause of acute chest discomfort is
myocardial ischemia or myocardial infarction.
• Occurs when the supply of myocardial oxygen is inadequate
for the demand.
• The classic manifestation of ischemia is angina, which is
usually described as a heavy chest pressure or squeezing, a
burning feeling, or difficulty breathing.
3. • The discomfort often radiates to the left shoulder, neck, or
arm.
• It typically builds in intensity over a few minutes.
• The pain may begin with exercise or psychological stress, but
ACS most frequently occurs without obvious precipitating
factors.
4.
5. • One third of patients who experience STEMI will die within 24 hours
of the onset of ischemia, and many of the survivors will suffer
significant morbidity.
• For many patients, the first manifestation of CHD will be sudden
death.
• The difficulty lies in discriminating patients with ACS or other life-
threatening conditions from those with noncardiovascular, non–life-
threatening chest pain.
• The diagnosis of ACS is missed in approximately 2% of patients.
6.
7. ECG
• An ECG, a source of decisive data, should be obtained within
10 minutes after arrival for individuals with ongoing chest
discomfort and as rapidly as possible in those who have a
history of chest discomfort consistent with ACS.
• The ECG helps to define both diagnosis and prognosis.
8. • New persistent or transient ST-segment abnormalities (≥0.05 mV)
that develop during a symptomatic episode at rest and resolve when
the symptoms resolve strongly suggest acute ischemia and severe
CAD.
• Nonspecific, ST-segment changes or T wave abnormalities of 0.2 mV
or less are not as helpful for risk stratification
9.
10.
11.
12.
13.
14.
15. ST SEGMENT ELEVATION
• Most patients who present with acute STEMI have underlying
atherosclerotic coronary artery disease.
• The usual pathophysiology of STEMI, sometimes evolving into a Q
wave MI, relates to blockage of one of the major epicardial coronary
arteries by a ruptured or eroded (ulcerated) atherosclerotic plaque,
an event followed by the formation of a clot (thrombus) at this intra-
coronary site.
16. • The earliest ECG changes seen with acute transmural
ischemia/infarction typically occur in the ST-T complex in the two
major, sequential phases:
• The acute phase is marked by the appearance of ST segment
elevations and sometimes tall positive (so-called hyperacute) T waves
in multiple (usually two or more) leads.
• The term “STEMI” refers specifically to MIs with new or increased
elevation of the ST segment, sometimes with prominent T waves,
which are usually associated with complete or near complete
occlusion of an epicardial coronary artery.
17.
18. • Reciprocal ST depressions may occur in leads whose positive poles
are directed about 180° degrees from those showing ST elevations.
• Thus, an inferior MI may be marked by ST elevations in leads II, III,
and aVF, along with ST depressions in I, and aVL.
• Elevation of any degree in two contiguous inferior leads with any
amount of ST depression in aVL is highly suspicious for inferior MI.
19.
20.
21. • The evolving phase occurs hours or days later and is characterized by
deep T wave inversions in the leads that previously showed ST
elevations.
22.
23. QRS Changes:
• Q Waves of Infarction MI, particularly when large and transmural, often
produces distinctive changes in the QRS (depolarization) complex.
• The characteristic depolarization sign is the appearance of new Q waves.
• With a transmural infarction, necrosis of heart muscle occurs in a localized
area of the ventricle.
• As a result the electrical voltages produced by this portion of the myocardium
disappear.
• Instead of positive (R) waves over the infarcted area, Q waves are often
recorded (either a QR or QS complex)
24. • The new Q waves of an MI generally appear within the first day or so
of the infarct.
• With an anterior wall infarction these Q waves are seen in one or
more of leads V1 to V6, I, and aVL.
• With an inferior wall MI the new Q waves appear in leads II, III, and
aVF.
25.
26.
27.
28. • Characteristically, completely occlusive thrombi leads to extensive
injury to the ventricular wall in the myocardial bed subtended by the
affected coronary artery.
• Infarction alters the sequence of depolarization ultimately reflected
as changes in the QRS complex.
29. Serum and Plasma Markers of Cardiac Damage
• Necrosis compromises the integrity of the sarcolemmal membrane;
intracellular macromolecules (serum and plasma cardiac markers)
begin to diffuse into the cardiac interstitium and ultimately into the
microvasculature and lymphatics in the region of the infarct.
• The rate of appearance of these macromolecules in the peripheral
circulation depends on several factors, including intracellular location,
molecular weight, local blood and lymphatic flow, and the rate of
elimination from blood.
30.
31. Cardiac specific troponins
• The preferred biomarker to detect myocardial injury is cardiac
troponin, which consists of three subunits that regulate the calcium-
mediated contractile process of striated muscle.
• These subunits include troponin C, which binds Ca2+; troponin I (TnI),
which binds to actin and inhibits actin-myosin interactions; and
troponin T (TnT), which binds to tropomyosin, thereby attaching the
troponin complex to the thin filament
32. • In patients with MI, concentrations of cTnT and cTnI detected by
conventional assays (non–high-sensitivity) can be detected
approximately 3 hours after the onset of chest pain.
• Because of continuous release from a degenerating contractile
apparatus in necrotic myocytes, elevations in cTnI may persist for 7 to
10 days after MI.
• Elevations in cTnT may persist for up to 10 to 14 days.
33. • The prolonged time course of the elevation in cTnT and cTnI is
advantageous for the late diagnosis of MI.
• Patients with STEMI who undergo successful recanalization of the
infarct-related artery have a rapid release of cardiac troponins, which
can indicate reperfusion.
34.
35. High-Sensitivity Cardiac Troponin.
• It’s more precise measurement of very low concentrations of cardiac-
specific troponin.
• Such assays have greater sensitivity,also have diminished clinical
specificity for MI because they detect true myocardial injury in a
variety of other clinical settings.
• The rapidly changing concentration of troponin over periods of 1-3
hours helps in discriminating acute myocardial infarction from
structural cardiac diseases
36. Creatinine kinase MB- iso enzyme
• CK-MB measured with a mass assay is the best alternative.
• Cardiac muscle contains both the MM and the MB isoenzyme of CK.
• Other tissues can contain small quantities of CK-MB, including the
small intestine, tongue, diaphragm, uterus, and prostate.
• CK-MB may rise in circumstances involving severe skeletal muscle
injury.
37. • CK rises within 4–8 h and generally returns to normal by 48–72 h.
• CK is not specific as it can be elevated in
• cardiac surgery,
• myocarditis, and
• electrical cardioversion.
38. • The nonspecific reaction to myocardial injury is associated with
polymorphonuclear leukocytosis, which appears within a few hours
after the onset of pain and persists for 3–7 days;
• The white blood cell count often reaches levels of 12,000–15,000/μL.
• The erythrocyte sedimentation rate rises more slowly than the white
blood cell count, peaking during the first week and sometimes
remaining elevated for 1 or 2 weeks.
39. CARDIAC IMAGING
• Abnormalities of wall motion on two-dimensional echocardiography
are almost universally present.
• Although acute STEMI cannot be distinguished from an old
myocardial scar or from acute severe ischemia by echocardiography.
• Echocardiographic estimation of left ventricular (LV) function is useful
prognostically.
• Detection of reduced function serves as an indication for therapy with
an inhibitor of the renin-angiotensin-aldosterone system.
40. • Several radionuclide imaging techniques are available for evaluating
patients with suspected STEMI.
• However, these imaging modalities are used less often than
echocardiography because they are more cumbersome and lack
sensitivity and specificity in many clinical circumstances.
41. • Myocardial perfusion imaging with [201Tl] or [99mTc]-sestamibi,
which are distributed in proportion to myocardial blood flow and
concentrated by viable myocardium, reveals a defect (“cold spot”) in
most patients during the first few hours after development of a
transmural infarct.
• Although perfusion scanning is extremely sensitive, it cannot
distinguish acute infarcts from chronic scars and, thus, is not specific
for the diagnosis of acute MI.