Section 3: Myocardial Ischemia and Infarction

Part 1. Principles of Ischemic Heart Disease (Coronary Artery Disease)

1. Introduction to Coronary Artery Disease (Ischemic Heart Disase)

Coronary artery disease is the number one killer worldwide. This chapter will introduce you to basic concepts of ischemic heart disease.

2. Classification of Acute Coronary Syndromes (ACS): Acute Myocardial Infarction (AMI) and Unstable Angina (UA)

The acute complication of coronary artery disease occurs when an athersclerotic plaque ruptures. This results in atherothrombosis which leads to an acute coronary syndrome. This chapter will introduce you to pathophysiology, classification and clinical implications of acute coronary syndromes.

3. The ECG in Clinical Practice

Optimal handling of ECG increases survival in patients with chest pain (acute coronary syndromes). This chapter discusses the essentials of ECG in the management of chest pain patients.

4. Principles of Myocardial Infarction Diagnostics

Learn how acute myocardial infarction is diagnosed and the difference between ST elevation myocardial infarction (STEMI), Non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA).

5. Myocardial Reaction in Ischemia and Infarction

Understanding how the myocardium reacts during ischemia is essential to understanding ECG changes in ischemic heart disease. This chapter will discuss principles governing myocardial oxygen consumption as well as myocardial reaction during ischemia. You should also read the complimentary chapter: The Ischemic Cascade during Exercise Testing.

6. Modification of the Natural Course in Myocardial Infarction

The natural course of acute myocardial infarction is discussed in this chapter.

7. Myocardial Infarction and the Left Ventricle

Learn why myocardial infarction is equal to left ventricular infarction.

Part 2: The ECG in Ischemia and Infarction

8. Myocardial Ischemia and the ST-T Segment

Acute ischemia causes ST-T changes. This is a difficult topic which is discussed in detail in this and the subsequent chapters.

9. ST Segment Depression in Ischemia and Differential Diagnoses

Learn all about ST segment depressions. This is an in-depth guide to causes and implications of various ST segment depressions, including those caused by acute myocardial ischemia / infarction.

10. ST Segment Elevation in Ischemia and Differential Diagnoses

Learn all about ST segment elevations. This is an in-depth guide to causes and implications of various ST segment elevations, including those caused by acute myocardial ischemia / infarction.

11. STEMI/STE-ACS Without ST Segment Elevation on ECG

Learn about clinical syndromes that do not directly manifest with ST segment elevations but must be managed as STEMI in order to improve survival.

12. T-wave Changes in Ischemia and Infarction

T-wave changes are frequently misunderstood, particularly in the setting of ischemia and infarction. This chapter provides a detailed discussion on the causes and implications of various T-wave changes (flat T-waves, inverted [negative] T-waves and hyperacute T-waves).

13. Pathological Q-waves and pathological R-waves

Learn how to differentiate various Q-wave changes, including normal Q-waves, normalvariants and pathological Q-waves. Pathological R-waves are also discussed.

14. Left Bundle Branch Block in Ischemia and Infarction

Learn why left bundle branch block poses a special challenge in patients with acute coronary syndromes.

15. Other ECG changes in Ischemia and Infarction

Ischemia may cause additional ECG changes which are discussed in this chapter.

16. Conduction Defects and Blocks in Ischemia and Infarction

17. Reperfusion assessment using 12-lead ECG

18. Localization of Ischemic and Infarct Area Using 12-lead ECG

In this chapter you will learn how to use the 12-lead ECG to localize the myocardial ischemia/infarction.

Part 3: Management of Acute Coronary Syndromes (ACS)

In these comprehensive chapters you will learn how to manage patients with chest pain, patients with STEMI and patients with NSTEMI.

19. Approach to patients with chest pain

20. Acute STEMI (ST Elevation Acute Myocardial Infarction)

21. NSTEMI (Non ST Elevation Acute Myocardial Infarction) and Unstable Angina (UA)

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