Cardiology Myocardial ischemia and infarction Definition and conceptual framework Acute coronary occlusion is the abrupt or progressive reduction of coronary blood flow sufficient to produce…

…infarction ECG Posterior (posterolateral) acute myocardial infarction (STEMI) The heart is rotated 30° to the left in the thorax. This positions the basal portion of…

…with concordant positive T wave in absence of conduction defect. R/S ratio 1 implies that the R wave is larger than the S wave.

…during purely diagnostic angiography. Elective PCI has reported mortality of 0.1–0.3%, large myocardial infarction in fewer than 3%, and stroke in 0…

…In a large network meta analysis, 3 month DAPT, but not 6 month DAPT, was associated with higher rates of myocardial infarction or stent thrombosis…

Myocardial ischemia and infarction ECG Definition and Pathophysiology Acute coronary syndromes (ACS) encompass a spectrum of clinical conditions characterized by a recent change in symptoms…

…of an adequate collateral circulation. A first or anterior infarction. Single vessel disease without collateral support. Chronic kidney disease, particularly in relation to VSR. Large…

…compared to those with Non ST Elevation Myocardial Infarction (NSTEMI) or unstable angina (UA), is attributed to the greater extent of ischemia present in STEMI…

…cardiovascular interventions. Dressler syndrome now occurs in fewer than 1% of AMI cases and is seen predominantly after larger infarctions and/or delayed reperfusion. Its…

…of acute coronary syndromes. The LMCA supplies a large myocardial territory through the left anterior descending (LAD) and left circumflex (LCx) arteries (Figure 1). Acute…

…clinically significant infarction. Mechanisms of injury Procedural injury may result from acute compromise of coronary flow. Mechanisms include: Coronary dissection with obstruction of the true…

…LV systolic function. The principal mechanisms are the combination of an abnormal thrombogenic endocardial surface and blood stasis. During the acute infarction phase, endocardial inflammation…

Myocardial ischemia and infarction Definition and Pathophysiology Left main coronary artery disease (LMCAD) refers to atherosclerotic narrowing of the left main coronary artery, which supplies…

…of PCI procedures overall. It is particularly associated with intervention on degenerated saphenous vein grafts (SVGs), rotational atherectomy, and procedures performed for acute myocardial infarction…

…small vessels, multivessel disease, bifurcation lesions, treatment of acute myocardial infarction Procedural and mechanical Stent underexpansion, incomplete wall apposition, residual inflow or outflow disease, edge…

…endothelial coverage. Complementary Characteristics IVUS and OCT are complementary rather than interchangeable. IVUS generally provides better visualization of overall vessel dimensions, plaque burden, large vess

ECG Myocardial ischemia and infarction T wave changes in acute myocardial infarction & ischemia A thorough discussion regarding the physiology of the T wavewas previously provided…

…disruption. Fewer than 5% of thin capped fibroatheromas have been identified as the source of an acute myocardial infarction during long term follow up. Moreover…

Cardiology Myocardial ischemia and infarction Definition and Pathophysiology Chronic coronary syndromes (CCS) comprise the clinical manifestations of chronic structural and/or functional disease involving the…

…assessment after myocardial infarction or before revascularisation. Evaluation of treatment effect in stable angina. Exercise induced arrhythmia or exercise induced syncope. Assessment of chronotropic function…

…common cause of pericardial effusion is infections, such as viral, bacterial, and tuberculous infections. Post pericardiotomy syndrome. Acute transmural myocardial infarction. Rupture of the free…

…dysfunction, side effects of medications and acute myocardial infarction. Holter ECG is useful to determine the frequency, severity and situational dependence of sinus bradycardia. If…

…women, respectively, should be considered abnormal. A common cause of abnormally large T waves is hyperkalemia, which results in high, pointed and asymmetric T waves…

…Therefore, in the presence of a tamponade, chest compressions have limited efficacy. Furthermore, administering large tidal volumes might inadvertently elevate intrathoracic pressures, additionally compromising venous…

…compliance of the pericardium. Rapid accumulation may cause tamponade with a relatively small volume, whereas a slowly enlarging effusion may reach a much larger size…

…elevation myocardial infarction (STEMI), cardiogenic shock most commonly reflects severe left ventricular (LV) dysfunction, accounting for approximately 80% of cases. Other causes include acute mechanical…

…et al, Twerenbold et al) Kinetics Troponin T (cTnT) and troponin I (cTnI) increase 2 3 hours after the onset of acute myocardial infarction. The…

…leading cardiovascular cause of death worldwide. Only stroke and acute myocardial infarction are more common. It is estimated that 10 million cases of venous thromboembolism…

…dissection CT of the brain Exclude intracerebral haemorrhage and assess early ischaemic changes CT angiography The standard investigation in acute stroke to identify large vessel…

Procedurer In acute circulatory failure it is not the number of cannulae that matters but the flow per unit time . A large bore, short cannula…

…in T4 produces a large change in TSH. During acute illness the TSH can be falsely low or high in the absence of thyroid disease…

…must never be injected into a joint in which infection has not been excluded. Indications Acute monoarthritis in which septic arthritis must be distinguished from…

…adults. Here the posterior part of the iliac crest is thick, red marrow is abundant, and the distance to vessels and abdominal organs is large…

…caused by a dysregulated host response to infection. Clinically this usually corresponds to an acute increase in the SOFA score of at least 2 points…

…the conjunctiva or the cornea. Never use a cotton bud on an embedded corneal foreign body — it scrapes away a large area of epithelium. 3…

…ancestry Previous muscle disease or a personal or family history of muscle disorders Acute infection Renal or hepatic impairment Hypothyroidism Vitamin D deficiency Concomitant interacting…

…milk ducts, malignancy differential Surgeon or mammography Sole of the foot Deep compartments Orthopaedic surgeon Close to large vessels, in the groin or on the…

…eGFR of 30 40 mL/min for lower urinary tract infection. At an eGFR <30 mL/min the antibacterial effect is lost. Dosed independently of…

ECG Myocardial ischemia and infarction Use of ECG in acute coronary syndromes & chest pain patients An ECG must be performed on all patients seeking medical…

…Acute myocardial infarction: a diagnosis based on cardiac troponins A diagnosis of acute myocardial infarction (AMI) is made only after blood analyses confirm elevated levels…

…medical treatment life threatening arrhythmias or cardiac arrest mechanical complications of acute myocardial infarction. acute heart failure recurrent dynamic ST segment or T wave changes…

…and infarction. Symptoms – Patients with acute myocardial infarction may present with typical ischemic chest pain, or with dyspnea, nausea, unexplained weakness, or a combination of…

…ACS Classification The clinical spectrum of Acute Coronary Syndromes encompasses Unstable Angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI), and ST Elevation Myocardial Infarction (STEMI)…

…Represents a periprocedural myocardial infarction associated with coronary artery bypass grafting (CABG). Clinical Presentation and Symptoms The diagnosis of an acute MI remains a comprehensive…

…evidence of acute myocardial ischaemia, electrocardiographic findings, cardiac biomarkers, imaging, angiography, and, occasionally, pathological examination. Pathologically, infarction represents myocardial cell death caused by prolonged ischaemia…

…in acute myocardial infarction (AMI) is modified by several factors. The most important of these, and their implications, are as follows: The size of the…

…A patient with acute STEMI may therefore display a normal LBBB pattern. LBBB may be caused by ischemia/infarction : There are numerous causes of LBBB…

…the ischemic area!) [2]. Take home message: in the setting of acute coronary syndromes, be quick to administer antithrombotic medications and reperfusion. Refer to G…

…ischemia and infarction Definition and pathophysiological context Non ST segment elevation myocardial infarction (NSTEMI) is considered within the spectrum of non ST elevation acute coronary…

…patients with left ventricular dysfunction and/or MVD. Nevertheless, the optimal extent and timing of intervention depend on the clinical setting, haemodynamic status, coronary anatomy…

…infarction (MI). MI denotes cardiomyocyte necrosis occurring in the clinical setting of acute myocardial ischaemia and is diagnosed according to the fourth universal definition of…

ECG Introduction The traditional classification of acute coronary syndromes (ACS) into ST segment elevation myocardial infarction (STEMI), non STEMI (NSTEMI), and unstable angina (UA) has…

…include: Recognition of symptoms suggestive of myocardial infarction. Rapid acquisition and interpretation of a 12 lead ECG. Assessment for haemodynamic instability, acute severe heart failure…

ECG Myocardial ischemia and infarction The ECG in the assessment of myocardial reperfusion The ECG is an invaluable tool to assess whether an occlusion has…

…be studied in detail. Figure 2. The electrocardiographic natural course in STEMI (ST elevation myocardial infarction). Pitfalls Acute transmural ischemia located in the basal portio

…ventricular cavity. The location of acute myocardial infarction refers to the area of the left ventricle When specifying the location of myocardial infarction, reference is…

…of patients with Non ST Elevation Myocardial Infarction (NSTEMI) and unstable angina (UA), which are collectively referred to as NSTE ACS (Non ST Elevation Acute…

…clinical concept Myocardial infarction with non obstructive coronary arteries (MINOCA) describes a clinical presentation in which the patient has symptoms suggestive of acute coronary syndrome…

…can be present [5]. Distinguishing Features: Pleuritic pain suggests pulmonary infarction, and a history of pain exacerbation with inspiration, along with a pleural friction rub…

…posterior component of a broader infarct territory. Clinical Presentation and Symptoms The source material addresses posterior infarction primarily in the context of suspected acute coronary…