Mycordial Infarction

acute myocardial infarction (AMI) is the medical term for an event commonly
known as a heart attack. An MI occurs when blood stops flowing properly to a part
of the heart, and the heart muscle is injured because it is not receiving enough
oxygen. Usually this is because one of the coronary arteries that supplies blood to
the heart develops a blockage due to an unstable buildup of white blood cells,
cholesterol and fat. The event is called "acute" if it is sudden and serious.
History
The patients A history is critical in diagnosing myocardial infarction and sometimes
may provide the only clues that lead to the diagnosis in the initial phases of the
patient presentation.
Patients with typical myocardial Infarction may have prodromal symptoms of
fatigue, chest discomfort, or malaise in the days preceding the event; alternatively,
typical STEMI may occur suddenly, without warning.
Other symptoms of myocardial infarction include the following:

Anxiety
Light-headedness with or without syncope
Cough
Nausea with or without vomiting
Diaphoresis
Wheezing

Physical examination
Physical examination findings for myocardial infarction can vary; one patient may
be comfortable in bed, with normal examination results, while another may be in
severe pain, with significant respiratory distress and a need for ventilatory support.

Patients with ongoing symptoms usually lie quietly in bed and appear pale and
diaphoretic. Hypertension may precipitate myocardial infarction, or it may reflect
elevated

catecholamine

levels

due

to

anxiety,

pain,

or

exogenous

sympathomimetics. Hypotension may indicate ventricular dysfunction due to

ischemia. Hypotension in the setting of myocardial infarction usually indicates a
large infarct secondary to either decreased global cardiac contractility or a right
ventricular infarct. Acute valvular dysfunction may be present. Mitral regurgitation
due to papillary muscle ischemia or necrosis may be present.

Doctors order:
-

Verapamil
Diltiazem
Alternatives include captopril, 12.5-50 mg given orally twice a day
beta-adrenergic blockers and ACE inhibitors

ECG RESULTS:

An AV nodal block or infranodal block may be evident.

A 53-year-old patient who had experienced 3 hours of chest pain had a 12-lead
electrocardiogram performed, and the results are as shown. He was given
sublingual nitroglycerin and developed severe symptomatic hypotension. His blood
pressure normalized with volume resuscitation.

MEDICATIONS:
Clopidogrel (Plavix)
Clopidogrel selectivel inhibits adenosine diphosphate (ADP) binding to platelet
receptors and subsequent ADP-mediated activation of glycoprotein GPIIb/IIIa
complex, thereby inhibiting platelet aggregation.
Aspirin (Anacin, Ascriptin, Bayer Aspirin)
Early administration of aspirin in patients with acute myocardial infarction has been
shown to reduce cardiac mortality rate by 23% in the first month.
Vorapaxar (Zontivity)
Vorapaxar reversibly inhibits protease-activated receptor 1 (PAR-1) which is
expressed on platelets, but its long half-life makes it effectively irreversible. It is
indicated to reduce thrombotic cardiovascular events in patients with a history of MI
or with peripheral arterial disease. It is not used as monotherapy, but added to
aspirin and/or clopidogrel.