Description
Heart attack also known as myocardial infarction, is a medical emergency where the heart muscle begins to die where there is not enough blood flow, it is usually caused by blockage of arteries.Three types of heart attack are: ST segment elevation myocardial infarction(STEMI) non-ST segment elevation myocardial infarction(NSTEMI) Coronary spasm, or unstable angina.
Summary Listen
- A patient presented with symptoms indicative of a potential cardiac issue, including ST elevation in ECG leads 2, 3, and AvF, and ST depression in leads V1, V2, V5, and V6. The initial diagnosis was a complete heart block with a stay-lifation in the specified ECG leads, and suspected cardiogenic shock.
- Initial treatment involved a loading dose and ionotrope support, along with fluid administration. The patient's condition initially stabilized, with blood pressure improving, but the cardiac catheterization lab was unavailable.
- A subsequent catheterization procedure revealed mild hypokinesis, pain in the inferior wall, left bundle branch block, and mitral regurgitation. The left ventricular function appeared relatively preserved, with isolated right corner artery involvement.
- The right corner artery was found to be 100% occluded. Thrombosuction was performed, followed by stent placement in the culprit artery. Final angiography showed good flow through the stent, but persistent ST elevation and tachycardia were noted.
- Acute coronary syndrome is classified into unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). History is crucial for diagnosis, including typical or atypical chest pain, duration, and associated symptoms. Differential diagnoses include other causes of chest pain like pulmonary embolism, esophageal issues, or musculoskeletal problems.
- Elderly, diabetic, and non-STEMI patients may present with atypical symptoms, such as dyspnea, weakness, or diaphoresis, rather than chest pain. Careful history taking is essential for accurate diagnosis and timely intervention.
- The classification of acute coronary syndrome depends on ECG findings and cardiac marker levels. STEMI is characterized by ST elevation and positive cardiac markers. NSTEMI has no ST elevation but positive cardiac markers. Unstable angina has no ST elevation and negative cardiac markers.
- In STEMI, the myocardium is completely occluded, leading to ST elevation. In NSTEMI and unstable angina, the occlusion is partial, resulting in no ST elevation, but potentially ST depression or T-wave inversion. The primary goal of treatment is to restore blood flow and prevent necrosis.
- Risk factors for coronary artery disease include hypertension, smoking, diabetes, obesity, and hypercholesterolemia. Women may present differently and have poorer outcomes compared to men.
- The diagnosis of STEMI requires specific ECG criteria, including ST segment elevation of at least 1 mm in two contiguous limb leads or 2 mm in two contiguous chest leads. Cardiac markers, such as troponin, are valuable for diagnosis, risk stratification, and assessing recent MI.
- Time is critical in managing STEMI. Early treatment can limit infarct size. Immediate treatment includes oxygen, nitrates, antiplatelet agents (aspirin and clopidogrel), statins, and pain management.
- Treatment strategies include primary percutaneous coronary intervention (PCI) or thrombolytic therapy. Absolute contraindications to thrombolytic therapy include active bleeding, intracranial neoplasm, or recent stroke.
- Successful thrombolysis is indicated by relief of symptoms, resolution of electrical instability, and at least 50% reduction in ST segment elevation. Patients with high-risk features after thrombolysis should undergo cardiac catheterization.
- Adjunct therapies include aspirin, clopidogrel, heparin, and nitrates. Beta-blockers should be used cautiously, considering contraindications such as bradycardia, hypotension, or heart failure. Statins are crucial for long-term management.
- Complications of acute myocardial infarction include ventricular aneurysm, ventricular rupture, ventricular septal defect, heart block, arrhythmias, Dressler's syndrome, pericarditis, and heart failure.
- The key to successful management of STEMI is rapid diagnosis, prompt initiation of reperfusion therapy, and careful management of complications to improve patient outcomes.
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