1. Prepared by:
malek ahmad

2. Definition and epidemiology
Aetiological factors and Risk factors
Pathophysiology
Sign and symptoms
Investigation
Differential diagnosis
Treatment and management
Complications
Prognosis

3. Definition
Irreversible necrosis of cardiac myocyte 20 to prolonged
ischemic (extention of ACS ( unstable angina, NSTEMI))
Epidemiology
 1.5 million cases of MI each year and CVD cause 12million deaths
each year
 High risk among African American and white population in US
 Male predominance and premenopausal women are protected (E2)
 Incidence increases with age

4. Aetiological factors Risk factors
 Atheromatous plaque >  Non-modifiable
 Age, Sex, FH
cracked and ruptured >  Modifiable
thrombus (occlusive or  Smoking and obestity
partially)  DM, HPT,Dyslipidemia
 Non atherosclerotic causes
 Coronary artery embolism  Vasculitis
 Congenital anomaly  Coronary embolism, trauma,
spasm (histamine, serotonin)
 Coronary artery vasculitis  Drugs- coccaine
 Congenital
– kawasaki disease in  Factor increase O2
child requirement / decrease O2
supply
 Dissecting aneurysm w  Others
coronary occlusion  Homocysteine
 Peripheral vascular D
 Stress

5.  Imbalance btwn O2 supply and O2 demand >
Cellular ischemia
 Atherosclerotic causes:
 Stable angina- fixed narrowing, thus arterial lumen must
reduced by 90% -cellular ischemia at rest, 50%- exercise
 Unstable angina- fissuring of AP > platelet accumulation >
transient thrombotic occlusion > platelet release VasoC
factors (TXA2n serotonin) + endothelial dysfunction>
compromise flow
 Perfusion must be restored w/in 40-60m, or lead to
irreversible injury due to severe ATP depletion >
increased extracellular ca conc, lactic acidosis and free
radical

6. Symptoms Signs
 Chest pain  Sign of hyperlipedemia
 Site- central and substernal  Evidence of DM, TD, Gout,
 Onset-sudden/exertion tar stained
 Character- tight, compress, squeez,
ache, burn, sharp  Bradycardia- CO,
 Radiation- left arm n neck*back arrhythmia
 Associated w  BP
 Timing- over 20 mins
 LGF
 Exacerbate n relieve- exertion n
GTN  Normal JVP, JVP- HF
 SOB-ischemia> EDP / systolic  4th heart sound, 3rd – HF
and diastolic dysF > pulmonary  Pericardial friction rub
P
 MR/ VSD
 Sweating, palpitation, fatigue ,
N, V (sympathetic overdrive)  Bibasal crackles
 Risk factors assesment

7. Blood
Imaging
• Troponin T(s:3- • Full thickness MI- ant n inf lead>
12h)(p:24-48h) STE, T wave inversion and +Qwave
Cardiac (r:5-14d)
ECG • Subendocardial MI- ST and T wave
change, no Q wave
enzyme • CK-MB (s:3-12h)
• Post MI- no Q wave, tall R wave in VI
(p:24h) (r:2-3d)
• RV + inf infarct-STE in V3 n V4
• Urine myoglobin
• Heart size, +- CHF +- pulmonary
edema
FBC • Anemia,
leukocytosis
CXR • Concomitant disease
• Exclude DD
• Chemistry profile: • Extent of infarction
creatinine ECHO • Assess complication- MR, pericardial
others • Lipid profile effusion, LV rupture
• CRP-inflamation
marker
Cardiac cathetherization

8. Anxiety disorders
Aortic dissection / Aortic sternosis
cholecystitis
Esophageal spasm, esophangitis, GERD
Myocarditis, pericarditis
Pneumothorax, pulmonary embolism

9. Medical care Surgical care Others
• Tx based on: • Percutaneous • Diet control
i- Restore balance coronary • Minimize activity
ii-Pain relief- intervention- • Consultation
opiates and STEMI, cardiogenic
• Coronary
antiemetics shock, whom
rehabilitation
iii-Prevent and Tx thrombolysis
of Cx failed, high • Health education
• Thrombolysis- bleeding tendency • Exercise stress test
aspirin, alteplase, • Urgent coronary
streptokinase artery graft
• Nitrates bypass- whom
• B-blockade angioplasty failed,
patient with
• ACE inhibitors
mechanical
• Anticoagulant- complication-VSD,
heparin LV, PM rupture

10. SupraV
Arrhythmias- arrhythmia, Sinus
VF +- VTachy
heart block brady/tachy, AF,
A tachy
CHF- systolic /
Recurrent Cardiogenic
diastolic
ischemia shock
dysfuntion
Acute MR- Pericarditis,
Ventricular
inferopost MI due ventricular
rupture at IVS/
to ischemia, aneurysm, mural
LV free wall
necrosis, rupture thrombi, HPT

11. 5-10% survivor
die within 1st
year after MI
AMI- Half of all
associated w patients w MI
30% of rehospitalized
mortality rate within 1 year
Variable n
depend to extent
of infarct,
residual LV
function,
revascularization