Covers ST-elevation myocardial infarction, from its place among acute coronary syndromes and the Fourth Universal Definition of MI through its atherothrombotic mechanism, ECG evolution and territory table, to reperfusion by primary PCI or fibrinolysis, in-hospital drugs, complications and prognosis. It includes the Killip classification, a table of fibrinolytic doses and contraindications, and a complications table.
Topic 26 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 7 sections, about 1,448 words (15 min of reading), with 16 flashcards.
In this note
Definition
Etiology and pathogenesis
Clinical features
Diagnosis
Treatment
Complications
Prognosis
Definition
Acute coronary syndromes (ACS): a spectrum of acute myocardial ischaemia — ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (topic 27). The first electrocardiogram (ECG) gives the working diagnosis (European Society of Cardiology, ESC 2023 ACS guideline).
STEMI: ischaemic symptoms with persistent ST elevation (or a STEMI equivalent), usually from complete thrombotic occlusion of an epicardial coronary artery, which leads to transmural necrosis if flow is not restored.
Fourth Universal Definition of Myocardial Infarction (2018)
Myocardial injury: cardiac troponin (cTn) above the 99th percentile upper reference limit; it is acute if the values rise and/or fall.
Acute myocardial infarction (MI): acute myocardial injury plus clinical evidence of acute ischaemia, i.e. at least one of: ischaemic symptoms; new ischaemic ECG changes; new pathological Q waves; imaging evidence of new loss of viable myocardium or a new regional wall motion abnormality of ischaemic pattern; coronary thrombus on angiography or autopsy.
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