I. See Also
- Chest Pain
- Cardiac Risk Factors
- Angina
- Angina Diagnosis
- Unstable Angina
- TIMI Risk Score
- Acute Coronary Syndrome Immediate Management
- Acute Coronary Syndrome Adjunctive Therapy
- High Risk Acute Coronary Syndrome Management
- Moderate Risk Acute Coronary Syndrome Management
- Low Risk Acute Coronary Syndrome Management
- Myocardial Infarction Stabilization
- Serum Cardiac Markers
- Electrocardiogram in Myocardial Infarction
- Echocardiogram in Myocardial Infarction
- Goldman Criteria for ICU Chest Pain Admission
II. Risk Factors
- See Cardiac Risk Factors
III. Epidemiology
- Prevalence of CAD in U.S.: 64 million (2001)
- Incidence of acute MI in U.S.: 1.2 million yearly
- No prior coronary symptoms in >50% with fatal acute MI
- Coronary deaths account for 20% of all deaths in U.S.
IV. Pathophysiology: Atherosclerotic Plaque
- Form over 10-15 years in response to vascular injury
- Significant Plaque present in 75% of age >25 years
-
Lipid core (atheroma)
- Injured endothelium attracts Macrophages
- Macrophages resorb LDL Cholesterol fatty streaks
- Lipids transform Macrophages into foam cells
- Surrounding wall (fibroatheroma)
- Surrounds lipid core
- Composed of fibroblasts and smooth muscle cells
- Acute MI or Acute Coronary Syndrome
V. Pathophysiology: Postinfarction remodeling
- Early Phase (<72 hours)
- Infarct zone expansion
- Myocardial wall thinning and ventricular dilation
- Increased elevated myocardial wall stress throughout cardiac cycle
- Renin-Angiotensin System activated (increased BNP)
- Late Phase (>72 hours)
- Left ventricle generalized effects and ventricular dilation over time resulting in distorted ventricular shape
- Mural hypertrophy occurs in response to ventricular load (decreases rate of dilation, preserves contractility)
- Fibrous tissue replaces necrotic myocytes in the first 4 weeks after Myocardial Infarction
- Ventricular effects do not improve with revascularization
- References
VI. Symptoms
- TIMI Risk Score
- See Angina Diagnosis
- Reviews the likelihood that Chest Pain is due to cardiovascular cause
- ACS is asymptomatic in 25% of Myocardial Infarctions
-
Chest Pain due to Myocardial Infarction is similar to Angina
- Deep, poorly localized chest ache
- Worse with activity
- Better with rest and Nitroglycerin
- Radiation
- Arm, Shoulder, hand or upper back
- Radiation to right arm or bilateral arms is more suggestive of coronary syndrome
- May also radiate to neck, jaw or throat (less specific)
- Deep, poorly localized chest ache
- Distinguishing features of Chest Pain due to Myocardial Infarction
- More intense than Angina
- More persistent than Angina (>30 minutes)
- Not fully relieved by palliative measures
- Rest
- Nitroglycerin (3 consecutive doses)
- Accompanied by systemic symptoms
VII. Signs
- Pallor
- Diaphoresis
- Tachycardia
- S4 Gallup Rhythm
- Signs of Congestive Heart Failure may also be present
- Rales on Lung Examination
- S3 Gallup Rhythm
-
Jugular Venous Distention
- Seen in Right Ventricular Infarction
VIII. Differential Diagnosis
IX. Diagnosis
-
Serum Cardiac Markers
- Serial Troponin
-
Electrocardiogram
- See Electrocardiogram in Myocardial Infarction
- Evaluate Electrocardiogram carefully
- Ischemic changes (e.g. ST segment depression or T Wave inversion) are commonly missed
- Echocardiogram
X. Management
XI. Complications
- Arrhythmia
- Congestive Heart Failure
- Cardiogenic Shock
- Acute Mechanical Complications
- Ventricular Septal Rupture
- Acute Mitral Regurgitation
- Pericarditis
- Ventricular aneurysm
- Recurrent Angina
- Dressler's Syndrome
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| Definition (MSH) | Thickening and loss of elasticity of the CORONARY ARTERIES, leading to progressive arterial insufficiency (CORONARY DISEASE). |
| Concepts | Disease or Syndrome (T047) |
| MSH | D003324 |
| ICD9 | 414.0 |
| ICD10 | I25.1 , K76.1, I25.10 |
| SnomedCT | 53741008, 266231003, 41702007, 155316000, 194841001, 266290000, 194795001, 155315001 |
| LNC | MTHU020784 |
| English | Arterioscleroses, Coronary, Arteriosclerosis, Coronary, Coronary Arterioscleroses, Coronary Arteriosclerosis, CORONARY ARTERIOSCLEROSIS, CORONARY SCLEROSIS, ARTERIOSCLEROTIC HEART DISEASE, Atherosclerotic heart disease, Coronary atheroma, coronary arteriosclerosis (diagnosis), coronary arteriosclerosis, ASHD - Atherosclerotic heart disease, Cardiac sclerosis, Coronary (artery) atherosclerosis, Coronary (artery) sclerosis, cardiac ischemia, myocardial ischemia, Disease;atherosclerotic;heart, arteriosclerotic heart disease, cardiac ischaemia, coronary atheroma, coronary sclerosis, ischaemic heart disease, coronary heart disease, myocardial ischaemia, coronary artery atherosclerosis, coronary artery diseases, coronary artery disease, coronary atherosclerosis, Atherosclerotic heart disease NOS, Coronary atherosclerosis (disorder), cardiac; sclerosis, coronary; arteriosclerosis, coronary; sclerosis, disease (or disorder); arteriosclerotic, coronary (artery), disease (or disorder); arteriosclerotic, heart, heart; arteriosclerosis, sclerosis; cardiac, sclerosis; coronary, arteriosclerosis; coronary (artery), arteriosclerosis; coronary, arteriosclerosis; heart, Atheroscleroses, Coronary, Atherosclerosis, Coronary, Coronary Atheroscleroses, Coronary Atherosclerosis, Arteriosclerotic heart disease, Coronary arteriosclerosis, Coronary sclerosis, Coronary arteriosclerosis (disorder), ASHD, Coronary artery arteriosclerosis, atherosclerotic heart disease, Coronary atherosclerosis, Arteriosclerosis coronary artery, Coronary artery atherosclerosis, Coronary artery sclerosis |
| German | KORONARSKLEROSE, Arteriosklerose der Koronararterie, Koronararterie Sklerose, arteriosklerotische Herzkrankheit, Koronarsklerose, Koronararteriosklerose, Atherosklerotische Herzkrankheit, Koronararteriensklerose, Sklerose, Koronar- |
| Dutch | kransslagaderateriosclerose, kransslagaderatherosclerose, kransslagadersclerose, arteriosclerotische hartaandoening, aandoening; arteriosclerotisch, coronair{arterie}, aandoening; arteriosclerotisch, hart, arteriosclerose; aandoening, coronair{arterie}, arteriosclerose; aandoening, hart, arteriosclerose; coronair, cardiaal; sclerose, coronair; arteriosclerose, coronair; sclerose, hart; arteriosclerose, sclerose; cardiaal, sclerose; coronair, Arteriosclerose, coronaire, Atherosclerose, coronaire, Atherosclerotische hartziekte, Coronaire arteriosclerose, Coronaire atherosclerose, Coronaire hartziekte, Coronairziekte |
| French | Artériosclérose de l'artère coronaire, Sclérose de l'artère coronaire, Athérosclérose artérielle coronaire, Athérosclérose coronaire, Sclérose coronaire, Maladie cardiaque artérioscléreuse, SCLEROSE CORONAIRE, Artériosclérose coronaire, Artériosclérose coronarienne, Athérosclérose coronarienne, Artériosclérose des artères coronaires, Artériosclérose des coronaires, Athérosclérose des artères coronaires, Athérosclérose des coronaires |
| Italian | Arteriosclerosi dell'arteria coronaria, Sclerosi coronarica, Stenosi dell'arteria coronaria, Aterosclerosi coronarica, Aterosclerosi dell'arteria coronaria, Cardiopatia arteriosclerotica, Arteriosclerosi coronarica |
| Portuguese | Arteriosclerose das coronárias, Esclerose coronária, Aterosclerose das artérias coronárias, Esclerose das artérias coronárias, Aterosclerose coronária, Cardiopatia arteriosclerótica, ESCLEROSE CORONARIA, Arteriosclerose Coronária, Aterosclerose Coronária |
| Spanish | Arterioesclerosis de la arteria coronaria, Ateroesclerosis de la arteria coronaria, Esclerosis coronaria, Esclerosis de la arteria coronaria, Ateroesclerosis coronaria, CORONARIA, ESCLEROSIS, Arteriosclerosis Coronaria, arteriosclerosis coronaria (trastorno), arteriosclerosis coronaria, arterioesclerosis coronaria, Enfermedad arterioesclerotica cardiaca, ateroesclerosis coronaria (trastorno), esclerosis coronaria, ateroesclerosis coronaria, enfermedad ateroesclerótica cardÃaca, enfermedad aterosclerótica cardÃaca, Aterosclerosis Coronaria |
| Japanese | å† è¡€ç®¡ç¡¬åŒ–ç—‡, å† çŠ¶å‹•è„ˆç²¥çŠ¶ç¡¬åŒ–ç—‡, å† å‹•è„ˆç²¥çŠ¶ç¡¬åŒ–ç—‡, 動脈硬化性心疾患, ï½¶ï¾�ジョウドウï¾�ャクジï½ï½¸ï½¼ï¾žï½®ï½³ï½ºï½³ï½¶ï½¼ï½®ï½³, ï½¶ï¾�ドウï¾�ャクコウカショウ, ï½¶ï¾�ケッカï¾�コウカショウ, ï½¶ï¾�ドウï¾�ャクジï½ï½¸ï½¼ï¾žï½®ï½³ï½ºï½³ï½¶ï½¼ï½®ï½³, ドウï¾�ャクコウカセイシï¾�シッカï¾�, アテãƒãƒ¼ãƒ 硬化症-å† çŠ¶, å† çŠ¶å‹•è„ˆç¡¬åŒ–, å† çŠ¶ã‚¢ãƒ†ãƒãƒ¼ãƒ 硬化症, å† çŠ¶å‹•è„ˆã‚¢ãƒ†ãƒãƒ¼ãƒ 硬化, å† çŠ¶å‹•è„ˆç¡¬åŒ–ç—‡, å† å‹•è„ˆã‚¢ãƒ†ãƒãƒ¼ãƒ 硬化, å† å‹•è„ˆç¡¬åŒ–ç—‡, 動脈硬化症-å† çŠ¶å‹•è„ˆ, å† å‹•è„ˆã‚¢ãƒ†ãƒãƒ¼ãƒ 性硬化, å† çŠ¶å‹•è„ˆã‚¢ãƒ†ãƒãƒ¼ãƒ 性硬化症, å† å‹•è„ˆç¡¬åŒ–, å† çŠ¶å‹•è„ˆã‚¢ãƒ†ãƒãƒ¼ãƒ 性硬化 |
| Czech | koronárnà arterioskleróza, Arterioskleróza koronárnÃch tepen, Koronárnà skleróza, Arteriosklerotické onemocnÄ›nà srdce, Ateroskleróza koronárnÃch arteriÃ, Skleróza koronárnà arterie, Koronárnà ateroskleróza |
| Korean | 죽�경화성 심장병 |
| Croatian | KORONARNA ARTERIOSKLEROZA |
| Hungarian | Coronaria atherosclerosis, Arteria cor onaria arteriosclerosis, Coronariasclerosis, Arteria coronaria atherosclerosis, SzÃv arterioscleroticus betegsége, Arteria coronaria sclerosis |
| Norwegian | Koronar arteriosklerose |
Ontology: Myocardial Infarction (C0027051)
| Definition (MEDLINEPLUS) |
Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don't get help immediately. It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include
These symptoms can sometimes be different in women. What exactly is a heart attack? Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat - called an arrhythmia - that causes a severe decrease in the pumping function of the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die. NIH: National Heart, Lung, and Blood Institute |
| Definition (NCI_FDA) | Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis. |
| Definition (NCI_CTCAE) | A disorder characterized by gross necrosis of the myocardium; this is due to an interruption of blood supply to the area. |
| Definition (NCI) | Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis. |
| Definition (CSP) | gross necrosis of the myocardium, as a result of interruption of the blood supply to the area. |
| Definition (MSH) | NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION). |
| Concepts | Disease or Syndrome (T047) |
| MSH | D009203 |
| ICD10 | I22 , I21 |
| SnomedCT | 66514008, 266288001, 155304006, 194796000, 233824008, 22298006 |
| LNC | LP98884-7, MTHU035551, LA14274-7, LA10558-7 |
| English | Myocardial Infarct, Infarctions, Myocardial, Myocardial Infarction, Myocardial Infarctions, Infarcts, Myocardial, Myocardial Infarcts, HEART ATTACK, Infarct, Myocardial, Infarction, Myocardial, MI, Myocardial infarction (MI), Attack heart (NOS), Infarct myocardial, cardiac infarction, Myocardial Infarction [Disease/Finding], attacking heart, heart attacks, attack hearts, infarctions myocardial, infarcts myocardial, myocardial infarctions, Infarction;heart, myocardial infarcts, Infarction;myocardial, AMI, attacks coronary, attacks hearts, coronary attack, disorder infarction myocardial, myocardial necrosis, syndrome myocardial infarction, heart attack, mies, Heart Attack, Attack - heart, Cardiac infarct, myocardial infarction, myocardial infarction (diagnosis), MI, MYOCARDIAL INFARCTION, MYOCARDIAL INFARCTION, MYOCARDIAL INFARCTION, (MI), INFARCTION (MI), MYOCARDIAL, -- Heart Attack, Cardiovascular Stroke, Cardiovascular Strokes, Stroke, Cardiovascular, Strokes, Cardiovascular, Myocardial infarct, Myocardial infarction, Heart attack, MI - Myocardial infarction, Cardiac infarction, Infarction of heart, Myocardial infarction (disorder), cardiac; infarction, infarction; myocardial, Cardiac infarction, NOS, Heart attack, NOS, Infarction of heart, NOS, Myocardial infarction, NOS, Heart Attacks, Infarctions (Myocardial), Myocardial infarction NOS, Attack coronary, heart infarction |
| German | MYOKARDINFARKT, Koronarattacke, Herzanfall, MI, Herzanfall (NNB), HERZANFALL, Herzinfarkt, Myokardinfarkt |
| Dutch | hartaanval, hartinfarct, hartaanval (NAO), MI, cardiaal; infarct, infarct; myocard, myocardinfarct, Hartinfarct, Infarct, myocard-, Myocardinfarct |
| French | Crise coronaire, IM, Crise cardiaque SAI, Crise cardiaque, CRISE CARDIAQUE, INFARCTUS DU MYOCARDE, IDM (Infarctus Du Myocarde), Infarctus du myocarde, Infarctus myocardique |
| Italian | MI, Attacco cardiaco, Attacco coronarico, Attacco cardiaco (NAS), Infarto del miocardio, Infarto miocardico |
| Portuguese | Ataque coronário, Ataque do coração, Ataque cardÃaco NE, EM, ATAQUE CARDIACO, ENFARTO DO MIOCARDIO, Enfarte do miocárdio, Infarto do Miocárdio |
| Spanish | IM, Crisis coronaria, Ataque al corazón, Ataque al corazón (NEOM), Infarto miocárdico, ATAQUE CARDIACO, INFARTO DE MIOCARDIO, Infarto al Miocardio, ataque al corazón, infarto cardÃaco, infarto de corazón, infarto de miocardio (trastorno), infarto de miocardio, Infarto de miocardio, Infarto del Miocardio |
| Japanese | 心臓発作(NOS), å† ç™ºä½œ, 心臓発作, ï½¶ï¾�ホッサ, ï½¼ï¾�ゾウホッサNOS, ï½¼ï¾�ゾウホッサ, ï½¼ï¾�ï½·ï¾�コウソク, å† çŠ¶å‹•è„ˆæ¢—å¡ž, å¿ƒç‹æ¢—塞, å† å‹•è„ˆæ¢—å¡ž, å¿ƒç‹æ¢—塞症 |
| Swedish | Hjärtinfarkt |
| Czech | infarkt myokardu, Srde�nà záchvat, Srde�nà záchvat (NOS), IM, Koronárnà záchvat, Infarkt myokardu |
| Finnish | Sydäninfarkti |
| Russian | INFARKT MIOKARDA, И�Ф�РКТ МИОК�РД� |
| Croatian | SRÄŒANI INFARKT |
| Polish | Świeży zawał serca, Zawał serca świeży, Zawał mięśnia sercowego, Zawał serca |
| Hungarian | Coronaria roham, SzÃvroham (k.m.n.), SzÃvroham, Infarctus myocardii, SzÃvizom infarctus, MI |
| Norwegian | Hjerteinfarkt, Hjerteattakk, Myokardinfarkt |
Ontology: Acute Coronary Syndrome (C0948089)
| Definition (MSH) | An episode of MYOCARDIAL ISCHEMIA that generally lasts longer than a transient anginal episode that ultimately may lead to MYOCARDIAL INFARCTION. |
| Definition (NCI_CTCAE) | A disorder characterized by signs and symptoms related to acute ischemia of the myocardium secondary to coronary artery disease. The clinical presentation covers a spectrum of heart diseases from unstable angina to myocardial infarction. |
| Definition (NCI) | Signs and symptoms related to acute ischemia of the myocardium secondary to coronary artery disease. The clinical presentation covers a spectrum of heart diseases from unstable angina to myocardial infarction. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D054058 |
| SnomedCT | 393587009, 394659003 |
| Japanese | æ€¥æ€§å† å‹•è„ˆç—‡å€™ç¾¤, ï½·ï½ï½³ï½¾ï½²ï½¶ï¾�ドウï¾�ャクショウコウグï¾� |
| English | Coronary Syndromes, Acute, Syndromes, Acute Coronary, Acute Coronary Syndromes, Acute Coronary Syndrome, Syndrome, Acute Coronary, Coronary Syndrome, Acute, Acute Coronary Syndrome [Disease/Finding], acute coronary syndromes, syndrome acute coronary, acute coronary syndrome (diagnosis), acute coronary syndrome, Acute coronary syndrome, Acute coronary syndrome (disorder), ACS - Acute coronary syndrome |
| Portuguese | SÃndrome Coronariana Aguda, SÃndrome coronário agudo |
| Spanish | SÃndrome Coronario Agudo, sÃndrome coronario agudo (trastorno), sÃndrome coronario agudo, SÃndrome coronario agudo |
| Finnish | Akuutti sepelvaltimo-oireyhtymä |
| German | Akutes Koronarsyndrom, akutes Koronarsyndrom |
| Italian | Sindrome coronarica acuta |
| Russian | KORONARNYI SINDROM OSTRYI, КОРО��Р�ЫЙ СИ�ДРОМ ОСТРЫЙ |
| Swedish | Akut koronarsyndrom |
| Czech | Akutnà koronárnà syndrom, akutnà koronárnà syndrom |
| French | Syndrome coronaire aigu, SCA (Syndrome Coronarien Aigu), Syndrome coronarien aigu |
| Polish | Zespół wieńcowy ostry |
| Hungarian | Acut coronaria syndroma |
| Norwegian | Akutt koronarsyndrom, Koronarsyndrom, akutt, AKS |
| Dutch | acuut coronairsyndroom |

