Diagnosis and management of ST-elevation of myocardial infarction

2016 ◽  
Author(s):  
David Erlinge ◽  
Göran Olivecrona
Keyword(s):  
Myocardial Infarction ◽  
Thrombus Formation ◽  
Beta Blockers ◽  
Adenosine Diphosphate ◽  
Acute Onset ◽  
Lifestyle Changes ◽  
Mitral Insufficiency ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation

ST-elevation myocardial infarction (STEMI) is generally caused by a ruptured plaque that triggers local thrombus formation, which occludes the coronary artery. STEMI should be diagnosed rapidly, based on the combination of ST-segment elevation and symptoms of acute myocardial infarction. The main treatment objective is myocardial tissue reperfusion as quickly as possible. The preferred method of reperfusion is primary percutaneous coronary interventionif transport time is below 2 hours, and thrombolysis if longer STEMI patients with acute onset cardiogenic shock should be evaluated by echocardiography to exclude mechanical complications, such as flail mitral insufficiency, ventricular septal defect or tamponade. Secondary prevention includes aspirin, adenosine diphosphate receptor antagonists, statins, beta-blockers, angiotensin-converting enzymeinhibitors, and lifestyle changes.

scholarly journals A rare cause of acute ST-elevation myocardial infarction: a case of coronary embolism secondary to calcified bicuspid aortic valve

2021 ◽  
Vol 31 (1) ◽  
pp. 116-121
Author(s):  
Anda Bularga ◽  
Andrew R Chapman ◽  
John Hung ◽  
Nicholas L. Mills ◽  
Marc R. Dweck
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Acute Onset ◽  
St Elevation Myocardial Infarction ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Coronary Embolism

Coronary embolism is an uncommon cause of acute myocardial infarction, which can have a similar clinical presentation to a plaque rupture event with acute onset of ischaemic symptoms, ST segment elevation on electrocardiogram (ECG) and signifi cant elevation in cardiac troponin, requiring immediate intervention. We report the case of a middle-aged female with a background history of previous non-ST elevation myocardial infarction, bicuspid aortic valve with severe stenosis and metastatic breast cancer. The patient underwent emergency coronary angiography following acute onset central chest pain and evidence of anterior ST segment elevation on ambulance 12-lead ECG. The procedure revealed complete occlusion of the mid left anterior descending coronary artery with immediate fl ow restoration following embolus aspiration and subsequent normal appearance of the left anterior descending coronary artery. Gross examination of the aspirated specimen resembled a calcified hard lump, which was further confirmed on microscopic examination revealing calcified fibrous tissue most likely an embolus from the calcified bicuspid aortic valve. The patient had evidence of near transmural myocardial infarction in the distribution of the left anterior descending coronary on cardiac magnetic resonance imaging (MRI). She made full recovery and was discharged on short-term dual antiplatelet therapy followed by lifelong aspirin and further assessment for aortic stenosis management.

scholarly journals Management of ST Elevation Myocardial Infarction (STEMI) in Different Settings

2021 ◽  
Author(s):  
Rod Partow-Navid ◽  
Narut Prasitlumkum ◽  
Ashish Mukherjee ◽  
Padmini Varadarajan ◽  
Ramdas G. Pai
Keyword(s):  
Myocardial Infarction ◽  
Treatment Strategies ◽  
Management Process ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Multiple Factors ◽  
St Segment ◽  
Threatening Condition ◽  
Life Threatening ◽  
St Elevation

AbstractST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that requires emergent, complex, well-coordinated treatment. Although the primary goal of treatment is simple to describe—reperfusion as quickly as possible—the management process is complicated and is affected by multiple factors including location, patient, and practitioner characteristics. Hence, this narrative review will discuss the recommended management and treatment strategies of STEMI in the circumstances.

Abstract 12762: Clinical Characteristics and Determinants of Non-Eligibility for Reperfusion in Patients With ST Segment Elevation Myocardial Infarction: Insights From the NCDR®

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tarun W Dasari ◽  
Steve Hamilton ◽  
Anita Y Chen ◽  
Tracy Y Wang ◽  
James A de Lemos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Characteristics ◽  
Major Contributor ◽  
Primary Pci ◽  
Hospital Outcomes ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
St Elevation

Background: There is little recent data describing the characteristics and outcomes of STEMI patients who do not undergo urgent reperfusion. Methods: Using the ACTION Registry®-GWTG™ database, we examined 232,208 STEMI patients presenting January 2007 through December 2013 at 793 U.S. centers. The cohort was divided into those who underwent reperfusion (n=194,916; 84%), had documented contraindication to reperfusion (n=31,518; 13.5%) and were eligible but not reperfused (n=5,774; 2.5%). Clinical characteristics and in-hospital outcomes were compared between these groups. Results: Compared with those reperfused, patients not reperfused were older, more often female and had higher rates of hypertension, diabetes, MI, stroke and atrial fibrillation. LBBB and CHF were more common in the non-reperfused groups upon presentation. The major documented contraindications to reperfusion were unsuitable anatomy for primary PCI (31%), symptoms onset > 12 hours (9%), patient/family refusal/DNR status (6%), resolved chest pain (6%) and ST elevation (5%) presentation to non-PCI centers (4%). Three-vessel disease and in-hospital CABG were more common in non-reperfused patients with and without contraindication compared with those receiving reperfusion (39 & 37% vs. 26%, p<0.001) and (17 & 17% vs. 3%, p<0.001 respectively). In-hospital outcomes are summarized in the table. Conclusion: Most STEMI patients who were not reperfused had a documented contraindication. Unsuitable anatomy for PCI was the major contributor to ineligibility. In hospital mortality, death/MI and cardiogenic shock were higher in the non-reperfused groups.

scholarly journals High risk electrocardiographic patterns in patients with acute coronary syndrome.

2020 ◽  
Vol 2 (1) ◽  
pp. 25-34
Author(s):  
Diego Echeverri- Marín ◽  
Cristhian Felipe Ramirez Ramos ◽  
Andrés Miranda-Arboleda ◽  
Gustavo Castilla-Agudelo ◽  
Clara Saldarriaga-Giraldo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Reperfusion Therapy ◽  
Early Reperfusion ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Acute Coronary Occlusion ◽  
St Segment ◽  
St Elevation ◽  
Electrocardiographic Findings

Acute myocardial infarction is the leading cause of death in the world and the electrocardiogram remains the diagnostic tool for determining an acute myocardial infarction with ST-segment elevation. In spite of this, only half of the patients present classic electrocardiogram findings compatible with the ST-elevation infarction criteria. There is a spectrum of electrocardiographic findings that may reflect a phenomenon of acute coronary occlusion, which should be promptly recognized by the clinician to offer early reperfusion therapy.

scholarly journals A case of left circumflex artery stenosis involving ST segment depression in multiple leads with ST elevation in lead augmented vector right

2019 ◽  
Vol 6 (7) ◽  
pp. 2598
Author(s):  
C. P. Karunadas ◽  
Cibu Mathew
Keyword(s):  
Beta Blockers ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Left Circumflex Artery ◽  
St Depression ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation

Electrocardiography (ECG) patterns of ST-segment elevation in lead aVR with or without diffuse ST segment depression may predict either left main coronary artery or triple vessel stenosis. Here, we have presented the case of a 56-year-old female involving such an ECG pattern with ST-segment depression in more than eight leads and ST Segment elevation in lead aVR, however, showing stenosis of the mid-segment of the left circumflex artery (LCX). She was scheduled to undergo percutaneous coronary intervention with implantation of a drug-eluting stent with respect to mid LCX stenosis. The patient was asymptomatic post procedure and was discharged on beta blockers. To conclude, the ECG pattern of ST depression in multiple leads with ST-elevation in aVR lead can occur in LCX obstruction as well. 

Abstract 169: Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Abhishek Sharma ◽  
Samin Sharma ◽  
Debabrata Mukherjee ◽  
Akash Garg ◽  
Carl Lavie ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Beta Blockers ◽  
Final Analysis ◽  
Reperfusion Therapy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Standard Medical Therapy ◽  
St Segment ◽  
Early Use

Background: It remains unclear if early use of intravenous (IV) beta-blockers (iBB) improves clinical outcomes patients with ST-segment elevation myocardial infarction (MI; STEMI), especially among those who received reperfusion therapy. Objective: To evaluate effect of early iBB use on clinical outcomes among patients with STEMI. Methods: A systematic review of randomized control trials in MEDLINE, EMBASE, CINAHL, and Cochrane databases comparing early use (administered within 12 hours of presentation) of iBB with standard medical therapy/placebo among patients who presented with STEMI. The effect of iBB was assessed by stratifying studies into pre-reperfusion and reperfusion trials and pooled treatment effects were estimated using relative risk with Mantel-Haenszel risk ratio, using a random-effects model Results: Twenty-one studies (N=74,801) were selected for final analysis. Clinical outcomes at 30 days and 1 year are summarized in table below. Conclusion: In the current reperfusion era, early use of iBB in patients with STEMI was associated with reduction in the risk of recurrent MI and ventricular tachyarrhythmias without any significant reduction in all-cause or CV mortality or increase in the risk of cardiogenic shock.

The Value of Electrocardiographic Changes in Evaluating the Prognosis of Acute ST-Elevation Myocardial Infarction (STEMI) After PCI

2021 ◽  
Vol 7 (5) ◽  
pp. 1435-1442
Author(s):  
Yang Yang ◽  
Xiuyu Liang ◽  
Yuzhe Fan ◽  
Gendong Zhou ◽  
Xiaohong Zhang
Keyword(s):  
Myocardial Infarction ◽  
Evaluation Method ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Observation Group ◽  
St Segment Elevation ◽  
St Segment ◽  
Thrombolytic Effect ◽  
St Elevation ◽  
The Difference

To explore the relationship between the changes of ECG indexes and the prognosis after PCI in patients with acute ST-elevation myocardial infarction (STEMI), and to develop the evaluation method and analyze the advantages and characteristics. 420 patients with acute myocardial infarction (AMI) were admitted to our hospital from March 2017 to April 2020. They were divided into the observation group (ST segment elevation type) with 220 patients and control group (non-ST segment elevation type) with 200 patients according to whether ST segment elevation was or not. ECG was detected before and 1 hour after operation, evaluation of thrombolytic effect, 6-minute walking test and echocardiography were performed 3 months after operation. Compared with the control group, the ECG of the observation group showed St Compared with the control group, the thrombolytic effect of the observation group was significantly improved, and the difference was statistically significant (P < 0.05); compared with the control group, the thrombolysis effect of the observation group was significantly improved, the difference was statistically significant (P < 0.05); ECG index can effectively reflect the recovery of cardiac function after PCI in patients with acute STEMI, and can effectively indicate the improvement of symptoms in patients with AMI, which is worthy of clinical application.

ST-segment elevation myocardial infarction

2021 ◽  
pp. 479-493
Author(s):  
Borja Ibanez ◽  
Stefan James
Keyword(s):  
Myocardial Infarction ◽  
Primary Angioplasty ◽  
Special Focus ◽  
St Segment Elevation ◽  
St Segment ◽  
Life Threatening ◽  
St Elevation ◽  
Reperfusion Strategy ◽  
Early Phases

ST-elevation myocardial infarction (STEMI) is a life-threatening conditioning caused by an abrup occlusion of an epicardial coronary artery. Reperfusion (ideally by primary angioplasty, and if not timely available by systemic fibrinolysis) massively improves survival in STEMI patients. Healthcare systems attending STEMI patients in the early phase are critical for a correct triage, reperfusion strategy selection and initial treatment. Besides reperfusion, coadjuvant therapies are critical to improve the success of management and in turn improves long-term mortality and morbidility associated with STEMI. The present chapter presents the state-of-art evidence guiding recommendations for treatment of STEMI with a special focus on the early phases of the process.

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