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MYOCARDIAL INFARCTION
ACS :4rth
UDMI
Universal 4rth
definition
,2020
Type 1: Atherosclerotic plaque
disruption
Type 2: mismatch between oxygen
supply and deman...
Type 4a: Periprocedural AMI(PCI)
• coronary dissection, occlusion of a major epicardial artery or a
side branch occlusion/...
WHEN TO SUSPECT
ACUTE MI
• CHEST PAIN
• SHORTNESS OF BREATH
• NEW HEART FAILURE
• SUDDEN CARDIAC ARREST
ECG: within
10 minutes
after first
contact
ST-elevation/new LBBB
NSTEMI
unstable angina
• ST-depression, T wave inversions...
STEMI ECG
J-point elevation and
concave ST
J-point elevation and
convex ST
ST/T merge with
upward single
convexity
STEMI
• New ST-segment elevation at the J-point in two contiguous leads with the cut-points:
≥0.1 mV in all leads other th...
NSTEMI
New horizontal or down
sloping ST-depression ≥0.5
mm in two contiguous leads
and/or T inversion >1 mm in
two contig...
Nondiagnostic initial ECG
Wait and watch
Troponin
Serial ECG is key :at first contact
,at 3hour ,at 6hour
Measurement :
• hS-Tp=00-0.02 nano gram /ml
• Kit test (Q...
The findings
on the ECG
depend upon
Duration – Hyperacute,
acute, evolving, or chronic
Size – Amount of
myocardium affecte...
Left bundle
branch block
• ST-depression of at least 1 mm in
leads V1, V2, or V3 or in leads II, III,
or Avf
• ST elevatio...
Old MI:
Fourth
Universal
Definition
• in the absence of left bundle
branch block or left
ventricular hypertrophy
• Any Q w...
Treatment
STEMI
TLT:STAR
NSTEMI
Myocardial infarction
Myocardial infarction
Myocardial infarction
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Myocardial infarction

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Myocardial infarction

Publicada em: Saúde e medicina
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Myocardial infarction

  1. 1. MYOCARDIAL INFARCTION
  2. 2. ACS :4rth UDMI
  3. 3. Universal 4rth definition ,2020 Type 1: Atherosclerotic plaque disruption Type 2: mismatch between oxygen supply and demand • Coronary dissection • Vasospasm • Emboli • Microvascular dysfunction • Increases in demand :HCM/HTN/HOCM Type 3 : MI resulting in death when biomarker values are unavailable
  4. 4. Type 4a: Periprocedural AMI(PCI) • coronary dissection, occlusion of a major epicardial artery or a side branch occlusion/thrombus, disruption of collateral flow, slow flow or no-reflow, or distal embolization Type 4b: PCI-related MI is stent/scaffold thrombosis Type 5: CABG : cTn values >10 times the 99th percentile URL in patients with normal baseline cTn values • new pathological Q waves • new graft occlusion or new native coronary artery occlusion • new loss of viable myocardium or new RWMA
  5. 5. WHEN TO SUSPECT ACUTE MI • CHEST PAIN • SHORTNESS OF BREATH • NEW HEART FAILURE • SUDDEN CARDIAC ARREST
  6. 6. ECG: within 10 minutes after first contact ST-elevation/new LBBB NSTEMI unstable angina • ST-depression, T wave inversions, or transient ST-elevation Nondiagnostic :Follow with serial ECG
  7. 7. STEMI ECG J-point elevation and concave ST J-point elevation and convex ST ST/T merge with upward single convexity
  8. 8. STEMI • New ST-segment elevation at the J-point in two contiguous leads with the cut-points: ≥0.1 mV in all leads other than leads V2-V3 • V2-V3: • ≥2 mm in men ≥40 years • ≥2.5 mm in men <40 years • ≥1.5 mm in women regardless of age
  9. 9. NSTEMI New horizontal or down sloping ST-depression ≥0.5 mm in two contiguous leads and/or T inversion >1 mm in two contiguous leads with prominent R wave or R/S ratio >1
  10. 10. Nondiagnostic initial ECG Wait and watch
  11. 11. Troponin Serial ECG is key :at first contact ,at 3hour ,at 6hour Measurement : • hS-Tp=00-0.02 nano gram /ml • Kit test (Qualitive ):>40 nano gram /ml • Routine quantitative :>give the value if it is >40 nano gram /ml (ROCHE’s Lab)
  12. 12. The findings on the ECG depend upon Duration – Hyperacute, acute, evolving, or chronic Size – Amount of myocardium affected Location – Anterior, lateral, inferior-posterior, or right ventricle
  13. 13. Left bundle branch block • ST-depression of at least 1 mm in leads V1, V2, or V3 or in leads II, III, or Avf • ST elevation of at least 1 mm in lead V5 Concordant changes : • ST changes in the opposite direction of the major QRS vector of >5 mm Discordant changes
  14. 14. Old MI: Fourth Universal Definition • in the absence of left bundle branch block or left ventricular hypertrophy • Any Q wave in leads V2 to V3 ≥0.02 sec or QS complex in V2 and V3; • Q wave ≥0.03 sec and ≥0.1 mV deep or QS complex in leads I, II, aVL, aVF; or V4 to V6 in any two leads of a contiguous lead grouping (I, aVL; V1 to V6; II, III, aVF) • R wave ≥0.04 sec in V1 to V2 and R/S ≥1 with a concordant positive T wave in the absence of a conduction defect.
  15. 15. Treatment
  16. 16. STEMI
  17. 17. TLT:STAR
  18. 18. NSTEMI

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