1. HeartPoint: Myocardial Infarction Clear patientoriented information on having a heart attack. Includes an animation of the pathological process and answers to a wide variety of common questions about this type of heart disease. http://www.heartpoint.com/mi.html

HEART ATTACK (also known as "MYOCARDIAL INFARCTION") HeartPoint animation: this will take approximately 1 minute to load. The proper use of the non-medical term "heart attack" is "Myocardial Infarction". Either term is scary. "Myocardial Infarction" (abbreviated as "MI") means there is death of some of the muscle cells of the heart as a result of a lack of supply of oxygen and other nutrients. This lack of supply is caused by closure of the artery ("coronary artery") that supplies that particular part of the heart muscle with blood. This occurs 98% of the time from the process of arteriosclerosis ("hardening of the arteries") in coronary vessels. Although it once was felt that most heart attacks were caused from the slow closure of an artery, say from 90 or 95% to 100%, it is now clear that this process can occur in even minor blockages where there is rupture of the cholesterol plaque. This in turn causes blood clotting within the artery, blocking the flow of blood. This sort of event is illustrated above. The heart muscle which is injured in this way can cause irregular rhythms which can be fatal, even when there is enough muscle left to pump plenty of blood. When the injured area heals, it will leave a scar. While the heart won't be able to pump quite as much as before, there is often plenty of good muscle left to take care of the job, and recovery can be quite complete. While heart attacks are clearly scary, with modern techniques, patients survive most of them. Furthermore, most can have a long and satisfying life, perhaps more satisfying than before. To learn more, click "Tell Me More".

2. Acute Myocardial Infarction, Management Of Patients With:Guideline Table of Contents. Print a PDF. References. Figures Tables Previous. Next 1999 UPDATED GUIDELINE ( WEB VERSION) ACC/AHA Guidelines for the Management of Patients With Acute myocardial infarction Task Force on Practice Guidelines (Committee on Management of Acute myocardial infarction) http://www.acc.org/clinical/guidelines/nov96/1999

var showMenu="ExpandMain:clinical;"; // document.modified = "Tuesday March 12, 2002"; document.modified = "03/12/2002"; Table of Contents Print a PDF References 1999 UPDATED GUIDELINE (WEB VERSION) ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction) Committee Members Thomas J. Ryan, MD, FACC, Chair; Elliott M. Antman, MD, FACC; Neil H. Brooks, MD, FAAFP.; Robert M. Califf, MD, FACC; L. David Hillis, MD, FACC; Loren F. Hiratzka, MD, FACC; Elliot Rapaport, MD, FACC; Barbara Riegel, DNSc, FAAN; Richard O. Russell, MD, FACC; Earl E. Smith III, MD, FACEP; W. Douglas Weaver, MD, FACC Task Force Members Raymond J. Gibbons, MD, FACC

3. Myocardial Infarction The main cause of myocardial infarction is atherosclerosis in the coronary arteries to figure 70 for the pathogenesis of myocardial infarction. This event results in impaired http://www.rjmatthewsmd.com/Definitions/myocardial_infarction.htm

This term refers to the death of a certain segment of the heart muscle (myocardium), usually the result of a focal complete blockage in one of the main coronary arteries or a branch thereof. The main cause of myocardial infarction is atherosclerosis in the coronary arteries. Refer to figure 70 for the pathogenesis of myocardial infarction. This event results in impaired contractility of the heart muscle within seconds, and is initially restricted to the affected segment. The myocardial ischemia or infarction begins in the endocardium (the inner lining of the heart) and spreads to the epicardium (the outer lining of the heart). Irreversible heart damage will occur if the blockage is complete for at least 15-20 minutes. Irreversible damage occurs maximally in the area at risk, and when the occlusion is maintained for 4-6 hours. Most of the damage occurs in the first 2-3 hours. Restoration of flow within the first 4-5 hours is associated with salvage of the heart muscle, but the salvage is greater if flow is restored in the first 1-2 hours. A major determinant of death and illness is the size of the infarct. Increasing the oxygen supply to the involved site of blockage by coronary reperfusion (angioplasty, figures

4. NRMI—National Registry Of Myocardial Infarction The National Registry of myocardial infarction (NRMI), sponsored by Genentech, Inc., is one of the largest observational studies of acute myocardial infarction (AMI). http://www.nrmi.org

Hospitals participating in NRMI 5 can access data reports, guidelines, protocols, educational archives, newsletters, a calendar of events, and publications via the NRMI 5 portion of the website. The National Registry of Myocardial Infarction (NRMI), sponsored by Genentech, is one of the largest observational studies of acute myocardial infarction (AMI). Since 1990, NRMI has collected data on more than 2 million AMI patients, and helped more than 1,600 participating hospitals assess their approach to AMI treatment and identify trends in patient outcome. Because of its size and scope, NRMI has had a profound impact on AMI treatment practices. As part of the commitment to improving AMI outcomes, NRMI also brings teams of healthcare professionals together at the hospital and health system levels to evaluate treatment procedures, monitor resource utilization, identify patient-selection issues, and monitor outcomes. NRMI 5 is an observational study sponsored by Genentech. It is not a controlled, randomized clinical trial. It does not test the effectiveness between therapeutic interventions, and therefore comparisons of outcomes across treatment groups must be interpreted with caution.

5. Myocardial Infarction myocardial infarction. Return to the tutorial menu. What is Ischemic Heart Disease? myocardial infarction (MI). The pathogenesis can include http://medlib.med.utah.edu/WebPath/TUTORIAL/MYOCARD/MYOCARD.html

Myocardial Infarction Return to the tutorial menu. What is Ischemic Heart Disease? Ischemic heart disease is caused by an imbalance between the myocardial blood flow and the metabolic demand of the myocardium. Reduction in coronary blood flow is related to progressive atherosclerosis with increasing occlusion of coronary arteries. Blood flow can be further decreased by superimposed events such as vasospasm, thrombosis, or circulatory changes leading to hypoperfusion. Coronary artery perfusion depends upon the pressure differential between the ostia (aortic diastolic pressure) and coronary sinus (right atrial pressure). Coronary blood flow is reduced during systole because of Venturi effects at the coronary orifices and compression of intramuscular arteries during ventricular contraction. Factors reducing coronary blood flow include: Decreased aortic diastolic pressure Increased intraventricular pressure and myocardial contraction Coronary artery stenosis, which can be further subdivided into the following etiologies: Fixed coronary stenosis Acute plaque change (rupture, hemorrhage)

6. Myocardial Infarction myocardial infarction. Return to the tutorial menu. What is Ischemic Heart Disease? Ischemic heart disease is caused by an imbalance between the myocardial blood flow and the metabolic demand of the http://www-medlib.med.utah.edu/WebPath/TUTORIAL/MYOCARD/MYOCARD.html

Myocardial Infarction Return to the tutorial menu. What is Ischemic Heart Disease? Ischemic heart disease is caused by an imbalance between the myocardial blood flow and the metabolic demand of the myocardium. Reduction in coronary blood flow is related to progressive atherosclerosis with increasing occlusion of coronary arteries. Blood flow can be further decreased by superimposed events such as vasospasm, thrombosis, or circulatory changes leading to hypoperfusion. Coronary artery perfusion depends upon the pressure differential between the ostia (aortic diastolic pressure) and coronary sinus (right atrial pressure). Coronary blood flow is reduced during systole because of Venturi effects at the coronary orifices and compression of intramuscular arteries during ventricular contraction. Factors reducing coronary blood flow include: Decreased aortic diastolic pressure Increased intraventricular pressure and myocardial contraction Coronary artery stenosis, which can be further subdivided into the following etiologies: Fixed coronary stenosis Acute plaque change (rupture, hemorrhage)

7. Cardiovascular Pathology This is the left ventricular wall which has been sectioned lengthwise to reveal a large recent myocardial infarction. The center http://medlib.med.utah.edu/WebPath/CVHTML/CV020.html

This is the left ventricular wall which has been sectioned lengthwise to reveal a large recent myocardial infarction. The center of the infarct contains necrotic muscle that appears yellow-tan. Surrounding this is a zone of red hyperemia. Remaining viable myocardium is reddish- brown.

8. EMedicine - Myocardial Infarction : Article By Sarah Stahmer, MD myocardial infarction Acute myocardial infarction (AMI) is the rapid development of myocardial necrosis caused by a critical imbalance between the oxygen supply and demand of the myocardium. front-loaded alteplase in acute myocardial infarction the ASSENT-2 double-blind http://www.emedicine.com/emerg/topic327.htm

(advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Emergency Medicine Cardiovascular Myocardial Infarction Last Updated: October 27, 2003 Rate this Article Email to a Colleague Synonyms and related keywords: MI, acute myocardial infarction, AMI, heart attack AUTHOR INFORMATION Section 1 of 11 Author Information Introduction Clinical Differentials ... Bibliography Author: Sarah Stahmer, MD , Residency Director, Associate Professor, Department of Emergency Medicine, University of Medicine and Dentistry at New Jersey, Robert Wood Johnson Medical School, Cooper Hospital Coauthor(s): , Assistant Professor, Department of Emergency Medicine, Cooper University Hospital Sarah Stahmer, MD, is a member of the following medical societies: Society for Academic Emergency Medicine Editor(s): Robert M McNamara, MD, FAAEM , Professor of Emergency Medicine, Temple University; Chief, Department of Internal Medicine, Section of Emergency Medicine, Temple University Hospital; Francisco Talavera, PharmD, PhD

9. EMedicine - Myocardial Infarction : Article By Sarah Stahmer, MD myocardial infarction Acute myocardial infarction (AMI) is the rapid development of myocardial necrosis caused by a critical imbalance between the oxygen http://www.emedicine.com/EMERG/topic327.htm

(advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Emergency Medicine Cardiovascular Myocardial Infarction Last Updated: October 27, 2003 Rate this Article Email to a Colleague Synonyms and related keywords: MI, acute myocardial infarction, AMI, heart attack AUTHOR INFORMATION Section 1 of 11 Author Information Introduction Clinical Differentials ... Bibliography Author: Sarah Stahmer, MD , Residency Director, Associate Professor, Department of Emergency Medicine, University of Medicine and Dentistry at New Jersey, Robert Wood Johnson Medical School, Cooper Hospital Coauthor(s): , Assistant Professor, Department of Emergency Medicine, Cooper University Hospital Sarah Stahmer, MD, is a member of the following medical societies: Society for Academic Emergency Medicine Editor(s): Robert M McNamara, MD, FAAEM , Professor of Emergency Medicine, Temple University; Chief, Department of Internal Medicine, Section of Emergency Medicine, Temple University Hospital; Francisco Talavera, PharmD, PhD

10. Physician Education Site For Cardiovascular Diseases New reviews in cardiac electrophysiology in the area of ventricular tachyarrhythmias after myocardial infarction. http://www.med-edu.com

11. EMedicine - Myocardial Infarction : Article By Samer Garas, MD myocardial infarction myocardial infarction (MI) is irreversible necrosis of heart muscle secondary to prolonged ischemia. myocardial infarction. http://www.emedicine.com/MED/topic1567.htm

(advertisement) Home Specialties Resource Centers CME ... Patient Education Articles Images CME Patient Education Advanced Search Consumer Health Link to this site Back to: eMedicine Specialties Medicine, Ob/Gyn, Psychiatry, and Surgery Cardiology Myocardial Infarction Last Updated: September 4, 2002 Rate this Article Email to a Colleague Synonyms and related keywords: AUTHOR INFORMATION Section 1 of 11 Author Information Introduction Clinical Differentials ... Bibliography Author: Samer Garas, MD , Cardiovascular Fellow, Department of Internal Medicine, Division of Cardiology, Emory University Coauthor(s): A Maziar Zafari, MD, PhD, FACC , Director of Education, Assistant Professor, Department of Internal Medicine, Division of Cardiology, Veterans Affairs Medical Center at Atlanta Samer Garas, MD, is a member of the following medical societies: Alpha Omega Alpha American College of Cardiology , and American Medical Association Editor(s): Eric Vanderbush, MD , Chief, Clinical Assistant Professor, Department of Internal Medicine, Division of Cardiology, Harlem Hospital Center and Columbia University;

12. MI Rule - The 12 Lead Solution! - Home Provides an interpretation of myocardial infarction in 12 lead ECGs and offers CEUs. http://www.mirule.com

msetm=true;mi=new Array(7);mindex=0; mi[mindex++]=14; mi[mindex++]=104; mi[mindex++]=309; mi[mindex++]=974; mi[mindex++]=54; mi[mindex++]=264; "The 12 Lead Solution" for 12 Lead Confusion! on error resume next var Flashmode FlashMode = False FlashMode = IsObject(CreateObject("ShockwaveFlash.ShockwaveFlash.4")) if FlashMode = True Then document.write "" document.write "" document.write "" document.write "" document.write "" document.write "" document.write "" Else document.write "No Flash Support" End If Thanks to your incredible support, the MI Rule has become an internationally recognized tool, reaching Canada, Europe, Australia and the Far East! document.write(''); Home What is the MI Rule? MI Rule Store ... Our Links MI Rule - The 12 Lead Solution! Apex Innovations 201 Rue Du Maurier Lafayette, LA 70503 Ph: 866-294-4599 Fax: 425-740-8506 Email: admin@mirule.com Site Powered By eDirectHost Online Website Builder Make Your Own Website Today

13. Plavix Indicated for the reduction of atherosclerotic events (myocardial infarction, stroke and vascular death) in patients with atherosclerosis documented by recent stroke, recent myocardial infarction, or established peripheral arterial disease. http://www.plavix.com/

14. EMedicine - Myocardial Infarction : Article By Samer Garas, MD myocardial infarction myocardial infarction (MI) is irreversible necrosis of heart muscle secondary to prolonged ischemia. This usually results from an imbalance of oxygen supply and demand. The http://www.emedicine.com/med/topic1567.htm

(advertisement) Home Specialties Resource Centers CME ... Patient Education Articles Images CME Patient Education Advanced Search Consumer Health Link to this site Back to: eMedicine Specialties Medicine, Ob/Gyn, Psychiatry, and Surgery Cardiology Myocardial Infarction Last Updated: September 4, 2002 Rate this Article Email to a Colleague Synonyms and related keywords: AUTHOR INFORMATION Section 1 of 11 Author Information Introduction Clinical Differentials ... Bibliography Author: Samer Garas, MD , Cardiovascular Fellow, Department of Internal Medicine, Division of Cardiology, Emory University Coauthor(s): A Maziar Zafari, MD, PhD, FACC , Director of Education, Assistant Professor, Department of Internal Medicine, Division of Cardiology, Veterans Affairs Medical Center at Atlanta Samer Garas, MD, is a member of the following medical societies: Alpha Omega Alpha American College of Cardiology , and American Medical Association Editor(s): Eric Vanderbush, MD , Chief, Clinical Assistant Professor, Department of Internal Medicine, Division of Cardiology, Harlem Hospital Center and Columbia University;

15. MedlinePlus Medical Encyclopedia: Heart Attack Alternative names Return to top. myocardial infarction; MI; Acute MI Definition Return to top. A heart attack (myocardial infarction http://www.nlm.nih.gov/medlineplus/ency/article/000195.htm

@import url(http://www.nlm.nih.gov/medlineplus/images/advanced.css); Skip navigation Medical Encyclopedia Other encyclopedia topics: A-Ag Ah-Ap Aq-Az B-Bk ... Z Heart attack Contents of this page: Illustrations Alternative names Definition Causes, incidence, and risk factors ... Prevention Illustrations Heart, section through the middle Heart, front view Acute MI Post myocardial infarction ECG wave tracings ... Heart attack symptoms Alternative names Return to top Myocardial infarction; MI; Acute MI Definition Return to top A heart attack (myocardial infarction) occurs when an area of heart muscle dies or is permanently damaged because of an inadequate supply of oxygen to that area. Causes, incidence, and risk factors Return to top Most heart attacks are caused by a clot that blocks one of the coronary arteries (the blood vessels that bring blood and oxygen to the heart muscle). The clot usually forms in a coronary artery that has been previously narrowed from changes related to atherosclerosis . The atherosclerotic plaque (buildup) inside the arterial wall sometimes cracks, and this triggers the formation of a clot, also called a thrombus. A clot in the coronary artery interrupts the flow of blood and oxygen to the heart muscle, leading to the death of heart cells in that area. The damaged heart muscle loses its ability to contract, and the remaining heart muscle needs to compensate for that weakened area.

16. Acute Myocardial Infarction (AMI) - TNKase (Tenecteplase) A new thrombolyic for acute myocardial infarction. Includes full prescribing information, efficacy, safety and contact details. http://www.tnkase.com

Deliver 5-Second Single Bolus Investigate the Molecule Efficacy Safety Full Package Insert Contact Us Site Map Resources ... Contraindications and Warnings The #1 lytic for the treatment of AMI Simple, 5-second single-bolus administration Efficacy and safety proven comparable to Activase Significantly fewer major non-cerebral bleeding complications vs Activase Nine years of ongoing clinical research Safety Information: All thrombolytic agents increase the risk of bleeding, including intracranial bleeding, and should be used only in eligible patients. In addition, thrombolytic therapy increases the risk of stroke, including hemorrhagic stroke, particularly in elderly patients. References: 1. Delta Marketing Dynamics. Thrombolytic Survey 2. Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Investigators. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomized trial. Lancet Please see TNKase full prescribing information . TNKase TM (Tenecteplase). Activase

17. Myocardial Infarction myocardial infarction. DESCRIPTION Acute myocardial infarction (AMI) is the rapid development of http://www.5mcc.com/Assets/SUMMARY/TP0612.html

Myocardial infarction DESCRIPTION: Acute myocardial infarction (AMI) is the rapid development of myocardial necrosis resulting from a sustained and complete reduction of blood flow to a portion of the myocardium, produced by a superimposed thrombosis, generated by a ruptured atherosclerotic plaque Clinical consequences - dependent on the size and location of the infarction and the rapidity with which blood flow can be re-established by pharmacologic or mechanical modalities After total occlusion myocardial necrosis is complete in 4-6 hours. Flow to ischemic area must remain above 40% of pre-occlusion levels for that area to survive. Infarctions can be divided into Q-wave and non Q-wave, with the former being transmural and associated with totally obstructed infarct-related artery and the latter being non-transmural and associated with patent, but highly narrowed infarct-related artery Total occlusion of the left main coronary artery which usually supplies 70% of the LV mass is catastrophic and results in death in minutes System(s) affected: Cardiovascular Genetics: N/A Incidence/Prevalence in USA: Predominant age: Over 40 Predominant sex: Over age 70: Male = Female CAUSES: Coronary thrombosis - most common cause due to ruptured plaque inducing platelet aggregation and then thrombosis has been identified as the initiating factor in most cases Coronary artery spasm Arteritis Embolic infarction Congenital coronary anomalies Oxygen supply - demand imbalance; carbon monoxide poisoning

18. MedlinePlus Medical Encyclopedia: Post Myocardial Infarction ECG Wave Tracings Medical Encyclopedia. Post myocardial infarction ECG wave tracings. Various phases can be seen through ECG wave tracings following a heart attack http://www.nlm.nih.gov/medlineplus/ency/imagepages/18030.htm

@import url(http://www.nlm.nih.gov/medlineplus/images/advanced.css); Skip navigation Medical Encyclopedia Post myocardial infarction ECG wave tracings Various phases can be seen through ECG wave tracings following a heart attack: Hyperacute phase begins immediately after a heart attack Fully evolved phase starts a few hours to days after a heart attack Resolution phase appears a few weeks after a heart attack Stabilized chronic phase is the last phase and typically has permanent pathological changes compared to a normal ECG tracing Update Date: 4/15/2001 Health Topics Drug Information Encyclopedia Dictionary ... National Institutes of Health Page last updated: 11 May 2004

19. East Riding And Hull Cardiac Rehabilitation Programme Innovative programme to provide equitable Cardiac Rehabilitation for all patients who have suffered a myocardial infarction. Improves morbidity and mortality through lifestyle changes. Winner of an NHS Beacon Award. http://www.eastridingcardiacrehab.com/

East Yorkshire Primary Care Trust NHS UK NHS Direct NHS Beacon site Welcome To EAST RIDING AND HULL CARDIAC REHABILITATION PROGRAMME INTRODUCTION Why The Service was Needed More than 2,000,000 people are disabled by heart disease in the UK of whom around 80% are currently unknown to cardiac services in secondary care. Every year a further 150,000 people survive a heart attack. Almost all of these patients could significantly benefit from rehabilitation. East Riding is typical of many Health Authorities and includes a large industrial city, with areas of multiple deprivation, several prosperous market towns and a widely dispersed rural population. A needs assessment conducted by the former East Riding Health Authority mapping the incidence of heart attack across the area a search of solutions adopted elsewhere was undertaken. Home Page Top of Page Website by Patients Setting up Administration Resources ... Links

20. GAP Program - Michigan AMI GAP in Michigan is an effort to improve care for AMI with education and toolbased application of the ACC/AHA Acute myocardial infarction Guidelines in acute care hospitals. http://www.acc.org/gap/mi/ami_gap.htm

// document.modified = "Monday March 15, 2004"; document.modified = "03/15/2004"; Acute Myocardial Infarction GAP Project in Michigan Tool Kit The Tool Kit consists of seven pieces based on the ACC/AHA Guidelines for Management of Patients with Acute Myocardial Infarction . Templates were developed by the Project Team in collaboration with the guideline writing committee and provided to participating hospitals. Participants were given the freedom to customize the tool kit to accommodate the unique conditions at their institutions. We encourage you to try these tools in your hospital. Also, please download and complete the AMI GAP Tool Kit Evaluation Form Additional Links AMI GAP publications and abstracts News stories about AMI GAP AMI GAP Satellite Conference, July 26, 2001 Guideline ACC/AHA Guidelines for Management of Patients with Acute Myocardial Infarction Principal Investigators Kim A. Eagle, MD, FACC

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