21. CTSN - Myocardial Infarction Text myocardial infarction. View TSDA Curriculum Online for this topic. 1. Acute myocardial infarction. Obstruction Thrombosis Occlusion http://www.ctsnet.org/doc/4467

Myocardial Infarction View TSDA Curriculum Online for this topic 1. Acute Myocardial Infarction Obstruction–> Thrombosis–> Occlusion Ischemic injury prolonged –> Irreversible injury 2. Location and Size Location and severity of obstruction Size of vascular bed O needs of myocardium Collateral development Coronary artery spasm Tissue factors Thrombotic and thrombolytic substances 3. Types of Infarction Transmural Acute coronary thrombosis Localized zone of distribution Subendothelial (non-transmural) Coronaries narrowed but patent Thrombotic occlusion–> thrombolysis Increased oxygen demand and/or decreased oxygen delivery Pulmonary embolism Hypotension Hypertension Aortic stenosis Anemia Operative procedures Cerebrovascular accident 4. Sites of Involvement Most involve LV and interventricular septum Up to 65% or IMI involve RV Isolated RV in 3-5% COPD RVH 5. Pathology Gross Changes Time Changes < 6 hours No change > 6 hours Pale, bluish, edematous 18-36 hours Tan, reddish purple >48 hours Gray, yellow lines at periphery 8-10 days decreased wall thickness, coagulation necrosis

22. Myocardial Infarction Redefined: A Consensus Document ALPERT AND THYGESEN, ET AL., myocardial infarction REDEFINED JACC Vol. 36, No. Preamble. I. Introduction Concept and Definition of myocardial infarction. II. http://www.acc.org/clinical/consensus/mi_redefined/

var showMenu="ExpandMain:clinical;"; // document.modified = "Tuesday March 12, 2002"; document.modified = "03/12/2002"; Table of Contents Print a PDF References ALPERT AND THYGESEN, ET AL., MYOCARDIAL INFARCTION REDEFINED Table of Contents Preamble I. Introduction: Concept and Definition of Myocardial Infarction II. Clinical Presentation III. Detection of Necrosis of Myocardial Cells ... Appendix C A list of contributors to this ESC/ACC Consensus Document is provided in Appendix B. The recommendations set forth in this report are those of the conference participants and do not necessarily reflect the official position of the American College of Cardiology. This document has been reviewed by members of the ESC Committee for Scientific and Clinical Initiatives and by members of the Board of the ESC who approved the document on April 15, 2000.

23. Lesson IX - Myocardial Infarction myocardial infarction. Topics for study Introduction ( Read this first) Inferior QWave MI Family. Anterior Q-Wave MI Family. MI + Bundle Branch Block. Non Q-Wave MI. The Pseudoinfarctions. Miscellaneous QRS Abnormalities. 1. IX. myocardial infarction. Frank G. Yanowitz, MD Introduction to ECG Recognition of myocardial infarction. When myocardial blood supply is abruptly reduced or cut off to http://www-medlib.med.utah.edu/kw/ecg/ecg_outline/Lesson9

IX. Myocardial Infarction Frank G. Yanowitz, MD Professor of Medicine University of Utah School of Medicine Topics for study: Introduction (Read this first) Inferior Q-Wave MI Family Anterior Q-Wave MI Family MI + Bundle Branch Block Non Q-Wave MI ... Miscellaneous QRS Abnormalities 1. Introduction to ECG Recognition of Myocardial Infarction When myocardial blood supply is abruptly reduced or cut off to a region of the heart, a sequence of injurious events occur beginning with subendocardial or transmural ischemia, followed by necrosis, and eventual fibrosis (scarring) if the blood supply isn't restored in an appropriate period of time. Rupture of an atherosclerotic plaque followed by acute coronary thrombosis is the usual mechanism of acute MI. The ECG changes reflecting this sequence usually follow a well-known pattern depending on the location and size of the MI. MI's resulting from total coronary occlusion result in more homogeneous tissue damage and are usually reflected by a Q-wave MI pattern on the ECG. MI's resulting from subtotal occlusion result in more heterogeneous damage, which may be evidenced by a non Q-wave MI pattern on the ECG.

24. Emergency Medicine At NCEMI: Emergency Medicine And Primary Care Resources Medical Links. Clinical Calculators Medical ETools. myocardial infarction probability (Goldman) Answer . Answer questions, then click Compute button below. http://www.ncemi.org/cgi-ncemi/edecision.pl?TheCommand=Load&NewFile=goldman_ches

25. ACC/AHA Guidelines For The Management Of Patients With Acute Myocardial Infarcti A report of the American College of Cardiology and American Heart Association Task Force on Practice Guidelines. Committee on Management of Acute myocardial infarction. http://216.185.112.5/presenter.jhtml?identifier=2865

26. Myocardial Infarction Information Diseases Database myocardial infarction Coronary artery thrombosis Heart attack MI Myocardial infarct, Disease Database Information http://www.diseasesdatabase.com/sieve/item1.asp?glngUserChoice=8664

27. MI Diagnosis 2000 Acute myocardial infarction (Restricted to one coronary territory); Coronary spasm (Reversible ST elevation, especially after nitroglycerin or calcium antagonist http://lib-sh.lsumc.edu/fammed/intern/mipull.html

MI Diagnosis Page by: E.J. Mayeaux, Jr., M.D. Louisiana State University Medical Center Shreveport, Louisiana Risk Factors for MI Major: Increased Cholesterol Hypertension Smoking Family History of MI Diabetes Mellitus Minor: Obesity Sedentary Lifestyle Must DDx from Pericarditis Pleural/ Pericardial Pain Friction Rub Diffuse ST changes in multiple leads. Lack of Q Waves Lack of rise of enzymes Causes of ECG ST Segment Elevation Acute myocardial infarction (Restricted to one coronary territory) Coronary spasm (Reversible ST elevation, especially after nitroglycerin or calcium antagonist) Pericarditis (Diffuse; associated P-R depression) Left ventricular aneurysm (Associated Q waves) Return to The Intern in the Middle of the Night Home Page Return to LSUHSC-S Family Medicine Home Page Return to the LSUHSC-S Home Page.

28. ALTACE Discusses the role ace inhibitors play in prevention of stroke, myocardial infarction and cardiovascular risk reduction. http://www.heart-attack-prevention.com

Do not take ALTACE during pregnancy, as death or injury to your unborn child may result. Read more below. ALTACE may help you reduce the risk of heart attack stroke , or cardiovascular death if you're a person aged And have had a previous heart attack And/or have had a previous stroke And/or have diabetes plus an additional cardiovascular risk factor, such as high blood pressure or high cholesterol, or you are a smoker And/or have a history of coronary artery disease , such as angina, previous bypass surgery, or angioplasty (stenting or ballooning) And/or have peripheral vascular disease ALTACE is also a standard therapy for controlling high blood pressure in adults. Prescription ALTACE is not for everyone. ALTACE may cause swelling of the mouth, tongue, or throat, which could cause extremely serious risk and requires immediate medical care. ALTACE may lower your blood sugar if you're taking medicine for diabetes. Please contact your doctor if you have symptoms of low blood sugar such as sweating or shakiness. Common side effects include persistent dry cough, dizziness, and light-headedness due to low blood pressure. Do not take ALTACE during pregnancy, as death or injury to your unborn child may result

29. Thrombolytic Agents In Acute Myocardial Infarction - 2000 Thrombolytic Agents in Acute myocardial infarction. Page by EJ Mayeaux, Jr., MD Louisiana State University Medical Center Shreveport, Louisiana. http://lib-sh.lsumc.edu/fammed/intern/mithromb.html

Thrombolytic Agents in Acute Myocardial Infarction Page by: E.J. Mayeaux, Jr., M.D. Louisiana State University Medical Center Shreveport, Louisiana Administration of Thrombolytic Agents 1. Start two 18-g peripheral intravenous lines. 2. No ABGs or central lines may be used or started before treatment. Streptokinase (Kabikinase, Streptase) Dilute two 750,000-unit vials of streptokinase with 5 ml of 5% dextrose in water. Gently swirl to dissolve. Add this dose of 1.5 million units to 150 mL of 5% dextrose in water. This should be infused over 60 minutes. Monitor for the first few hours for signs of anaphylaxis or allergic reaction. Infusion should be slowed if the blood pressure drops 25 mm Hg or terminated if asthmatic symptoms appear. Monitor prothrombin time, partial thromboplastin time, and fibrinogen levels during therapy. Alteplase, recombinant (tPA Activase) Dilute two 50-mg vials with sterile water for injection provided in the package. Gently swirl to dissolve.

30. Health And Medical Information: Diseases And Conditions, Medical Dictionary, Pro A look at heart attack (myocardial infarction) and the causes, symptoms, diagnosis, treatment options, recovery and prevention. http://www.medicinenet.com/Script/Main/Art.asp?li=MNI&ArticleKey=379

31. THE MERCK MANUAL, Sec. 16, Ch. 202, Coronary Artery Disease Topics. General. Prevention Of Coronary Artery Disease. Angina Pectoris. myocardial infarction. click here for navigation help. myocardial infarction. http://www.merck.com/mrkshared/mmanual/section16/chapter202/202d.jsp

32. Coronary Artery Disease Discussion about the risk factors, myocardial infarction, sex and your heart, as well as many other heart disease related topics. http://www.medbroadcast.com/condition_info_details.asp?disease_id=39

33. ACC/AHA Guidelines For The Management Of Patients With Acute Myocardial Infarcti of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute myocardial infarction). http://www.americanheart.org/presenter.jhtml?identifier=2865

34. Heart Attack, Heart Attack Symptoms, Heart Attack Signs, Hypertension Heart Atta Self care guide, symptoms, signs, prevention, hypertension heart attacks, silent myocardial infarction and diagnosis. http://www.health.indiamart.com/heart-disease/heart-attack.html

You Can Advertise Here HealthCare Heart Diseases Heart Attack (Myocardial Infarction) What is a heart attack? A heart attack (myocardial infarction) is the death of heart muscle due to the loss of blood supply. Usually, the loss of blood supply is caused by a complete blockage of a coronary artery(an artery that supplies blood to the heart muscle) by a blood clot. What are the features of a heart attack? Pain: is the cardinal symptom of a heart attack. The pain is often described as a tightness or heaviness in the chest. It is often severe enough to be the worst pain that can be experienced. the usual location of the pain is in the center of the chest but it frequently radiates to the left arm or the jaw. Anxiety: fear of impending death. Breathlessness, Nausea and vomiting, Sweating, pallor and a fast pulse. Sudden death: loss of blood supply disturbs the orderly transmission of electrical impulses in the heart and as a result the heart stops to effectively pump blood. Permanent brain damage and death can occur unless oxygenated blood flow is restored within five minutes. Approximately 40% of people suffering a heart attack die before reaching to the hospital. What causes a heart attack?

35. Myocardial Infarction myocardial infarction. 1999 Update ACC/AHA Guidelines for the Management of Patients With Acute myocardial infarction Executive Summary and Recommendations. http://www.americanheart.org/presenter.jhtml?identifier=3004562

36. The Heart Attack (1945): He Usually Lived With A Female An article about a San Francisco newspaperman C.H. Brick Garrigues, separated from his wife, unhappy in his job, a cigarette smoker, trying to become a successful writer, suffers a myocardial infarction. http://www.ulwaf.com/He-Usually/45heart.html

TOP He Usually Lived With a Female by George Garrigues Internet version A series of articles based upon the life of Charles Harris (Brick) Garrigues as revealed in his letters and other writing A Los Angeles cop once wrote about Brick Garrigues: "Joined C.P. summer of 1936. Sent by Grover and Gladys Johnson to S.F. to investigate for C.P. in murder trial . . . Member C.P. fraction Newspaper Guild . . . This is the man whose ears were knocked down by Tom Cavett in 1936. Age 30 - 6 ft. 2 in. 195 lbs. Red sandy hair. Unscrupulous writer. Usually lives with a female. Not active lately." Brick's son wrote: I held a mystery in my hand: two sheets of aged paper, browned by the passage of some seventy years, bits and pieces flaking off in my fingers, scattering on the carpet. As I contemplated these brittle pages, I came to realize that I had to find the answers, to find the man behind the words: This man whom I had known for so many years, but had scarcely known at all. This comforter of small children. This wearer of hats and smoker of pipes. This reader and writer of books. This twentieth century man, this flawed man; my father, Charles Harris Garrigues. And so I went looking for him.

37. Chapter 4: Myocardial Infarction - Cardiovascular Diseases Team Leader Dr David Fone, Date of completion 30.9.98. 4 myocardial infarction. The management of acute myocardial infarction. British Cardiac Society, 1996. http://hebw.uwcm.ac.uk/cardio/chapter4.html

CARDIOVASCULAR DISEASES Team Leader: Dr David Fone Date of completion: 4: Myocardial infarction This bulletin is a supplement to, not a substitute for, professional skills and experience. Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation. The Statements The Evidence 4.1 Clinical guidelines Acute myocardial infarction characteristically presents with an acute onset of severe chest pain at rest i . Clinical guidelines and audit standards for the management of acute myocardial infarction are available from the British Cardiac Society i , the American Heart Association ii and European Society of Cardiology iii (Health gain notation - 1 "beneficial" i. de Bono DP, Hopkins A, for a working party of the joint audit committee of the British Cardiac Society and the Royal College of Physicians of London. The management of acute myocardial infarction . British Cardiac Society, 1996. http://www.cardiac.org.uk/ (Type V evidence - expert opinion) ii.

38. Heart Attack - Heart: Health And Medical Information About Heart Disease And Oth Heart Attack (myocardial infarction). Revising Medical Author Dennis Lee, MD Revising Medical Editor Daniel Kulick, MD, Jay Marks http://www.medicinenet.com/Heart_Attack/article.htm

MedicineNet Home Heart Home > Heart Attack Advanced Search Printer-Friendly Format Add to Favorites Email to a Friend ... Next page Heart Attack (Myocardial Infarction) Revising Medical Author: Dennis Lee, MD Revising Medical Editor: Daniel Kulick, MD Jay Marks, MD Research Assistant: Megan Barrington What is a heart attack? What causes a heart attack? What are the symptoms of a heart attack? What are the complications of a heart attack? ... Heart Attack At A Glance What is a heart attack? A heart attack (also known as a myocardial infarction) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and pressure. If blood flow is not restored within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for 6-8 hours at which time the heart attack usually is “complete.” The dead heart muscle is replaced by scar tissue. Approximately one million Americans suffer a heart attack each year. Four hundred thousand of them die as a result of their heart attack.

39. Myocardial Infarction myocardial infarction. myocardial infarction. MEDLINEplus heart attack. A collection myocardial infarction / diagnosis. Evaluation of http://omni.ac.uk/browse/mesh/C0027051L0027051.html

low graphics Myocardial Infarction Myocardial Infarction Myocardial Infarction / diagnosis Myocardial Infarction / drug therapy Myocardial Infarction / rehabilitation ... Myocardial Infarction / therapy broader: Myocardial Ischemia other: Coronary Disease Myocardial Ischemia Myocardial Infarction MEDLINEplus : heart attack A collection of resources, aimed at consumers, on the topic of heart attacks. It includes a set of pre-formatted MEDLINE searches, providing free access to the MEDLINE database. This removes the complications of developing effective search strategies. Links are also provided to a wide range of resources from government and other sources, including overviews, clinical trials, directories, journals and statistics. Provided by the U.S. National Library of Medicine. Patient Education Myocardial Infarction Myocardial infarction A collection of images and text forming a short tutorial on ischemic heart disease, from the University of Utah's WebPath service. The causes of ischemic heart disease in general are summarised and myocardial infaction and ischemic cardiomyopathy are discussed in particular with details of pathogenesis, gross and microscopic morphological changes over time, and relevant images. A bibliography is included. Teaching Materials Myocardial Ischemia Myocardial Infarction Heart attack This interactive tutorial on heart attack has been produced by the Patient Education Institute, and made available on the Web by the National Library of Medicine MEDLINEplus service. The tutorial provides information on heart attacks and covers heart anatomy, symptoms, causes, angina, treatment, what to do when you feel the signs and symptoms of a heart attack, and how to prevent having a heart attack. Viewing this tutorial requires Flash plug-in.

40. Myocardial Infarction – Detailed Guideline myocardial infarction – Detailed Guideline. This guideline was commissioned by the Department of Health from the Centre for Health http://www.nice.org.uk/Docref.asp?d=16494

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