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Potentially life-threatening emergency
Myocardial infarction
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Other Resources UpToDate PubMed
Potentially life-threatening emergency

Myocardial infarction

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Contributors: Christine Osborne MD, Ryan Hoefen MD, PhD
Other Resources UpToDate PubMed

Synopsis

Clinical or pathologic event caused by myocardial ischemia, most often secondary to plaque rupture with subsequent thrombus formation, with resultant myocardial injury or necrosis as demonstrated by the rise and fall of cardiac biomarkers (troponin, creatine kinase-MB [CK-MB]) in the setting of typical symptoms such as chest pain and shortness of breath. Furthermore, there must be evidence of underlying myocardial damage such as suggestive ECG (echocardiographic) evidence of loss of viable myocardium or new regional wall motion abnormality. Acute myocardial infarction can be classified as follows:
  • ST-elevation myocardial infarction (STEMI) – Demonstration of new ST segment elevations, new left bundle branch block (LBBB), or new posterior infarction with ST segment changes on ECG in a patient with chest pain and elevated cardiac biomarkers.
  • Non ST-elevation myocardial infarction (NSTEMI) – Demonstration of ST depressions, T-wave inversions without ST segment elevations, or pathologic Q waves on ECG in a patient with chest pain and elevated cardiac biomarkers.
  • Unstable angina – Patients with chest pain and ischemic symptoms without elevation in cardiac biomarkers and with or without evidence of ischemia on ECG.
A 2018 study has shown that patients with acute myocardial infarction and cardiogenic shock have a lower risk of death at 30 days following culprit-lesion-only percutaneous coronary intervention (PCI) than with multivessel PCI. However, mortality at 1 year following treatment was not significantly different.

Codes

ICD10CM:
I21.3 – ST elevation (STEMI) myocardial infarction of unspecified site

SNOMEDCT:
22298006 – Myocardial Infarction

Differential Diagnosis & Pitfalls

Best Tests

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 11/13/2018
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Potentially life-threatening emergency
Myocardial infarction
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Myocardial infarction (Prodromal Symptoms) : Chest pain, Fatigue, Malaise, Dyspnea
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