Myocardial Infarction

Dennis Reison, MD: Disclosures

• No financial disclosures

BIOMARKERS

Identification of acute

thrombosis in AMI

Intracoronary Thrombolytic Rx

TIMI Trials

Intravenous Thrombolysis

TPA

PCI

Clinical Criteria for MI

“The clinical definition of MI denotes the presence of acute myocardial

injury detected by abnormal cardiac biomarkers in the setting of evidence

of acute myocardial ischemia”

Myocardial injury

• Elevation of cTn above the 99th percentile• Rise and fall of cTn levels in a pattern c/w an

acute event

Evidence of Acute Myocardial Ischemia

• Symptoms of myocardial ischemia• New Ischemic EKG changes• Development of pathological Q waves• Imaging evidence of new loss of myocardium• Identification of coronary thrombosis (Type 1)

Criteria for AMI

• Evidence for acute myocardial injury-cTn

+• Symptoms of myocardial ischemia• New Ischemic EKG changes• Development of pathological Q waves• Imaging evidence of new loss of myocardium• Identification of coronary thrombosis (Type 1)

AMI Classification

• Myocardial Infarction Type 1-STEMI/NSTEMI• Myocardial Infarction Type 2-Supply/Demand• Myocardial Infarction Type 3-Sudden Death• Myocardial Infarction Type 4-PCI Related• Myocardial Infarction Type 5-CABG Related

Type 1 AMI

Treatment of AMI-1

• PCI of Culprit lesion• Thrombolytic Rx• Beta blockers• ACE-I/ARB• Dual anti-platelet therapy• Heparin-UFH/LMW• Statins

Temporal Pattern of Cardiovascular Risk after the Onset of Acute Infection.

Musher DM et al. N Engl J Med 2019;380:171-176

Pathogenesis of Pump Failure in AMI

Shock 2 Trial

• No mortality benefit for IABP in CGS

Shock Team• Interventional Cardiology• Cardiovascular Surgery• Heart Failure Cardiology• Pulmonary/Intensive Care Medicine• Anesthesiology

IMPELLA

INCREASED MEAN AORTIC

PRESSURE

LEFT VENTRICULAR UNLOADING

INCREASED ORGAN PERFUSION

DECREASED LV OXYGEN

REQUIREMENTS

Summary

• Pathophysiology and History of AMI• Fourth Universal Definition of AMI• Myocardial Injury• Myocardial Ischemia• Cardiogenic Shock• Impella for LV Failure