Mycordial Infarction acute myocardial infarction (AMI) is the medical term for an event commonly known as a heart attack. An MI occurs when blood stops flowing properly to a part of the heart, and the heart muscle is injured because it is not receiving enough oxygen. Usually this is because one of the coronary arteries that supplies blood to the heart develops a blockage due to an unstable buildup of white blood cells, cholesterol and fat. The event is called "acute" if it is sudden and serious.History The patients A history is critical in diagnosing myocardial infarction and sometimes may provide the only clues that lead to the diagnosis in the initial phases of the patient presentation.Patients with typical myocardial Infarction may have prodromal symptoms of fatigue, chest discomfort, or malaise in the days preceding the event; alternatively, typical STEMI may occur suddenly, without warning.Other symptoms of myocardial infarction include the following: Anxiety Light-headedness with or without syncope Cough Nausea with or without vomiting Diaphoresis WheezingPhysical examinationPhysical examination findings for myocardial infarction can vary; one patient may be comfortable in bed, with normal examination results, while another may be in severe pain, with significant respiratory distress and a need for ventilatory support.

Patients with ongoing symptoms usually lie quietly in bed and appear pale and diaphoretic. Hypertension may precipitate myocardial infarction, or it may reflect elevated catecholamine levels due to anxiety, pain, or exogenous sympathomimetics. Hypotension may indicate ventricular dysfunction due to ischemia. Hypotension in the setting of myocardial infarction usually indicates a large infarct secondary to either decreased global cardiac contractility or a right ventricular infarct. Acute valvular dysfunction may be present. Mitral regurgitation due to papillary muscle ischemia or necrosis may be present.

Doctors order: Verapamil Diltiazem Alternatives include captopril, 12.5-50 mg given orally twice a day beta-adrenergic blockers and ACE inhibitors

ECG RESULTS:

An AV nodal block or infranodal block may be evident.

A 53-year-old patient who had experienced 3 hours of chest pain had a 12-lead electrocardiogram performed, and the results are as shown. He was given sublingual nitroglycerin and developed severe symptomatic hypotension. His blood pressure normalized with volume resuscitation.

MEDICATIONS: Clopidogrel (Plavix)Clopidogrel selectivel inhibits adenosine diphosphate (ADP) binding to platelet receptors and subsequent ADP-mediated activation of glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation. Aspirin (Anacin, Ascriptin, Bayer Aspirin) Early administration of aspirin in patients with acute myocardial infarction has been shown to reduce cardiac mortality rate by 23% in the first month.Vorapaxar (Zontivity)Vorapaxar reversibly inhibits protease-activated receptor 1 (PAR-1) which is expressed on platelets, but its long half-life makes it effectively irreversible. It is indicated to reduce thrombotic cardiovascular events in patients with a history of MI or with peripheral arterial disease. It is not used as monotherapy, but added to aspirin and/or clopidogrel.