Myocardial infarction

Definition (CAP)

• Evidence of myocardial necrosis with any 1 of the following:

1. Cardiac biomarkers (pref. Troponins) showing sudden rise or fall
2. Sudden unexpected cardiac death involving cardiac Arrest
3. Pathological findings of acute MI

 

Signs of MI (windows VISTA)

1. Vagal activation (vomiting, bradycardia)
2. Impaired myocard. Func. (s1,s2 soft; hypotension; inc. JVP; Oliguria; Cold, clammy skin)
3. Sympathetic activation (Pallor, sweating, tachycardia)
4. Tissue damage (Low grade fever)
5. A complication (MR / VSD producing pansystolic murmur

Enzymes elevated in MI (TALC - talcum powder)

1.  Troponin T/I
2.  AST
3.  LDH
4.  CK-MB

Complications of MI

• Immediate (RAILgaadi)

a) RV infarction
b) Arrythmias (VT, AF, VF) - may also be due to I.v. Xylocaine overdose
c) LHF

• Early (PSVT ka MELA laga hua hai !!)

a) Pericarditis

b) Sudden death

c) VSD

d) Thromboembolic complications (Pulmonary, Arterial)

e) MR (Papillary muscle dysfunction or rupture)

f)  LV free wall rupture (Pericardial tamponade)

g) Arterial compl. (same as mentioned in d) )

 

•  Late (PADS)

a) Psychological reaction (DADDA- Denial, Acceptance, Dependency, Depression, Adjustment - this is from earliest change to last)
b) Arrythmias (ventricular like VF, VT)
c) Dressler’s syndrome (Autoimmune phenomenon characterized by fever, pericarditis, pleuritis, pneumonitis)
d) Shoulder (Frozen shoulder) – Pain n stiffness of left shoulde