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Infarction
Epidemiology
It is a medical emergency, and the leading cause of death for
both men and women all over the world
• Hypercoagulable states
Polycythemia vera
Thrombocytosis
Heart:
May be normal
Abnormally located ventricular Impulse
Soft heart sounds
Atrial gallop S4 or ventricular gallop S3
Systolic murmur due to papillary muscle or
ventricular septal rupture
Pericardial friction rub
Electrocardiogram (ECG)
Hyper acute T Immediately 6-24 hours
waves (Tall Peaked
T waves in leads
facing infarction)
Arises from Aorta behind the Arises from the Aorta behind
right aortic sinus of valsalva the left aortic Sinus of valsalva
Supplies: Left anterior descending (LAD)
•Posterior Inferior wall of LV Supplies:
•Right Ventricle and atrium via Anterior wall of left ventricle
marginal branch Anterior two thirds of
•SA and AV node interventricular septum
Left Circumflex (LCX)
Supplies:
Lateral wall of left ventricle
Echocardiography:
Provides assessment of ventricular function and wall motion.
Doppler echo is used to diagnose post infarction mitral
regurgitation or ventricle septal defect
Angiography:
A chest X-ray
showed large
Cardiac silhouette
and
bilateral interstitial
markings
consistent with
pulmonary edema.
Q-wave infarction
Non-Q wave infarction
• Thrombolytic therapy
• Percutaneous coronary intervention
(PCI)
• Bypass surgery
Streptokinase
Older patients with concomitant hypertension (>160mmHg), no
previous exposure to streptokinase or recent streptococcal
infection.
Urokinase
Alteplase
Reteplase
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Thrombolytic therapy
Indications
1. Within 12 hours of the onset of typical chest pain of AMI
2. ST elevation of > 1mm in two contiguous leads or Q waves
3. New Left bundle branch block
Contraindications
1. Dissecting aortic aneurysm
2. Uncontrolled hypertension > 180/110
3. Active peptic ulcer
4. Bleeding Diathesis
5. History of cerebrovascular disease
6. Recent trauma or surgery especially of head or spine
7. Traumatic CPR
8. Pregnancy
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Percutaneous coronary intervention (PCI)
• PCI done to abort a myocardial infarction is
known as primary PCI
• Beta blockers
• Angiotensen-converting enzyme inhibitors
• Anticoagulation (typically with heparin)
• Antiplatelet agents such as Clopidogrel
7. Mural Thrombus
Coronary angiography
Medical Therapy