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INTRODUCTION

ESSENTIALS OF DIAGNOSIS

  • Chest discomfort, usually described as “pressure,” “dull,” “squeezing,” or “aching.”

  • Characteristic electrocardiographic changes.

  • Elevated biomarkers, such as troponin.

  • Imaging may show new regional wall motion abnormality with preserved wall thickness.

  • The elderly, women, and diabetics may have atypical presentation.

GENERAL CONSIDERATIONS

Acute myocardial infarction (MI) is a clinical syndrome that results from the occlusion of a coronary artery, with resultant death of cardiac myocytes in the region supplied by that artery. Depending on the distribution of the affected coronary artery, acute MI can produce a wide range of clinical sequelae, varying from a small, clinically silent region of necrosis to a large overwhelming area of infarcted tissue resulting in cardiogenic shock and death. Over 1 million people experience MI in the United States each year; approximately one every 40 seconds.

The risk of having an acute MI increases with age, male gender, smoking, dyslipidemia, diabetes, hypertension, abdominal obesity, a lack of physical activity, low daily fruit and vegetable consumption, alcohol overconsumption, and psychosocial index. As much as 90% of the risk of acute MI has been attributed to the modifiable risk factors. The diagnostic criteria for acute MI are listed in Table 8–1.

Table 8–1.ESC/ACC Definition of Myocardial Infarction

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