Myocardial

Infarction
case 3 diff. diagnosis

isl
Acute coronary syndromes
Definition
Acute myocardial infarction (AMI)

Infarction of an area of the heart

muscle, usually as a result of occlusion
of a coronary artery.
Stedmans medical dictionary

Clinical syndrome that results from an

injury to myocardial tissue that is
caused by an imbalance between
myocardial oxygen supply and demand.
Pathogenesis of chest pain

Fissue orTissue
ruptures
factor is

Occlusive
Coronary
plaque released
exposure with
of the
atherosclerosis
Crack of fissure
is an in the
endothelial matrix
essential
diseased
part ofarterial wall injury ext
thearterial

thrombus
coagulation
elements
process in most plateletcascade and
activation
patients. promotes formation of
and thrombus
formationfibrin
Clinical manifestations
onset
sudden ; severe

precipitating factor
lighter exertion
emotional or environmental
stresses
Clinical manifestations
quality
chest discomfort is described as
pressure, aching, burning, crushing,
squeezing, heavy, swelling, or bursting

quantity
severe

radiation
may radiate to the left arm or
the neck
Clinical manifestations
sigs and symptoms
dyspnea
diaphoresis
nausea and vomiting
response of chest discomfo
to antianginal agents
timing
infarctions occur during the early
morning hours (6:00 am to 12:00 noon)
variable; often > 30 minutes
 Clinical manifestations
anxious and restless

Pallor
asso. with perspiration and coolness of the
extremities

Although many pxs have a normal pulse rate and

blood pressure within the first hour
of patients with anterior infarction have
manifestations of sympathetic nervous system
hyperactivity (tachycardia and/or hypertension
with inferior infarction show evidence of
parasympathetic hyperactivity (bradycardia and/or
hypotension).
 Clinical manifestations
precordium is usually quiet, and the apical
impulse may be difficult to palpate.

In pxs with anterior wall infarction, an

abnormal systolic pulsation caused by
dyskinetic bulging of infarcted myocardium may
develop in the periapical area within the first
days of the illness and then may resolve

Other physical signs of ventricular

dysfunction include fourth and third heart
sounds, decreased intensity of the first heart
sound, and paradoxical splitting of the second
heart sound
 Clinical manifestations
transient midsystolic or late systolic apical systolic
murmur due to dysfunction of the mitral valve apparatus may
be present.

pericardial friction rub is heard at some time in the

course of the disease, if they are examined frequently.

The carotid pulse is often decreased in volume,

reflecting reduced stroke volume.

Temperature elevations up to 38C may be observed during

the first week

The arterial pressure is variable; in most patients with

transmural infarction, systolic pressure declines by
approximately 1015 mmHg from the preinfarction state.
Pertinent data
Male

50 yr old

Chest pain ; unrelieved by rest and

persisted for several hours