Myocardial Infarction Questions & Answers

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Questions & Answers

Overview

What are the irregular vital signs that may be observed in myocardial infarction (MI, heart attack)?

What is myocardial infarction (MI, heart attack), and what is the annual incidence in the US?

Which symptoms are recognized as common warning signs preceding a myocardial infarction (MI, heart attack)?

What are the characteristics of typical chest pain in acute myocardial infarction (MI, heart attack)?

Which lab tests are useful in the diagnosis of myocardial infarction (MI, heart attack)?

What is the most important diagnostic tool in the initial evaluation of suspected myocardial infarction (MI, heart attack)?

What is the role of coronary angiography in suspected myocardial infarction (MI, heart attack)?

What prehospital care is indicated in chest pain and suspected myocardial infarction (MI, heart attack)?

Which medications should be used to stabilize patients with ongoing acute chest pain and suspected myocardial infarction (MI, heart attack)?

When is emergent coronary angiography and primary PCI indicated in STEMI (heart attack), and which treatment should be considered if PCI is not available?

What is the initial treatment approach in non-ST-segment elevation acute coronary syndrome (non-STE-ACS, NSTEMI, MI, heart attack)?

What is the role of coronary care units, and how beneficial are they in the treatment of myocardial infarction (MI, heart attack)?

What is the etiology of myocardial infarction (MI, heart attack)?

What is the role of cardiac biomarkers in the evaluation of myocardial infarction (MI, heart attack)?

How is myocardial infarction (MI, heart attack) associated with acute coronary syndrome (ACS)?

What are the potential long-term complications of myocardial infarction (MI, heart attack)?

What is the role of coronary thrombolysis and mechanical revascularization in acute myocardial infarction (MI, heart attack)?

What are the benefits of late recanalization of an infarct-related artery in acute myocardial infarction (MI, heart attack)?

What are the treatment options that can be used to supplement coronary thrombolysis and mechanical revascularization in the treatment of myocardial infarction (MI, heart attack)?

What is a myocardial infarction (MI, heart attack), and what is the most common symptom?

What are the criteria used to diagnose myocardial infarction (MI, heart attack)?

What are the types of myocardial infarction (MI, heart attack), and how is each defined?

What is acute coronary syndrome (ACS), and what are the two main categories of ACS?

What is myocardial ischemia, and how does it ultimately lead to myocardial infarction (MI, heart attack)?

What are the factors that contribute to myocardial injury, and what is the result of persistent oxygen deprivation to the myocardium?

What is the role of coagulation necrosis in myocardial infarction (MI, heart attack), and how does myocardial fibrosis contribute to ventricular remodeling?

What is reperfusion injury, and how might it be prevented?

What are stunned myocardium and myocardial hibernation, and how do they occur?

How does the atheromatous plaque responsible for acute myocardial infarction (MI, heart attack) develop, and what is its role in acute coronary syndrome (ACS)?

What is the etiology of acute coronary syndrome (ACS)?

What are the nonmodifiable risk factors and the modifiable risk factors for atherosclerosis?

What are the causes of myocardial infarction (MI, heart attack) other than atherosclerosis?

What conditions are associated with pediatric coronary artery disease, and what are the factors that contribute to acute myocardial infarction (MI, heart attack) in childhood and adolescence?

What is the mortality rate associated with coronary artery disease (CAD) in the US?

Which risk factors for coronary artery disease (CAD) were identified in the INTERHEART study?

What is the incidence of myocardial infarction (MI, heart attack) in the US?

Which groups are at highest risk of mortality due to acute myocardial infarction (MI, heart attack)?

How have the mortality rates of coronary artery disease (CAD) and myocardial infarction (MI, heart attack) changed outside the US?

What is the prognosis of acute myocardial infarction (MI, heart attack)?

Which factors are associated with a better prognosis of myocardial infarction (MI, heart attack)?

Which factors are associated with a worse prognosis of myocardial infarction (MI, heart attack)?

Which baseline parameters are prognostic predictors of 30-day mortality due to acute myocardial infarction (MI, heart attack)?

What is the Killip classification system and how is it used in acute myocardial infarction (MI, heart attack)?

What should patients do when they experience active symptoms of acute coronary syndrome (ACS) (MI, heart attack)?

How is nitroglycerin used in patients at risk for acute coronary syndrome (ACS) when they experience symptoms?

What is the role of diet and exercise in the treatment of a cardiovascular event (MI, heart attack)?

What educational resources are available for patients with coronary artery disease (CAD) or myocardial infarction (MI, heart attack)?

Presentation

What is the role of patient history in diagnosing myocardial infarction (MI, heart attack), and what are the typical presenting symptoms?

When time of day does myocardial infarction (MI, heart attack) most often occur, and what mechanisms are involved?

What should initial rapid evaluation for myocardial infarction (MI, heart attack) include?

What is the role of risk assessments in the evaluation of acute coronary syndrome (ACS) symptoms?

Which patients require a high index of suspicion of myocardial infarction (MI, heart attack)?

In addition to chest pain, what other symptoms of myocardial infarction (MI, heart attack) should be considered when evaluating a patient for MI?

What is the role of heart rate in the evaluation of symptoms of myocardial infarction (MI, heart attack)?

How can physical exam findings vary in myocardial infarction (MI, heart attack)?

What is the role of blood pressure in the evaluation of symptoms of myocardial infarction (MI, heart attack)?

Why might respiratory rate be elevated in myocardial infarction (MI, heart attack)?

How is body temperature associated with myocardial infarction (MI, heart attack)?

What do distended neck veins indicate in the setting of myocardial infarction (MI, heart attack)?

Which heart exam findings are associated with heart damage in the setting of myocardial infarction (MI, heart attack)?

Which chest exam findings are associated with myocardial infarction (MI, heart attack)?

Which abdominal exam findings are associated with myocardial infarction (MI, heart attack)?

Which findings on physical exam of the extremities are associated with myocardial infarction (MI, heart attack)?

DDX

Which GI symptoms are associated with myocardial ischemia and myocardial infarction (MI, heart attack)?

Which musculoskeletal symptoms are associated with myocardial ischemia and myocardial infarction (MI, heart attack)?

Why is myocardial infarction misdiagnosed more often in younger patients?

How can ischemic changes be more readily recognized in myocardial infarction (MI, heart attack), and what are common nonischemic causes of ST-segment elevation?

What are the differential diagnoses for Myocardial Infarction?

Workup

What are the objectives of lab testing and imaging studies in myocardial infarction (MI, heart attack)?

What is the most important tool in the initial evaluation of suspected acute coronary syndrome (ACS) or myocardial infarction (MI, heart attack)?

Which lab tests do guidelines recommend in the workup of myocardial infarction (MI, heart attack)?

What is the role of ECG in the initial evaluation of patients with suspected acute coronary syndrome (ACS) or myocardial infarction (MI, heart attack)?

What are the criteria for using ECG in the workup of suspected myocardial infarction (MI, heart attack), and how often should it be performed?

Why is ECG an effective tool in detecting myocardial ischemia and acute myocardial infarction (MI, heart attack)?

What are the ECG features in ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What are the high-, intermediate-, and low-probability ECG features of myocardial infarction (MI, heart attack)?

How is the distribution of ECG abnormalities associated with the involved myocardium in myocardial infarction (MI, heart attack)?

How is posterior-wall myocardial infarction (MI, heart attack) identified on ECG?

What can abnormalities in a large number of ECG leads indicate in myocardial infarction (MI, heart attack)?

What ECG findings characteristic of myocardial infarction (MI, heart attack) may be seen in other conditions?

What does convex ST-segment elevation with upright or inverted T waves on ECG generally indicate in myocardial infarction (MI, heart attack)?

How can a permanent pacemaker affect the recognition of STEMI on ECG?

What are the non-ischemic causes of ST-segment elevation?

Which cardiac biomarkers have been used to evaluate suspected acute myocardial infarction (MI, heart attack)?

How has cardiac troponin detection and quantification changed over the years, and when should serial measurements of cardiac troponins be obtained?

How often should cardiac troponins be measured after the initial level is obtained at presentation?

What is troponin and when is it found in serum?

According to guidelines, what is the role of cardiac troponin testing in the diagnosis and prognosis of acute myocardial infarction (MI, heart attack)?

How long are troponin serum levels elevated in myocardial infarction (MI, heart attack), and what is the role of troponin testing in chest pain?

What is B-type natriuretic peptide (BNP), and what is its role in the workup of myocardial infarction (MI, heart attack)?

When should a CBC count be obtained in suspected myocardial infarction (MI, heart attack), and which conditions should be excluded prior to thrombolytic therapy?

When is a platelet count necessary in the workup of suspected myocardial infarction (MI, heart attack), and what may abnormal results indicate?

Which lab values should be closely monitored in patients with myocardial infarction (MI, heart attack)?

What are the causes of hypoxemia in patients with myocardial infarction (MI, heart attack), and how are oxygen levels monitored?

What is the role of a lipid profile in the workup of myocardial infarction (MI, heart attack)?

What is the role of imaging in the work-up of acute myocardial infarction (MI, heart attack)?

What is the role of coronary angiography in the workup of acute coronary syndrome (ACS), and which treatment options may be indicated by the results?

Which imaging study is an alternative to invasive angiography to exclude acute coronary syndrome (ACS) when there is a low to intermediate likelihood of coronary artery disease (CAD)?

What is the efficacy of myocardial perfusion imaging (MPI) with SPECT or PET scanning in myocardial infarction (MI, heart attack)?

What is the role of ECG in the workup of acute myocardial infarction (MI, heart attack)?

Treatment

What is the first goal in the management of acute myocardial infarction (MI, heart attack), and what is the objective of the initial therapy?

Why is it important to distinguish STEMI from non-STEMI in the initial evaluation of acute coronary syndrome (ACS)?

What is the role of evolocumab (Repatha) in the prevention of prevention of strokes, myocardial infarction (MI), and coronary revascularization?

How can morbidity and mortality from myocardial infarction (MI, heart attack) be significantly reduced, and what is the key to improved survival?

Why is effective communication between EMS personnel and emergency department staff important?

What prehospital care can be provided by EMS personnel in patients with myocardial infarction (MI, heart attack)?

What causes most myocardial infarction-related deaths, and what can prehospital care providers do to improve outcomes?

What are the secondary objectives of prehospital care by paramedical and emergency personnel in myocardial infarction (MI, heart attack)?

When is prehospital fibrinolytic therapy indicated for myocardial infarction (MI, heart attack), and what is its availability?

How is an initial evaluation of acute myocardial infarction (MI, heart attack) performed in the emergency department?

What are the goals of the overall management plan for acute myocardial infarction (MI, heart attack)?

When are oxygen saturation monitoring via pulse oximetry and supplemental oxygen indicated in acute myocardial infarction (MI, heart attack)?

What is the recommended dosage of aspirin in the treatment of acute coronary syndrome (ACS), and which form of aspirin is preferred?

What are nitrates, how are they used in the treatment of acute myocardial infarction (MI, heart attack), and what is the recommended dosage?

What is the recommended dosage of nitrates when chest pain persists or recurs?

When are nitrates contraindicated in patients with symptoms of acute coronary syndrome (ACS)?

What is the drug of choice for the treatment of refractory or severe pain associated with myocardial infarction (MI, heart attack), what is the recommended dosage, and which vital signs must be monitored?

Which analgesics are contraindicated in the treatment of refractory or severe pain in myocardial infarction (MI, heart attack)?

What are the essential components of STEMI management, and which treatment option is emphasized in current clinical guidelines?

Which aspects of emergency intervention are key in shortening total ischemic time in ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

When are early mechanical intervention (primary PCI) and early reperfusion strategies indicated in the treatment of acute coronary syndrome (ACS)?

How readily available are primary PCI services, and how can emergency medical personnel ensure access by patients with myocardial infarction (MI, heart attack)?

What is the management approach to ST-elevation myocardial infarction (STEMI) (MI, heart attack) in a hospital with, and a hospital without, primary percutaneous coronary intervention (PCI)?

What is percutaneous coronary intervention (PCI), and what is its role in the treatment of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What are the guidelines for performing PCI in the treatment of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

How does PCI accomplish reperfusion, and what is the role of stents in PCI?

How can cardiac rupture be predicted during primary PCI for treatment of ST-segment elevation myocardial infarction (MI) (STEMI)?

What is fibrinolysis, and when is it indicated in the treatment of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What adverse effect is associated with fibrinolytic therapy, and which patients are at greatest risk?

Which fibrinolytic agents are available for the management of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What is the role of coronary artery bypass grafting (CABG) in the acute management of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What is the role of anticoagulant therapy in the acute management of ST-elevation myocardial infarction (STEMI) (MI, heart attack), and what are the available options?

How is anticoagulation used in patients receiving fibrinolytic therapy for the treatment of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What is the role of aspirin in the treatment of ST-elevation myocardial infarction (STEMI) (MI, heart attack), and which other agents are used for dual antiplatelet therapy?

Which antiplatelet agents are used in patients undergoing primary PCI for ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

How are antiplatelet agents used in patients receiving fibrinolytic therapy for ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

In addition to clopidogrel, which other antiplatelet agents may be used in ST-elevation myocardial infarction (STEMI) (MI, heart attack) management?

What is ticagrelor, and what is its role in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI)?

What is the role of glycoprotein (GP) IIb/IIIa receptor inhibitors in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI), and which agents are preferred?

What is the dosage regimen of bivalirudin in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI)?

What are the key points of managing non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI), and what are the alternative management strategies?

Which patients with non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI) are candidates for an early invasive management strategy?

How do beta blockers work, and how are they used in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI)?

When are beta blockers contraindicated in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI)?

When are non-dihydropyridine calcium channel blockers indicated in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI)?

Which antiplatelet agent is preferred in non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI), and what is the recommended dosage?

What are the benefits of P2Y12 receptor inhibitors in the management of myocardial infarction, and which are most commonly used in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI)?

What is the treatment regimen for clopidogrel, and when is it indicated in the treatment of non-ST-elevation acute coronary syndrome (unstable angina NSTEMI)?

What is the dosage regimen of prasugrel in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI), and when is it contraindicated?

Which patients with non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI) should receive anticoagulant therapy?

What is the dosage regimen for unfractionated heparin (UH) in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI), and what is its disadvantage?

What is the dosage regimen of low molecular weight heparin (LMWH) in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEM), and what are the benefits and risks of enoxaparin?

What is dosage regimen of fondaparinux in the treatment of non-ST-elevation acute coronary syndrome (unstable angina and NSTEMI), and when is it contraindicated?

What are the goals of management after the initial treatment and stabilization of acute myocardial infarction (MI, heart attack)?

What are the roles of ACE inhibitors, ARBs, and aldosterone blockers in the treatment of acute myocardial infarction (MI, heart attack)?

What are the guidelines for the use of beta blockers in long-term treatment after acute myocardial infarction (MI, heart attack)?

What are the current clinical practice guidelines for the use of long-term statin therapy in acute myocardial infarction (MI, heart attack)?

Which lifestyle modifications are associated with a reduction in recurrent myocardial infarction (MI, heart attack) and prevention of further progression of cardiovascular disease?

Which rehabilitation programs should be offered to patients with myocardial infarction (MI, heart attack)?

What are the special considerations in treating elderly patients with myocardial infarction (MI, heart attack)?

What are the complications of myocardial infarction (MI, heart attack)?

What is the incidence of cardiac arrhythmias in patients with acute myocardial infarction (MI, heart attack), and what treatment is indicated?

What are the major mechanical complications of myocardial infarction (MI, heart attack)?

What is a left ventricular aneurysm, and what are the risk factors for these aneurysms after acute myocardial infarction (MI, heart attack)?

When do ventricular septal ruptures occur in the setting of acute myocardial infarction (MI, heart attack), and which patients are at greatest risk for this complication?

How can morbidity and mortality associated with ventricular septal rupture be avoided?

Where do ventricular ruptures occur, and which interventions are essential to survival?

How common does right ventricular infarction complicate inferior myocardial infarction (MI), and how is it diagnosed?

What is the presentation of ventricular infarction in patients with myocardial infarction (MI, heart attack), which interventions are indicated, and which medications are contraindicated?

How are complications of myocardial infarction (MI, heart attack) diagnosed, and how is pseudoaneurysm differentiated from a true aneurysm on imaging?

What is the incidence of left ventricular mural thrombus in the setting of acute anterior myocardial infarction (MI, heart attack), and what are the associated risks and treatment?

What are the incidence and clinical presentation of early pericarditis after myocardial infarction (MI, heart attack)?

What future and emerging therapies exist for the treatment of myocardial infarction (MI, heart attack)?

Guidelines

What are the guidelines for prehospital and emergency care in patients with ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What is the recommended reperfusion strategy for patients with ST-elevation myocardial infarction (STEMI) (MI, heart attack) and symptom onset within the preceding 12-24 hours?

What are the 2013 ACC/AHA guidelines for PCI after administration of fibrinolytic therapy in the treatment of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What are the treatment guidelines for PCI in ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What are the 2015 ACC/AHA/SCAI treatment guidelines for percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What are the 2017 ESC treatment guidelines for percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What are the 2011 ACC/AHA/SCAI treatment guidelines for percutaneous coronary intervention (PCI) and bare-metal stents (BMS) or drug-eluting stents (DES) for myocardial infarction (MI, heart attack)?

What are the 2014 ESC/EACTS and 2017 ESC guidelines regarding the use of drug-eluting stents (DES) in percutaneous coronary intervention (PCI) for the treatment of myocardial infarction (MI, heart attack)?

What are the 2013 ACC/AHA guidelines for antithrombotic therapy in patients undergoing primary PCI for ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What are the 2014 ACC/AHA guidelines for coronary artery bypass grafting (CABG) in the treatment of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

What are the 2014 ACC/AHA guidelines for coronary artery bypass grafting (CABG) after failed percutaneous coronary intervention (PCI) in the treatment of myocardial infarction (MI, heart attack)?

What are the 2015 AHA guidelines for secondary prevention after coronary artery bypass grafting (CABG)?

What are the 2015 SCAI/ACC/HFSA/STS guidelines for mechanical circulatory support (MCS) devices in the treatment of myocardial infarction (MI, heart attack)?

According to the 2013 ISHLT guidelines for acute cardiogenic shock, when is mechanical circulatory support (MCS) indicated in the treatment of myocardial infarction (MI, heart attack)?

According to the 2016 ACC/AHA guidelines, which medications should be included in a dual antiplatelet therapy (DAPT) regimen in the treatment of myocardial infarction (MI, heart attack)?

What are the 2016 ACC/AHA guidelines for the use of dual antiplatelet therapy (DAPT) in non-ST-elevation acute coronary syndrome (NSTE-ACS) or ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

Which P2Y12 inhibitor is preferred in non-ST-elevation acute coronary syndrome (NSTE-ACS) or ST-elevation myocardial infarction (STEMI), according to the 2016 ACC/AHA guidelines on duration of dual antiplatelet therapy (DAPT)?

According to the 2016 ACC/AHA guidelines on dual antiplatelet therapy (DAPT), when is treatment continued for more than a year, and when is treatment stopped after 6 months in NSTE-ACS or STEMI?

According to the 2016 ACC/AHA guidelines on dual antiplatelet therapy (DAPT), when is prasugrel contraindicated in coronary artery disease (CAD)?

Medications

What are the goals of pharmacotherapy for myocardial infarction (MI, heart attack), and what are the goals of emergency department medical therapy for MI?

Which medications in the drug class Antiplatelet Agents are used in the treatment of Myocardial Infarction?

Which medications in the drug class Antithrombotic Agents are used in the treatment of Myocardial Infarction?

Which medications in the drug class Glycoprotein IIb/IIIa Inhibitors are used in the treatment of Myocardial Infarction?

Which medications in the drug class Vasodilators are used in the treatment of Myocardial Infarction?

Which medications in the drug class Beta-adrenergic blockers are used in the treatment of Myocardial Infarction?

Which medications in the drug class Angiotensin-Converting Enzyme Inhibitors are used in the treatment of Myocardial Infarction?

Which medications in the drug class Angiotensin-Receptor Blockers are used in the treatment of Myocardial Infarction?

Which medications in the drug class Thrombolytics are used in the treatment of Myocardial Infarction?

Which medications in the drug class Analgesics are used in the treatment of Myocardial Infarction?

Which medications in the drug class PCSK9 Inhibitors are used in the treatment of Myocardial Infarction?