Myocardial Infarction 2019 - Medtelligence• Evidence for acute myocardial injury-cTn + •...
Transcript of Myocardial Infarction 2019 - Medtelligence• Evidence for acute myocardial injury-cTn + •...
Myocardial Infarction
Dennis Reison, MD: Disclosures
• No financial disclosures
BIOMARKERS
Identification of acute
thrombosis in AMI
Intracoronary Thrombolytic Rx
TIMI Trials
Intravenous Thrombolysis
TPA
PCI
Clinical Criteria for MI
“The clinical definition of MI denotes the presence of acute myocardial
injury detected by abnormal cardiac biomarkers in the setting of evidence
of acute myocardial ischemia”
Myocardial injury
• Elevation of cTn above the 99th percentile• Rise and fall of cTn levels in a pattern c/w an
acute event
Evidence of Acute Myocardial Ischemia
• Symptoms of myocardial ischemia• New Ischemic EKG changes• Development of pathological Q waves• Imaging evidence of new loss of myocardium• Identification of coronary thrombosis (Type 1)
Criteria for AMI
• Evidence for acute myocardial injury-cTn
+• Symptoms of myocardial ischemia• New Ischemic EKG changes• Development of pathological Q waves• Imaging evidence of new loss of myocardium• Identification of coronary thrombosis (Type 1)
AMI Classification
• Myocardial Infarction Type 1-STEMI/NSTEMI• Myocardial Infarction Type 2-Supply/Demand• Myocardial Infarction Type 3-Sudden Death• Myocardial Infarction Type 4-PCI Related• Myocardial Infarction Type 5-CABG Related
Type 1 AMI
Treatment of AMI-1
• PCI of Culprit lesion• Thrombolytic Rx• Beta blockers• ACE-I/ARB• Dual anti-platelet therapy• Heparin-UFH/LMW• Statins
Temporal Pattern of Cardiovascular Risk after the Onset of Acute Infection.
Musher DM et al. N Engl J Med 2019;380:171-176
Pathogenesis of Pump Failure in AMI
Shock 2 Trial
• No mortality benefit for IABP in CGS
Shock Team• Interventional Cardiology• Cardiovascular Surgery• Heart Failure Cardiology• Pulmonary/Intensive Care Medicine• Anesthesiology
IMPELLA
INCREASED MEAN AORTIC
PRESSURE
LEFT VENTRICULAR UNLOADING
INCREASED ORGAN PERFUSION
DECREASED LV OXYGEN
REQUIREMENTS
Summary
• Pathophysiology and History of AMI• Fourth Universal Definition of AMI• Myocardial Injury• Myocardial Ischemia• Cardiogenic Shock• Impella for LV Failure