acute myocardial infarction


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acute myocardial infarction (AMI)

Etymology: L, acutus, + Gk, mys, muscle, kardia, heart; L, infarcire, to stuff
the early critical stage of necrosis of heart muscle tissue caused by blockage of a coronary artery. It is characterized by elevated S-T segments in the reflecting leads and elevated levels of cardiac enzymes. See also myocardial infarction.

acute myocardial infarction

Cardiology The abrupt death of heart muscle due to acute occlusion or spasm of the coronary arteries Epidemiology ±1.5 million MIs/yr–US, 75,000 AMI follow strenuous physical activity, of whom13 die; ±14 of all deaths in the US are due to AMIs; > 60% of the AMI-related deaths occur within 1 hr of the event; most are due to arrhythmias, in particular ventricular fibrillation Triggers Heavy exertion in ±5% of Pts, which is inversely related to Pt's habitual physical activity Etiology Occlusion of major coronary artery–CA, in a background of ASHD, due primarily to the plugging of the vessel with debris from an unstable plaque–see Uncomplicated plaque Clinical Main presenting symptom–retrosternal chest pain accompanied by tightness, discomfort, & SOB; cardiac pain often radiates to the arm & neck, and less commonly to the jaw; the pain of AMI generally is. not relieved with nitroglycerin, in contrast to esophageal pain, which is often identical in presentation, and may respond, albeit slowly, to nitroglycerin; the characteristic clinical picture notwithstanding, there is a high rate of false negative diagnoses of AMIs Diagnosis Clinical presentation, physical examination, EKG–sensitivity in diagnosing AMI is 50–70%, and is lower in lateral MIs than in anterior and inferior MIs; CXR may demonstrate left ventricular failure, cardiomegaly Echocardiography M-mode, 2-D & Doppler Radioisotopic studies Radionuclide angiography, perfusion scintigraphy, infarct-avid scintigraphy, & PET can be used to detect an AMI, determine size & effects on ventricular function, and establish prognosis; a radiopharmaceutical, 99mTc-sestamibi, has become the perfusion imaging agent of choice, given its usefulness for measuring the area of the myocardium at risk for AMI, and for recognizing the myocardium salvaged after thrombolytic therapy Other imaging techniques–eg, CT, and MRI Lab CK-MB, troponin I DiffDx AMI is the most common cause of acute chest pain in older adults, other conditions must be excluded–Prevention ↓ Smoking, ↓ cholesterol, ↓ HTN; ↑ aerobic exercise; influence of other factors-eg maintaining normal body weight, euglycemic state in diabetes, estrogen-replacement therapy, mild-to-moderate alcohol consumption, effect of prophylactic low-dose aspirin-on incidence of AMI is less clear. See AIMS, ASSET, EMERAS, EMIP, GISSI, GISSI-2, GUSTO-1, INJECT, ISIS-2, ISIS-3, LATE, MITI-1, MITI-2, RAPID, TAMI-5, TAMI-7, TEAM-2, TIMI-2, TIMI-4, Trial.
Differential diagnosis of acute myocardial infarction
Arm pain
Myocardial ischemia, cervical/thoracic vertebral pain, thoracic outlet syndrome
Epigastric pain
Myocardial ischemia, GI tract–esophagus, peptic ulcers, pancreas, liver disease–cholecystitis, hepatic distension, pericardial pain, pneumonia
Retrosternal pain
Myocardial ischemia, aortic dissection, esophageal pain, mediastinal lesions, pericardial pain, PTE
Shoulder pain
Myocardial ischemia, cervical vertebra, acute musculoskeletal lesions, pericardial pain, pleuritis, subdiaphragmatic abscess, thoracic outlet syndrome
.

a·cute cor·o·nar·y syn·drome

(ACS) (ă-kyūt' kōr'ŏ-nar-ē sin'drōm)
A general term for clinical syndromes due to reduction of blood flow in coronary arteries (e.g., unstable angina, acute myocardial infarction).
Synonym(s): acute myocardial infarction, preinfarction angina, unstable angina.

acute myocardial infarction (·kyōōtˑ mī·ō·karˑ·dē·l in·farkˑ·shn),

n early stage of heart muscle mortification caused by blockage in a coronary artery.

a·cute cor·o·nar·y syn·drome

(ACS) (ă-kyūt' kōr'ŏ-nar-ē sin'drōm)
A general term for clinical syndromes due to reduction of blood flow in coronary arteries.
Synonym(s): preinfarction angina, unstable angina.
References in periodicals archive ?
The diagnosis of acute myocardial infarction should be seriously considered in all young smokers.
Prevention of left ventricular remodeling with G-CSF after acute myocardial infarction: Final one-year results of the FIRSTLINEAMI trial (Front-integrated revascularization and stem cell liberation in evolving acute myocardial infarction by granulocyte colony-stimulating factor).
Of the 32 patients, 22 had had an acute myocardial infarction.
The denial of chest pain in 32 patients with acute myocardial infarction.
Knowledge and Practices of Generalist and Specialist Physicians Regarding Drug Therapy for Acute Myocardial Infarction.
Repair of infarcted myocardium has been demonstrated in experimental models of acute myocardial infarction (AMI), with both improved myocardial function and survival, following local administration of bone marrow-derived stem cells (BMSC) (5-8).
Dauerman and Sobel, both affiliated with the Cardiovascular Center at the University of Vermont, collect the latest scientific evidence illustrating the increasing important of pharmacoinvasive therapy in the treatment of ST elevation acute myocardial infarction.
Cardiac rupture during maximal exercise testing before hospital discharge after acute myocardial infarction [in Italian].
Because LBBB may both obscure the ECG features of acute myocardial infarction and increase its mortality (1), current American College of Cardiology/American Heart Association guidelines recommend reperfusion therapy for all patients with LBBB whose history suggests acute myocardial infarction (2).
These biologicals are used to treat anemias, neutropenia, growth hormone deficiency, diabetes, and acute myocardial infarction, respectively.
com/research/16ab5a/primary_angioplast) has announced the addition of the "Primary Angioplasty: Mechanical Interventions for Acute Myocardial Infarction, Second Edition" book to their offering.
Compared with the general population, they have four to six times the risk of sudden death, even though long-term survival after acute myocardial infarction has improved dramatically in recent years.

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