Introduction A non–ST-elevation acute coronary syndrome (NSTE-ACS) is caused by a severe flow-limiting stenosis or acute thrombotic obstruction of a coronary artery (see Chapter 13 ). In the absolute majority of cases,levels of myocardial markers also are elevated, indicating myocardial…
Introduction A ST-segment myocardial infarction (STEMI) is caused by the occlusion of a major epicardial coronary artery and is generally triggered by rupture of a vulnerable plaque, with subsequent formation of an occlusive thrombus. Rapid restoration of coronary blood flow…
Case Presentation A 57-year-old man presents to a community hospital without capability for primary percutaneous coronary intervention (PPCI) in the early morning (4 am ) with a 1.5-hour history of severe chest pain. His medical history is significant for hypertension.…
Introduction The key principles that underlie management of myocardial infarction (MI) are based on the pathophysiology of the condition and the time course of irreversible myocardial injury. The fundamental goals of managing acute MI include (1) minimizing the duration of…
Introduction Of the more than 8 million visits to emergency departments (EDs) in the United States for chest pain or other potential ischemic symptoms, only a small minority will yield a diagnosis of an acute coronary syndrome (ACS). Less than…
Introduction Acute myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide (see Chapter 2 ). Although an estimated 157,000 patients will die each year in the United States as a result of an MI, this statistic belies…
Introduction Outcomes after percutaneous coronary intervention (PCI) have improved significantly over the past few decades, in large part because of newer stent platforms, better implantation techniques, and improved adjunctive medical therapy. However, the risk of recurrent cardiac events after successful…
Introduction Previous chapters have detailed the important roles of clinical presentation (see Chapter 6 ), cardiovascular risk factors, electrocardiography (ECG), and biomarkers (see Chapter 7 and Chapter 8 ) in the initial assessment of patients who present with acute chest…
Introduction Cardiac troponin (cTn) is the preferred biomarker for the evaluation of patients with suspected acute myocardial infarction (MI) (see Chapter 7 ). In addition, it makes sense that other biomarkers that reflect the varied causes and consequences of MI,…
Introduction Cardiac troponin (cTn) is the biomarker of choice for the evaluation of patients with symptoms suggestive of acute myocardial ischemia. Increases in cTn are necessary for the diagnosis of acute myocardial infarction (MI). Some even have opined that with…