Overview
Definition
A spectrum of clinical presentations ranging from ST-segment elevation myocardial infarction (STEMI) to non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA).
Epidemiology
A leading cause of death globally. Millions of cases present to emergency departments annually.
Etiology & Risk Factors
- Atherosclerotic plaque rupture with superimposed thrombosis
- Coronary artery vasospasm
- Coronary dissection
Clinical Symptoms
- Substernal chest pain (crushing, heavy, radiating to jaw/left arm)
- Diaphoresis (sweating)
- Dyspnea
- Nausea/Vomiting
Clinical Approach
Diagnosis
- 12-lead ECG within 10 minutes (ST elevation, ST depression, T wave inversions)
- Cardiac biomarkers (High-sensitivity Troponin)
- Coronary Angiography
Management
- MONA (Morphine, Oxygen, Nitroglycerin, Aspirin) - *Note: Morphine/O2 use depends on O2 sat and pain*
- Dual Antiplatelet Therapy (DAPT: Aspirin + P2Y12 inhibitor)
- Anticoagulation (Heparin)
- Reperfusion therapy (PCI for STEMI, CABG if multivessel)
Complications
- Cardiogenic shock
- Ventricular arrhythmias (VT/VF)
- Heart failure
- Papillary muscle rupture