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Specialized Circulations in Susceptible Tissues
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
Typically, patients present as acute ST segment elevation myocardial infarction (STEMI) with typical clinical features including chest pain/discomfort and with dyspnea, and tachycardia attributed to LV failure. They show ST segment elevation on ECG (but no reciprocal ST depression), and troponins are often diagnostically elevated. There is often a recent history of unaccustomed exercise or of a fright or injury. The condition may follow major surgery or be associated in some way with sympathetic nervous excitation. It may be the first evidence of an epinephrine or norepinephrine secreting pheochromocytoma (Loscalzo et al., 2018). The condition typically occurs in older, postmenopausal females with male/female ratio of 1:10—the opposite gender ratio for young persons with STEMI (Arora et al., 2019). It can be complicated by all problems of STEMI, including death, arrhythmia, heart failure, even apical heart rupture (O'Rourke, 1973; Jaguszewski et al., 2012; Loscalzo et al., 2018). The abnormality of contraction affects the whole apex of the heart but with no confinement to the territory of any particular coronary artery.
The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Acute coronary syndrome (ACS) (see Figure 6.23) is an umbrella term encompassing a spectrum of clinical presentations all caused by the same disease process, resulting in clot formation in the coronary arterial blood supply. This is triggered by the erosion or rupture of a fibrous plaque, disrupting coronary arterial blood flow to the myocardium. Myocardial injury and/or death is a medical emergency and results from flow disruption. These clinical presentations can be categorised as: Unstable angina, ischaemic pain without myocardial death.Non-ST segment elevation myocardial infarction (NSTEMI).ST segment elevation myocardial infarction (STEMI).
The T wave
Published in Andrew R Houghton, Making Sense of the ECG, 2019
T wave inversion can occur not only as a temporary change in myocardial ischaemia but also as a more prolonged (and sometimes permanent) change in myocardial infarction. In Chapter 15, we mentioned that myocardial infarctions are often divided into: ST segment elevation myocardial infarction (STEMI)Non-ST segment elevation myocardial infarction (NSTEMI)
Advances in the available pharmacotherapy for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation
Published in Expert Opinion on Pharmacotherapy, 2023
Antonio Greco, Simone Finocchiaro, Dominick J. Angiolillo, Davide Capodanno
More than seven million cases of acute coronary syndrome (ACS) are diagnosed every year, representing a leading cause of mortality worldwide, with prominent social and economic implications [1]. Based on the presence or absence of persistent elevation of the ST segment at the electrocardiogram, ACS can be categorized into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (NSTE-ACS). The latter includes non-ST-segment-elevation myocardial infarction (NSTEMI) and unstable angina (UA), two entities that differ for the degree of myocardial injury (i.e. increased cardiac biomarkers in NSTEMI, but not in UA). NSTEMI is the most frequent type of acute myocardial infarction (MI) and accounts for the majority of ACS, usually on the background of a nonocclusive coronary thrombus [2].
Citrate pretreatment attenuates hypoxia/reoxygenation-induced cardiomyocyte injury via regulating microRNA-142-3p/Rac1 aix
Published in Journal of Receptors and Signal Transduction, 2020
Haiyan Xiang, Juesheng Yang, Jin Li, Linhui Yuan, Fei Lu, Chen Liu, Yanhua Tang
In recent years, with the change of people’s lifestyle and dietary structure, the incidence of coronary atherosclerosis and heart disease is on the rise and tends to be younger [1]. Among them, acute ST-segment elevation myocardial infarction is the most serious clinical manifestation of coronary heart disease [2]. Recovering myocardial perfusion as early as possible is the most effective measure to resolve acute coronary heart disease. The wide application of powerful new technologies such as coronary artery bypass grafting and percutaneous coronary intervention has rapidly restored the blocked coronary artery perfusion, saved the dying myocardial cells, and significantly improved the clinical therapeutic effect [3]. However, myocardial injury induced by reperfusion itself, namely, myocardial ischemia reperfusion injury, has become a bottleneck restricting the treatment of coronary heart disease. How to effectively prevent and treat myocardial ischemia reperfusion injury has become one of the most important problems to be solved in clinical cardiovascular work [4].
Spontaneous coronary artery dissection, a commonly overlooked etiology of acute coronary syndrome
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Ashish Kumar Roy, Moni Roy, Manajyoti Yadav, Kalyan C. Potu, Sudhir Mungee
Electrocardiography (EKG) showed inferior ST segment elevation myocardial infarction (STEMI) and patient was taken for emergent coronary angiography (Figure 1). Emergent cardiac catheterization showed the mid segment of left anterior descending (LAD) artery with 90% rapid tapering followed by distal pruning (Figure 2). The LAD finding on coronary angiography was consistent with spontaneous coronary artery dissection (SCAD). During the procedure, patient was having active chest pain; therefore, percutaneous coronary intervention with ballooning under low inflation pressure was done for 1 min with advancement of guidewire into distal LAD, but no change in vessel size or flow was appreciated with the intervention or retraction of guidewire (Figures 3,4). Left circumflex artery (LCX) was noted to be a large codominant vessel with 20% stenosis. Right coronary artery (RCA) with no evidence of stenosis was noted. Due to cardiac catheterization findings suggestive of SCAD, a stent was not placed. Left ventricular ejection fraction on cardiac catheterization was noted to be low at 40% and a follow up echocardiogram was done. Transthoracic echocardiogram confirmed a left ventricular ejection fraction of 40%, akinesia of the mid to apical segments and inferior hypokinesis (Figure 5).