myocardial infarction 2019 - medtelligence• evidence for acute myocardial injury-ctn + •...
TRANSCRIPT
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Myocardial Infarction
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Dennis Reison, MD: Disclosures
• No financial disclosures
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BIOMARKERS
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Identification of acute
thrombosis in AMI
Intracoronary Thrombolytic Rx
TIMI Trials
Intravenous Thrombolysis
TPA
PCI
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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”
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Myocardial injury
• Elevation of cTn above the 99th percentile• Rise and fall of cTn levels in a pattern c/w an
acute event
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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)
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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)
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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
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Type 1 AMI
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Treatment of AMI-1
• PCI of Culprit lesion• Thrombolytic Rx• Beta blockers• ACE-I/ARB• Dual anti-platelet therapy• Heparin-UFH/LMW• Statins
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Temporal Pattern of Cardiovascular Risk after the Onset of Acute Infection.
Musher DM et al. N Engl J Med 2019;380:171-176
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Pathogenesis of Pump Failure in AMI
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Shock 2 Trial
• No mortality benefit for IABP in CGS
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Shock Team• Interventional Cardiology• Cardiovascular Surgery• Heart Failure Cardiology• Pulmonary/Intensive Care Medicine• Anesthesiology
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IMPELLA
INCREASED MEAN AORTIC
PRESSURE
LEFT VENTRICULAR UNLOADING
INCREASED ORGAN PERFUSION
DECREASED LV OXYGEN
REQUIREMENTS
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Summary
• Pathophysiology and History of AMI• Fourth Universal Definition of AMI• Myocardial Injury• Myocardial Ischemia• Cardiogenic Shock• Impella for LV Failure
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