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Radiation island codes12/28/2023 ![]() Further pain relief with morphine can be given for patients that continue report discomfort after nitroglycerin administration however judicious use is not recommended as it may adversely affect outcomes. Nitroglycerin administration can reduce anginal pain however it should be avoided in patients who have used phosphodiesterase inhibiting medication within the last 24 hours and in cases of right ventricular infarction. It is important to rule out conditions that can mimic an acute coronary syndrome like acute aortic dissection or acute pulmonary embolism.Īll patients with an acute myocardial infarction should be started on a beta blocker, high intensity statin, aspirin, and a P2Y12 inhibitor as soon as possible, with certain exceptions. If PCI is not possible within the first 120 minutes of first medical contact, fibrinolytic therapy should be initiated within 30 minutes of patient arrival at the hospital. Patients should undergo percutaneous coronary intervention (PCI) within 90 minutes of presentation at a PCI capable hospital or within 120 minutes if transfer to a PCI capable hospital is required. Patients that are hypoxemic or at risk for hypoxemia benefit from oxygen therapy however, recent studies show possible deleterious effects in normoxic patients. Types 4 and 5 MIs are related to coronary revascularization procedures like Percutaneous Coronry Intervention (PCI) or Coronary artery Bypass Grfting ( CABG).Īfter making the diagnosis of acute ST-elevation myocardial infarction, intravenous access should be obtained, and cardiac monitoring started. Sudden cardiac death patients who succumb before any troponin elevation comprise Type 3 MI. Other potential etiologies include coronary asospasm, coronary embolus, and spontaneous coronary artery dissection ( SCAD). This demand supply mismatch can be due to multiple reasons including but not limited to presence of a fixed stable coronary obstruction, tachycardia, hypoxia or stress. However, the presence of fixed coronary obstruction is not necessary. Type 2 MI is the most common type of MI encountered in clinical settings in which is there is demand-supply mismatch resulting in myocardial ischemia. ![]() Most patients with ST-segment elevation MI (STEMI) and many with non-ST-segment elevation MI (NSTEMI) comprise this category. ![]() Myocardial infarction in general can be classified from Type 1 to Type 5 MI based on the etiology and pathogenesis. Type 1 MI is due to acute coronary atherothrombotic myocardial injury with plaque rupture. The major risk factors for ST-elevation myocardial infarction are dyslipidemia, diabetes mellitus, hypertension, smoking, and family history of coronary artery disease. The cause of this abrupt disruption of blood flow is usually plaque rupture, erosion, fissuring or dissection of coronary arteries that results in an obstructing thrombus. An ST-elevation myocardial infarction occurs from occlusion of one or more of the coronary arteries that supply the heart with blood.
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