a combination of angina (unstable or stable), non-S–T elevation *myocardial infarction (NSTEMI), and S–T elevation myocardial infarction (STEMI). It implies the presence of coronary artery disease.... acute coronary syndrome
death of a segment of heart muscle, which follows interruption of its blood supply (see coronary thrombosis). Myocardial infarction is usually confined to the left ventricle. The patient experiences a ‘heart attack’: sudden severe chest pain, which may spread to the arms and throat. Although severe chest pain is the most widely recognized symptom of myocardial infarction, many patients – especially women – do not have chest pain. Other presenting symptoms include abdominal pain, nausea, vomiting, sweating, shortness of breath, and dizziness. The main danger is that of ventricular *fibrillation, which accounts for most of the fatalities. Other *arrhythmias are also frequent. Other complications include heart failure, rupture of the heart, phlebothrombosis, pulmonary embolism, pericarditis, shock, mitral regurgitation, and perforation of the septum between the ventricles.
Patients with myocardial infarction are best cared for in a specialized coronary care unit with facilities for the early detection, prevention, and treatment of arrhythmias and *cardiac arrest. Blockage of a major coronary artery is detected by elevation of the *S–T segment on the *electrocardiogram (STEMI or S–T elevation myocardial infarction). It is relieved by emergency *coronary angioplasty (commonly called primary *percutaneous coronary intervention) or the intravenous infusion of a drug to dissolve thrombus (*thrombolysis). Most survivors of myocardial infarction are able to return to a full and active life, including those who have been successfully resuscitated from cardiac arrest. Lesser degrees of coronary obstruction may not be seen on the electrocardiogram but are revealed by the detection of raised *troponin levels in the blood (NSTEMI or non-S–T elevation myocardial infarction). Treatment is with *antiplatelet drugs and early percutaneous coronary intervention.... myocardial infarction
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