Abstract

April 2007

Section 1 Cardiovascular Medicine

The discovery that nearly all cases of acute myocardial infarction were caused by thrombotic occlusion of a coronary artery led to the development of therapies that restore blood flow to the occluded artery, and as a result, the number of people who die each year of myocardial infarction has decreased significantly. This chapter reviews the epidemiology, pathogenesis, and diagnosis of acute myocardial infarction. Treatment is discussed in sections on emergent therapy, reperfusion therapy, and adjunctive medical therapy; and the complications of myocardial infarction are reviewed. The chapter also discusses the efficacy of HMG-CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors, warfarin, antiarrhythmics, and risk-factor modification for prevention of myocardial infarction. The long-term prognosis is determined primarily by the severity of left ventricular dysfunction, the presence and degree of residual ischemia, and the potential for malignant ventricular arrhythmia. Tables outline the clinical symptoms of evolving or recent myocardial infarction versus established myocardial infarction, the Killip classifications of acute myocardial infarction, and the recommendations for use of an invasive strategy for the management of patients with unstable angina or non–ST segment elevation myocardial infarction. Graphs present comparative findings of clinical trials. This chapter contains 146 references.

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