http://www.scribd.

com/doc/78022719/NCP-Chest-Pain

Myocardial infarction, commonly known as a heart attack, is the irreversible necrosis of heart muscle secondary
to prolonged ischemia. This is most commonly due to occlusion (blockage) of a coronary artery following the
rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty
acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction
in blood supply) and ensuing oxygen shortage, if left untreated for a sufficient period of time, can cause damage
or death (infarction) of heart muscle tissue (myocardium).

Signs and symptoms of myocardial ischemia:

Crushing pain on the chest (angina pectoris), behind the sternum, often radiating to the lower jaw or the left arm
Fear of dying
Nausea
Shock (manifesting as paleness, low blood pressure, fast weak pulse) shock
Rhythm disturbances (in particular, increasing prevalence of ventricular ectopia, ventricular tachycardia, AV bloc

ECG Manifestations of Acute Myocardial Ischaemia (in Absence of LVH and LBBB)are :

ST elevation
New ST elevation at the J-point in two contiguous leads with the cut-off points: 0.2 mV in men or 0.15 mV in
women in leads V2V3 and/or 0.1 mV in other leads.

ST depression and T-wave changes.
New horizontal or down-sloping ST depression >0.05 mV in two contiguous leads; and/or T inversion 0.1 mVin
two contiguous leads with prominent R-wave or R/S ratio 1

Management

An MI requires immediate medical attention. Treatment attempts to salvage as much myocardium as possible
and to prevent further complications, hence the phrase "time is muscle". Oxygen, aspirin, and nitroglycerin may
be administered. Morphine was classically used if nitroglycerin was not effective; however, it may increase
mortality in the setting of NSTEMI. A 2009 and 2010 review of high flow oxygen in myocardial infarction found
increased mortality and infarct size, calling into question the recommendation about its routine use. Other
analgesics such as nitrous oxide are of unknown benefit. Percutaneous coronary intervention (PCI) or fibrinolysis
are recommended in those with an STEMI. (Wikipedia)

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