TY - CHAP M1 - Book, Section TI - Myocardial Ischemia A1 - Saxena, Shivam A1 - Hollenberg, Steven M. A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. Y1 - 2023 N1 - T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSMyocardial ischemia results from an imbalance between myocardial oxygen demand and supply.Myocardial infarction is diagnosed by a compatible clinical history, evolution of characteristic ECG changes, and a rise and fall of cardiac troponins.Patients with myocardial ischemia are divided by presentation into those with or without ST elevation, in accordance with treatment strategies. Patients with ST elevation benefit from immediate reperfusion with percutaneous coronary intervention.Risk stratification is the key to initial management of patients with non-ST-elevation acute coronary syndromes. An early invasive approach is preferred in patients with high-risk non-ST-elevation acute coronary syndromes.All patients with suspected myocardial ischemia should be given aspirin upon presentation.Aspirin, P2Y12 inhibitors, β-blockers, renin-angiotensin-aldosterone system antagonists, and statins have been shown to decrease mortality after myocardial infarction.Prognosis after myocardial infarction is most closely related to the degree of left ventricular impairment.Echocardiography is extremely useful for the diagnosis of complications after myocardial infarction.Patients with cardiogenic shock should be stabilized with prompt revascularization and may require inotropes or mechanical circulatory support. Invasive hemodynamic monitoring should be strongly considered. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/10/08 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1201801476 ER -