RT Book, Section
A1 Saxena, Shivam
A1 Hollenberg, Steven M.
A2 Schmidt, Gregory A.
A2 Kress, John P.
A2 Douglas, Ivor S.
SR Print(0)
ID 1201801476
T1 Myocardial Ischemia
T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264264353
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1201801476
RD 2024/10/03
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.