Myocardial infarction
- Stress echocardiography: its emerging role in identifying viable myocardium
In patients with chronic ischemia or left ventricular systolic dysfunction, this test can indicate whether the damaged myocardium is still viable and, therefore, whether revascularization would be beneficial.
- Management of acute myocardial infarction in the elderly
Because elderly patients are at greater cardiac risk than younger patients, they have more to gain from treatment. Risk-benefit analysis plays a pivotal role in treatment decision-making, since treatments may pose more risk for older patients.
- Noninvasive risk assessment after myocardial infarction
BACKGROUND Mortality from acute myocardial infarction is substantially less than it was two and even one decade ago. This improvement in both short-term and postdischarge outcome results both from early interventions to restore myocardial perfusion and mitigate expansion and remodeling, and from later assessment and management of functional status at the time of hospital discharge.
OBJECTIVE Recent studies suggest that invasive evaluation of the patient who has had a myocardial infarction (MI) should not be recommended on a routine basis. This review provides an approach to the noninvasive assessment of the patient.
DISCUSSION Stress testing to ascertain post-MI ischemia, ejection fraction determination to evaluate ventricular volumes and function, and ambulatory electrocardiographic monitoring, electrophysiologic study, and signal-averaged electrocardiography to assess presence and type of ventricular ectopy are discussed.
CONCLUSION The approach to the post-MI patient offered herein is felt to be medically sound and cost-effective. Refinement and alterations in this approach will be necessary as outcomes in specific patient groups, such as thrombolysis patients, women, and the elderly, become clearer.
- Tools for noninvasive assessment of coronary arterial reperfusion
Coronary angiography has been the standard method to rapidly assess coronary reperfusion status after acute MI, but the availability, cost, and risks of the procedure are potential concerns. Noninvasive markers are showing promise as alternatives to angiography.
- Electrocardiographic criteria for anterior myocardial infarction
Five criteria tested in 1,324 consecutive patients confirmed the diagnostic value of the standard 12-lead electrocardiogram.
- Assessment of the size of acute myocardial infarction I: biochemical methods
For routine purposes, measurement of slowly catabolized enzymes is the most practical way to determine infarct size.
- Assessment of the size of acute myocardial infarction II: electrocardiography and imaging methods
The electrocardiogram gives a reasonable estimate of infarct size; among visual methods, magnetic resonance imaging has the greatest potential for accuracy.