Pathophysiology and management of myocardial infarction

Abstract

Acute obstruction of a coronary artery is the most common cause of ST-segment elevation myocardial infarction (STEMI). The most common clinical presentation of myocardial infarction is acute chest pain. It is essential that initial assessment and management be rapid but methodical and evidence based focusing on distinguishing between chest pain secondary to acute coronary syndrome and that caused by nonischemic etiologies. Early revascularization is the mainstay of improving outcomes. Primary percutaneous coronary intervention (PCI) supported by appropriate antithrombotic therapy is the preferred approach when rapidly available. Guideline-directed medical therapy, secondary prevention, and lifestyle modification complement successful long-term management. In this chapter, we will discuss the management of acute STEMI, highlighting some important key elements in the pathophysiology of and mechanisms by which STEMI can develop.