AMI Mortality rate15-30% 20-30% >

MI 4mortality 260% arrythmia mortality 50-70%

plaque 6catecholamine MI

angiotensin-converting enzyme inhibitor

arrythmia

arrythmia

Wall affected Anterior Anterolateral Anteroseptal Inferior Lateral

Leads V2-V4 I, aVL, V3V6 V1-V4 II, III, aVF I, aVL, V5, V6 V8, V9

Artery involved Left coronary artery, Left Anterior descending (LAD) LAD and diagonal branches, circumflex and marginal branches LAD right coronary artery (RCA) circumflex branch or left coronary artery RCA or circumflex artery

Reciprocal changes II, III, aVF II, III, aVF I, aVL II, III, aVF V1-V4 (R greater than S in V1 & V2, ST-segment depression, elevated T wave) -

Posterior Right ventricular

V4R-V6R

RCA

Inferior MI

Acute Anterior MI

Anteroseptal MI

24WBC marcrophage 1 2-4W 2-3M 3-6M 4-6M

Enzyme

20-30 NTG DM arrhythmia

MI 1

S4S3()

138

ST evelation T wave inversion T Q wave 8-12hQ0.04>R1/4(25%) ST unstable angina STQ-MI

Creatine phosphokinase(CK)6hr. 18-24 hr peak 72hr IsoenzymeCK-MB

Cardiac troponin T(cTnT)TroponinI(ctnI)

3-12 7-14 MI2-3MI 1-4myoglobin 1

Myoglobin

SGOT12hour 24-36 3-5

LDH 24-48 1-3

Fever38 12000-150001 ESR1-2

~MI-99m pyrophosphate1-5

Aspirin Reperfusion therapy Thrombolysis angioplasty Beta blocker Anticoagular Other grug

()AMI 4-18%primary VF/VTMI 4 automted external defibrillators AEDs

()NTG Morphine5-10mg iv st. q4h repeat On BP monitor morphine out of hospital fibrinolysi50%

out of hospital fibrinolysi50%O2 3-5l/min90%

VF5%3primary VF

morphineO2NTGaspirin 12 leade1012 complete EKG CCU1-3

EKG ST