Fact-sheet: Myocardial infarction
Updated on 08/29/2017 at 3:36 PM
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Definition
Myocardial ischemia secondary to prolonged impairment of myocardial perfusion
Secondary to coronary occlusion in the majority of cases
Clinical features
Chest pain
Cardiac arrhythmias
Suggestive ECG abnormalities
Laboratory findings
Elevated cardiac biomarkers (troponin level)
Ultrasound
Wall motion abnormality (hypokinesia or akinesia) in the affected territory
Occasional intracavitary thrombus
CT
Myocardial hypoperfusion appearing as subendocardial or even transmural hypoattenuation on early-phase imaging (arterial or portal)
Delayed enhancement (between 5 and 15 min) in the area of necrosis
Persistence of a hypodense area on delayed imaging = "no-reflow" phenomenon, a poor prognostic factor
Left intraventricular thrombus well assessable
MRI
Cine sequences:
Wall motion abnormalities (hypokinesia or akinesia)
Assessment of LVEF and ventricular volumes
First-pass perfusion sequence:
Myocardial hypoperfusion appearing as subendocardial or even transmural hypointensity
Late gadolinium enhancement sequences:
Enhancement in the area of necrosis
Persistence of a subendocardial hypointense area within the infarct = "no-reflow" phenomenon, a poor prognostic factor
Left intraventricular thrombus well assessable
Nuclear medicine
Stress myocardial scintigraphy
Detection of significant coronary lesions with exertion