Myocardial infarction

624: 613: 695:. Females are more likely to have unusual or unexplained tiredness and nausea or vomiting as symptoms. Females having heart attacks are more likely to have palpitations, back pain, labored breath, vomiting, and left arm pain than males, although the studies showing these differences had high variability. Females are less likely to report chest pain during a heart attack and more likely to report nausea, jaw pain, neck pain, cough, and fatigue, although these findings are inconsistent across studies. Females with heart attacks also had more indigestion, 1654: 9775:"2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" 1356: 2162:. The dose should be increased to the highest tolerated. Contrary to most guidelines, the use of beta blockers does not appear to affect the risk of death, possibly because other treatments for MI have improved. When beta blocker medication is given within the first 24–72 hours of a STEMI no lives are saved. However, 1 in 200 people were prevented from a repeat heart attack, and another 1 in 200 from having an abnormal heart rhythm. Additionally, for 1 in 91 the medication causes a 62: 2574:, and left ventricular impairment are all associated with poorer prognosis. Without treatment, about a quarter of those affected by MI die within minutes and about forty percent within the first month. Morbidity and mortality from myocardial infarction has, however, improved over the years due to earlier and better treatment: in those who have a STEMI in the United States, between 5 and 6 percent die before leaving the hospital and 7 to 18 percent die within a year. 2406: 656:, is pain radiating to the right arm and shoulder. Similarly, chest pain similar to a previous heart attack is also suggestive. The pain associated with MI is usually diffuse, does not change with position, and lasts for more than 20 minutes. It might be described as pressure, tightness, knifelike, tearing, burning sensation (all these are also manifested during other diseases). It could be felt as an unexplained anxiety, and pain might be absent altogether. 1717: 1700:. ST elevation is associated with infarction, and may be preceded by changes indicating ischemia, such as ST depression or inversion of the T waves. Abnormalities can help differentiate the location of an infarct, based on the leads that are affected by changes. Early STEMIs may be preceded by peaked T waves. Other ECG abnormalities relating to complications of acute myocardial infarctions may also be evident, such as 2549:. It should start soon after discharge from the hospital. The program may include lifestyle advice, exercise, social support, as well as recommendations about driving, flying, sports participation, stress management, and sexual intercourse. Returning to sexual activity after myocardial infarction is a major concern for most patients, and is an important area to be discussed in the provision of holistic care. 1473: 1241: 2361:, with the dose depending on whether further surgical management or fibrinolysis is planned. Prasugrel and ticagrelor are recommended in European and American guidelines, as they are active more quickly and consistently than clopidogrel. P2Y12 inhibitors are recommended in both NSTEMI and STEMI, including in PCI, with evidence also to suggest improved mortality. 1839: 1821: 1310:. If there is ongoing inflammation, the cap may be thin or ulcerate. Exposed to the pressure associated with blood flow, plaques, especially those with a thin lining, may rupture and trigger the formation of a blood clot (thrombus). The cholesterol crystals have been associated with plaque rupture through mechanical injury and inflammation. 2417:(PCI) is the treatment of choice for STEMI if it can be performed in a timely manner, ideally within 90–120 minutes of contact with a medical provider. Some recommend it is also done in NSTEMI within 1–3 days, particularly when considered high-risk. A 2017 review, however, did not find a difference between early versus later PCI in NSTEMI. 1672:(ECGs) are a series of leads placed on a person's chest that measure electrical activity associated with contraction of the heart muscle. The taking of an ECG is an important part of the workup of an AMI, and ECGs are often not just taken once but may be repeated over minutes to hours, or in response to changes in signs or symptoms. 2117:, exercising, and trying to achieve a healthy weight. Exercise is both safe and effective even if people have had stents or heart failure, and is recommended to start gradually after 1–2 weeks. Counselling should be provided relating to medications used, and for warning signs of depression. Previous studies suggested a benefit from 530:

world, the risk of death in those who have had a STEMI is about 10%. Rates of MI for a given age have decreased globally between 1990 and 2010. In 2011, an MI was one of the top five most expensive conditions during inpatient hospitalizations in the US, with a cost of about $ 11.5 billion for 612,000 hospital stays.

4515:"European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts)" 3568:"ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)" 2851:

Depictions of heart attacks in popular media often include collapsing or loss of consciousness which are not common symptoms; these depictions contribute to widespread misunderstanding about the symptoms of myocardial infarctions, which in turn contributes to people not getting care when they should.

2507:

In the past, high flow oxygen was recommended for everyone with a possible myocardial infarction. More recently, no evidence was found for routine use in those with normal oxygen levels and there is potential harm from the intervention. Therefore, oxygen is currently only recommended if oxygen levels

1629:

for measuring injury to the heart muscle than other tests. A rise in troponin occurs within 2–3 hours of injury to the heart muscle, and peaks within 1–2 days. The level of the troponin, as well as a change over time, are useful in measuring and diagnosing or excluding myocardial infarctions, and the

2711:

Rates of death from ischemic heart disease (IHD) have slowed or declined in most high-income countries, although cardiovascular disease still accounted for one in three of all deaths in the US in 2008. For example, rates of death from cardiovascular disease have decreased almost a third between 2001

2466:

If PCI cannot be performed within 90 to 120 minutes in STEMI then fibrinolysis, preferably within 30 minutes of arrival to hospital, is recommended. If a person has had symptoms for 12 to 24 hours evidence for effectiveness of thrombolysis is less and if they have had symptoms for more than 24 hours

1572:

Sudden unexpected cardiac death, including cardiac arrest, where symptoms may suggest MI, an ECG may be taken with suggestive changes, or a blood clot is found in a coronary artery by angiography and/or at autopsy, but where blood samples could not be obtained, or at a time before the appearance of

2627:

as a result of the heart being unable to adequately pump blood may develop, dependent on infarct size, and is most likely to occur within the days following an acute myocardial infarction. Cardiogenic shock is the largest cause of in-hospital mortality. Rupture of the ventricular dividing wall or

1452:

Injury to the myocardium also occurs during re-perfusion. This might manifest as ventricular arrhythmia. The re-perfusion injury is a consequence of the calcium and sodium uptake from the cardiac cells and the release of oxygen radicals during reperfusion. No-reflow phenomenon—when blood is still

2261:

A myocardial infarction requires immediate medical attention. Treatment aims to preserve as much heart muscle as possible, and to prevent further complications. Treatment depends on whether the myocardial infarction is a STEMI or NSTEMI. Treatment in general aims to unblock blood vessels, reduce

2008:

instead of saturated fats may reduce the risk of myocardial infarction, although there is not universal agreement. Dietary modifications are recommended by some national authorities, with recommendations including increasing the intake of wholegrain starch, reducing sugar intake (particularly of

529:

Worldwide, about 15.9 million myocardial infarctions occurred in 2015. More than 3 million people had an ST elevation MI, and more than 4 million had an NSTEMI. STEMIs occur about twice as often in men as women. About one million people have an MI each year in the United States. In the developed

2043:

measures may also act at a population level to reduce the risk of myocardial infarction, for example by reducing unhealthy diets (excessive salt, saturated fat, and trans-fat) including food labeling and marketing requirements as well as requirements for catering and restaurants and stimulating

2080:

has been studied extensively in people considered at increased risk of myocardial infarction. Based on numerous studies in different groups (e.g. people with or without diabetes), there does not appear to be a benefit strong enough to outweigh the risk of excessive bleeding. Nevertheless, many

1813:

Medical societies and professional guidelines recommend that the physician confirm a person is at high risk for Chronic Coronary Syndrome before conducting diagnostic non-invasive imaging tests to make a diagnosis, as such tests are unlikely to change management and result in increased costs.

1843: 1842: 1826: 1824: 1154:) has been associated with MI and other acute cardiovascular events. For sudden cardiac deaths, every increment of 30 units in Pollutant Standards Index correlated with an 8% increased risk of out-of-hospital cardiac arrest on the day of exposure. Extremes of temperature are also associated. 2569:

The prognosis after myocardial infarction varies greatly depending on the extent and location of the affected heart muscle, and the development and management of complications. Prognosis is worse with older age and social isolation. Anterior infarcts, persistent ventricular tachycardia or

1844: 1825: 6251: 1245: 1244: 691:, and these symptoms may also occur without any pain at all. Dizziness or lightheadedness is common and occurs due to reduction in oxygen and blood to the brain. In females, the most common symptoms of myocardial infarction include shortness of breath, weakness, and 2794:. Similarly, South Asians (including South Asians that have migrated to other countries around the world) experience higher rates of acute myocardial infarctions at younger ages, which can be largely explained by a higher prevalence of risk factors at younger ages. 5379:

Ho AF, Wah W, Earnest A, Ng YY, Xie Z, Shahidah N, et al. (November 2018). "Health impacts of the Southeast Asian haze problem – A time-stratified case crossover study of the relationship between ambient air pollution and sudden cardiac deaths in Singapore".

1841: 1823: 1246: 2884:

may be classified as line-of-duty injuries by statute or policy. In some countries or states, a person having had an MI may be prevented from participating in activity that puts other people's lives at risk, for example driving a car or flying an airplane.

1318:

Atherosclerotic disease is not the only cause of myocardial infarction, but it may exacerbate or contribute to other causes. A myocardial infarction may result from a heart with a limited blood supply subject to increased oxygen demands, such as in fever,

647:

is one of the most common symptoms of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper

6850:

Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP (December 2013). "Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force".

6386:

Lipinski MJ, Escárcega RO, D'Ascenzo F, Magalhães MA, Baker NC, Torguson R, et al. (May 2014). "A systematic review and collaborative meta-analysis to determine the incremental value of copeptin for rapid rule-out of acute myocardial infarction".

360:. About 30% of people have atypical symptoms. Women more often present without chest pain and instead have neck pain, arm pain or feel tired. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause 2139:

is continued indefinitely, as well as another antiplatelet agent such as clopidogrel or ticagrelor ("dual antiplatelet therapy" or DAPT) for up to twelve months. If someone has another medical condition that requires anticoagulation (e.g. with

1641:, are discouraged. CK-MB is not as specific as troponins for acute myocardial injury, and may be elevated with past cardiac surgery, inflammation or electrical cardioversion; it rises within 4–8 hours and returns to normal within 2–3 days. 7943:

Jobs A, Mehta SR, Montalescot G, Vicaut E, Van't Hof AW, Badings EA, et al. (August 2017). "Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials".

1243: 949:

or MI, particularly if one has a male first-degree relative (father, brother) who had a myocardial infarction before age 55 years, or a female first-degree relative (mother, sister) less than age 65 increases a person's risk of MI.

2228:

and a New York Heart Association grade II or III after 40 days of the infarction. Defibrillators detect potentially fatal arrhythmia and deliver an electrical shock to the person to depolarize a critical mass of the heart muscle.

8335:

Sepehrvand N, James SK, Stub D, Khoshnood A, Ezekowitz JA, Hofmann R (October 2018). "Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials".

3011: 4389:"Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology" 1266:

that blocks the artery; this can occur in minutes. Blockage of an artery can lead to tissue death in tissue being supplied by that artery. Atherosclerotic plaques are often present for decades before they result in symptoms.

1107:. Heart attacks appear to occur more commonly in the morning hours, especially between 6AM and noon. Evidence suggests that heart attacks are at least three times more likely to occur in the morning than in the late evening. 8802:

Weir RA, McMurray JJ, Velazquez EJ (May 2006). "Epidemiology of heart failure and left ventricular systolic dysfunction after acute myocardial infarction: prevalence, clinical characteristics, and prognostic importance".

4798:

Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. (March 2014). "Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis".

1421:

and cannot be predicted by the presence or absence of Q waves on an ECG. The position, size and extent of an infarct depends on the affected artery, totality of the blockage, duration of the blockage, the presence of

972:

that are implicated are within a non-coding region. The majority of these variants are in regions that have not been previously implicated in coronary artery disease. The following genes have an association with MI:

2808:

who are eligible for coverage remain uninsured because immigrant families face a range of enrollment barriers, including fear, confusion about eligibility policies, difficulty navigating the enrollment process, and

2552:

In the short-term, exercise-based cardiovascular rehabilitation programs may reduce the risk of a myocardial infarction, reduces a large number of hospitalizations from all causes, reduces hospital costs, improves

4883: 2396:

found they do not change the risk of death when given to people with a suspected NSTEMI prior to PCI, nor do heparins change the risk of death. They do decrease the risk of having a further myocardial infarction.

2262:

blood clot enlargement, reduce ischemia, and modify risk factors with the aim of preventing future MIs. In addition, the main treatment for myocardial infarctions with ECG evidence of ST elevation (STEMI) include

9887: 9868: 6347:"2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines" 2144:) this may need to be adjusted based on risk of further cardiac events as well as bleeding risk. In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death. 1695:

can be used to diagnose an ST segment myocardial infarction (STEMI). A rise must be new in V2 and V3 ≥2 mm (0,2 mV) for males or ≥1.5 mm (0.15 mV) for females or ≥1 mm (0.1 mV) in two other

2495:. Situations in which thrombolysis may be considered, but with caution, include recent surgery, use of anticoagulants, pregnancy, and proclivity to bleeding. Major risks of thrombolysis are major bleeding and 1562:. STEMIs make up about 25–40% of myocardial infarctions. A more explicit classification system, based on international consensus in 2012, also exists. This classifies myocardial infarctions into five types: 1453:

unable to be distributed to the affected myocardium despite clearing the occlusion—also contributes to myocardial injury. Topical endothelial swelling is one of many factors contributing to this phenomenon.

1762:

scan of the heart, is able to visualize the heart, its size, shape, and any abnormal motion of the heart walls as they beat that may indicate a myocardial infarction. The flow of blood can be imaged, and

3682:"2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines" 2828:

and financial concerns about accessing care were associated with delays in seeking emergency care for acute myocardial infarction which can have significant, adverse consequences on patient outcomes.

8513:

Rahim L, Allana S, Steinke EE, Ali F, Khan AH (November 2017). "Level of knowledge among cardiac nurses regarding sexual counseling of post-MI patients in three tertiary care hospitals in Pakistan".

4428:

Davis TM, Fortun P, Mulder J, Davis WA, Bruce DG (March 2004). "Silent myocardial infarction and its prognosis in a community-based cohort of Type 2 diabetic patients: the Fremantle Diabetes Study".

2074:, drugs that act to lower blood cholesterol, decrease the incidence and mortality rates of myocardial infarctions. They are often recommended in those at an elevated risk of cardiovascular diseases. 7498:"Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials" 1413:

region, and tissue begins to die within 15–30 minutes of loss of blood supply. The dead tissue is surrounded by a zone of potentially reversible ischemia that progresses to become a full-thickness

636:

Chest pain that may or may not radiate to other parts of the body is the most typical and significant symptom of myocardial infarction. It might be accompanied by other symptoms such as sweating.

3273:"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015" 2619:

transmitted from the heart during PCI, as a result of bleeding following anticoagulation, or as a result of disturbances in the heart's ability to pump effectively as a result of the infarction.

8696:"Prognostic value of clinical variables at presentation in patients with non-ST-segment elevation acute coronary syndromes: results of the Proyecto de Estudio del Pronóstico de la Angina (PEPA)" 4836:"Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies" 2499:. Pre-hospital thrombolysis reduces time to thrombolytic treatment, based on studies conducted in higher income countries; however, it is unclear whether this has an impact on mortality rates. 1569:

MI related to ischemia, such as from increased oxygen demand or decreased supply, e.g., coronary artery spasm, coronary embolism, anemia, arrhythmias, high blood pressure, or low blood pressure

2487:. Thrombolysis is not recommended in a number of situations, particularly when associated with a high risk of bleeding or the potential for problematic bleeding, such as active bleeding, past 1840: 1822: 2085:

continue to recommend aspirin for primary prevention, and some researchers feel that those with very high cardiovascular risk but low risk of bleeding should continue to receive aspirin.

4556:"AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute" 2786:

of risk factors that are unrecognized and therefore not treated, which places these individuals at a greater likelihood of experiencing adverse outcomes and therefore potentially higher

933:

intake affects heart attack risk. Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed.

7295:

Perez MI, Musini VM, Wright JM (October 2009). "Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event".

3003: 2224:, an electric device connected to the heart and surgically inserted under the skin, may be recommended. This is particularly if there are any ongoing signs of heart failure, with a low 1242: 2719:, IHD had become the leading cause of death by 2004, accounting for 1.46 million deaths (14% of total deaths) and deaths due to IHD were expected to double during 1985–2015. Globally, 584:). When there is evidence of an MI, it may be classified as an ST elevation myocardial infarction (STEMI) or Non-ST elevation myocardial infarction (NSTEMI) based on the results of an 6087: 5344:

Mustafic H, Jabre P, Caussin C, Murad MH, Escolano S, Tafflet M, et al. (February 2012). "Main air pollutants and myocardial infarction: a systematic review and meta-analysis".

929:

has been shown in studies to be associated with a decreased risk of myocardial infarction, while other studies find little evidence that reducing dietary saturated fat or increasing

9808:

Min Cho S, et al. (2021). "Machine learning compared with conventional statistical models for predicting myocardial infarction readmission and mortality: a systematic review".

8868:

Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. (American Heart Association Statistics Committee and Stroke Statistics Subcommittee) (January 2012).

2700:

estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease; with it being the leading cause of death in high- or middle-income countries and second only to

7160:

Hodis HN, Mack WJ (July 2014). "Hormone replacement therapy and the association with coronary heart disease and overall mortality: clinical application of the timing hypothesis".

9149:"Disentangling the relative importance of different socioeconomic resources for myocardial infarction incidence and survival: a longitudinal study of over 300,000 Finnish adults" 6802:

Clinical guideline 181: Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease

2880:

if it results, for example, from unusual emotional stress or unusual exertion. In addition, in some jurisdictions, heart attacks had by persons in particular occupations such as

2444:

is only considered when the affected area of heart muscle is large, and PCI is unsuitable, for example with difficult cardiac anatomy. After PCI, people are generally placed on

8755:"Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE)" 8380: 2577:

It is unusual for babies to experience a myocardial infarction, but when they do, about half die. In the short-term, neonatal survivors seem to have a normal quality of life.

2369:, help to prevent the enlargement of a clot, and are also given in myocardial infarction, owing to evidence suggesting improved mortality rates. In very high-risk scenarios, 4894: 4215:

Coventry LL, Finn J, Bremner AP (November–December 2011). "Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis".

2341:

to reduce the clot size and reduce further clotting in the affected artery. It is known to decrease mortality associated with acute myocardial infarction by at least 50%.

6252:"Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis" 5662:

Lonn E (September 2007). "Homocysteine in the prevention of ischemic heart disease, stroke and venous thromboembolism: therapeutic target or just another distraction?".

2318:. Morphine or other opioid medications may also be used, and are effective for the pain associated with STEMI. There is poor evidence that morphine shows any benefit to 1985:

Physical activity can reduce the risk of cardiovascular disease, and people at risk are advised to engage in 150 minutes of moderate or 75 minutes of vigorous intensity

4154:

Canto JG, Goldberg RJ, Hand MM, Bonow RO, Sopko G, Pepine CJ, Long T (December 2007). "Symptom presentation of females with acute coronary syndromes: myth vs reality".

8466:"Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis" 7701: 7766:

McCarthy CP, Mullins KV, Sidhu SS, Schulman SP, McEvoy JW (June 2016). "The on- and off-target effects of morphine in acute coronary syndrome: A narrative review".

2530:

with evaluation for implementation of hypothermia protocols. Furthermore, those with cardiac arrest, and ST elevation at any time, should usually have angiography.

7557:"Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations" 6566:

Schinkel AF, Valkema R, Geleijnse ML, Sijbrands EJ, Poldermans D (May 2010). "Single-photon emission computed tomography for assessment of myocardial viability".

5619:

Clarke R, Halsey J, Bennett D, Lewington S (February 2011). "Homocysteine and vascular disease: review of published results of the homocysteine-lowering trials".

4329: 2801:(SES) areas, which is close to 25% of the US population, myocardial infarctions (MIs) occurred twice as often compared with people who lived in higher SES areas. 9680:

Gaziano TA, Gaziano JM (15 September 2016). "Global Evolving Epidemiology, Natural History, and Treatment Trends of Myocardial Infarction". In Morrow DA (ed.).

2723:(DALYs) lost to ischemic heart disease are predicted to account for 5.5% of total DALYs in 2030, making it the second-most-important cause of disability (after 2238: 1630:

diagnostic accuracy of troponin testing is improving over time. One high-sensitivity cardiac troponin can rule out a heart attack as long as the ECG is normal.

2009:

refined sugar), consuming five portions of fruit and vegetables daily, consuming two or more portions of fish per week, and consuming 4–5 portions of unsalted

10738: 7217: 6796: 6592: 8028:

Dalal F, Dalal HM, Voukalis C, Gandhi MM (July 2017). "Management of patients after primary percutaneous coronary intervention for myocardial infarction".

2051:

Most guidelines recommend combining different preventive strategies. A 2015 Cochrane Review found some evidence that such an approach might help with

629:

Areas where pain is experienced in myocardial infarction, showing common (dark red) and less common (light red) areas on the chest (top) and back (bottom).

8998:"Individual education, area income, and mortality and recurrence of myocardial infarction in a Medicare cohort: the National Longitudinal Mortality Study" 4368: 8651:

Papneja K, Chan AK, Mondal TK, Paes B (March 2017). "Myocardial Infarction in Neonates: A Review of an Entity with Significant Morbidity and Mortality".

5477:

Chatzidimitriou D, Kirmizis D, Gavriilaki E, Chatzidimitriou M, Malisiovas N (October 2012). "Atherosclerosis and infection: is the jury still not in?".

3320:

Coventry LL, Finn J, Bremner AP (2011). "Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis".

2561:. Longer-term studies indicate that exercise-based cardiovascular rehabilitation programs may reduce cardiovascular mortality and myocardial infarction. 1810:

scans can visualize the perfusion of heart muscle. SPECT may also be used to determine viability of tissue, and whether areas of ischemia are inducible.

7723:

Yadlapati A, Gajjar M, Schimmel DR, Ricciardi MJ, Flaherty JD (December 2016). "Contemporary management of ST-segment elevation myocardial infarction".

7013:"Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials" 3138: 2642:

may develop as a long-term consequence, with an impaired ability of heart muscle to pump, scarring, and an increase in the size of the existing muscle.

956:

have found 27 genetic variants that are associated with an increased risk of myocardial infarction. The strongest association of MI has been found with

937:

do appear to increase risk. Acute and prolonged intake of high quantities of alcoholic drinks (3–4 or more daily) increases the risk of a heart attack.

11164: 4250:

Chen W, Woods SL, Puntillo KA (July–August 2005). "Sex differences in symptoms associated with acute myocardial infarction: a review of the research".

2279: 2172:

therapy should be started within 24 hours and continued indefinitely at the highest tolerated dose. This is provided there is no evidence of worsening

2194:

therapy has been shown to reduce mortality and subsequent cardiac events and should be commenced to lower LDL cholesterol. Other medications, such as

6899: 6544: 4103:

Marcus GM, Cohen J, Varosy PD, Vessey J, Rose E, Massie BM, et al. (January 2007). "The utility of gestures in patients with chest discomfort".

3411: 3097:(1st ed.). Geneva: World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization. pp. 3–18. 2941: 2114: 1744:

has no role in the acute diagnostic algorithm; however, it can confirm a clinical suspicion of Chronic Coronary Syndrome when the patient's history,

9049:"Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events; the FINMONICA MI Register Study" 3229:"Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" 3108: 2093:

There is a large crossover between the lifestyle and activity recommendations to prevent a myocardial infarction, and those that may be adopted as

1964:

There is a large crossover between the lifestyle and activity recommendations to prevent a myocardial infarction, and those that may be adopted as

8116:"Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" 595:, where the heart is not contracting at all or so poorly that all vital organs cease to function, thus leading to death. It is also distinct from 560:, which describes a sudden or short-term change in symptoms related to blood flow to the heart. Unlike the other type of acute coronary syndrome, 3271:

Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease Injury Incidence Prevalence Collaborators) (October 2016).

2978: 2314:) may improve blood supply to the heart. It is an important part of therapy for its pain relief effects, though there is no proven benefit to 1732:

may assist in modifying clinical suspicion of ongoing myocardial infarction in patients that can't be ruled out or ruled in following initial

7803:"Reappraisal of thienopyridine pretreatment in patients with non-ST elevation acute coronary syndrome: a systematic review and meta-analysis" 1554:

A myocardial infarction is usually clinically classified as an ST-elevation MI (STEMI) or a non-ST elevation MI (NSTEMI). These are based on

6079: 5423:

Sun Z, Chen C, Xu D, Li T (October 2018). "Effects of ambient temperature on myocardial infarction: A systematic review and meta-analysis".

2911: 6291:"Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome" 1542: 1034: 786:, occur more frequently in females, the elderly, those with diabetes, in people who have just had surgery, and in critically ill patients. 7062:"Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews" 4285:

DeVon HA, Zerwic JJ (July–August 2002). "Symptoms of acute coronary syndromes: are there gender differences? A review of the literature".

2708:. Worldwide, more than 3 million people have STEMIs and 4 million have NSTEMIs a year. STEMIs occur about twice as often in men as women. 10026: 8953:

Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S (January 2008). "Epidemiology and causation of coronary heart disease and stroke in India".

6709: 2759:

is associated with an increased risk of poorer survival. There are well-documented disparities in myocardial infarction survival by

2212:) may be used if there is evidence of left ventricular dysfunction after an MI, ideally after beginning treatment with an ACE inhibitor. 1968:

after an initial myocardial infarction, because of shared risk factors and an aim to reduce atherosclerosis affecting heart vessels. The

802:

after a person has died. Such silent myocardial infarctions represent between 22 and 64% of all infarctions, and are more common in the

10379: 7474: 6815:

Stradling C, Hamid M, Taheri S, Thomas GN (2014). "A review of dietary influences on cardiovascular health: part 2: dietary patterns".

3779: 3492: 664:, has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed it had a poor 9569: 9590: 1006: 1111:

is also associated with a higher risk of MI. One analysis has found an increase in heart attacks immediately following the start of

10069: 6490:"2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation" 1042: 7113:"Review of guidelines on primary prevention of cardiovascular disease with aspirin: how much evidence is needed to turn a tanker?" 4651:"Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy" 862:, the primary cause of myocardial infarction, with other risk factors including male sex, low levels of physical activity, a past 591:

The phrase "heart attack" is often used non-specifically to refer to myocardial infarction. An MI is different from—but can cause—

10003: 9701:

Morrow DA, Bohula EA (15 September 2016). "Heart Failure and Cardiogenic Shock After Myocardial Infarction". In Morrow DA (ed.).

9617:

Allison TG, Murphy JG (6 December 2012). "Stress Test Selection". In Murphy JG, Lloyd MA, Brady PA, Olsen LJ, Shields RC (eds.).

9399:"Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction" 2782:

have a greater burden of myocardial infarction and other cardiovascular events. On a population level, there is a higher overall

2764: 1026: 9372: 6717: 11157: 10796: 10113: 7066: 1605: 1218: 1054: 1282:. Atherosclerosis is characterized by progressive inflammation of the walls of the arteries. Inflammatory cells, particularly 10014: 9754: 9733: 9712: 9691: 9670: 9649: 9628: 8852: 8448: 8421: 6658: 6461: 6436: 6183: 6121: 5880: 4480: 4362: 4044: 3987: 3550: 3102: 2256: 1183:

among others have been linked to atherosclerosis and myocardial infarction. As of 2013, there is no evidence of benefit from

1123: 510:, with the additional use of PCI in those at high risk. In people with blockages of multiple coronary arteries and diabetes, 9722:

Morrow DA, Braunwald E (15 September 2016). "Classification and Diagnosis of Acute Coronary Syndromes". In Morrow DA (ed.).

1206:

is associated with premature atherosclerosis; whether elevated homocysteine in the normal range is causal is controversial.

10600: 10437: 9984: 1488:(labelled LCA and RCA). A myocardial infarction (2) has occurred with blockage of a branch of the left coronary artery (1). 1433:

alter the normal conduction pathways of the heart and weaken affected areas. The size and location put a person at risk of

7693: 6622: 2646:

develops in about 10% of MI and is itself a risk factor for heart failure, ventricular arrhythmia, and the development of

1724:

Noninvasive imaging plays an important role in the diagnosis and characterisation of myocardial infarction. Tests such as

10791: 10605: 10595: 10184: 7223:

Clinical guideline 172: Secondary prevention in primary and secondary care for patients following a myocardial infarction

2681: 2586: 2545:

benefits many who have experienced myocardial infarction, even if there has been substantial heart damage and resultant

1876:, and other muscles, bones and nerves surrounding the chest. In addition to myocardial infarction, other causes include 909:. Lack of physical activity has been linked to 7–12% of cases. Less common causes include stress-related causes such as 11292: 10902: 10733: 10347: 4321: 2414: 2267: 2185: 1587: 1462: 1336: 487: 243: 9190:"Income and short-term case fatality after myocardial infarction in the whole middle-aged population of Malmö, Sweden" 5248:"Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data" 4602:"Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data" 1122:

have a modestly increased risk of myocardial infarction, especially in the presence of other risk factors. The use of

11150: 10773: 7645:"Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis" 3364:"Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: a review of the literature" 2701: 7416:

Safi S, Sethi NJ, Nielsen EE, Feinberg J, Jakobsen JC, Gluud C, et al. (Cochrane Heart Group) (December 2019).

1814:

Patients who have a normal ECG and who are able to exercise, for example, most likely do not merit routine imaging.

1675:

ECG readouts produce a waveform with different labeled features. In addition to a rise in biomarkers, a rise in the

11302: 10768: 8870:"Executive summary: heart disease and stroke statistics--2012 update: a report from the American Heart Association" 3179:"ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation" 2370: 1119: 671:

Typically, chest pain because of ischemia, be it unstable angina or myocardial infarction, lessens with the use of

357: 4920:"Moderate ethanol ingestion and cardiovascular protection: from epidemiologic associations to cellular mechanisms" 10637: 10418: 9743:

Morrow DA (15 September 2016). "Clinical Approach to Suspected Acute Myocardial Infarction". In Morrow DA (ed.).

9546: 8556:

Jaarsma T, Steinke EE, Gianotten WL (2010). "Sexual problems in cardiac patients: how to assess, when to refer".

2527: 2441: 1885: 969: 953: 1306:

and other cells move into the plaque and act to stabilize it. A stable plaque may have a thick fibrous cap with

1191:, however, calling the association into question. Myocardial infarction can also occur as a late consequence of 10713: 10708: 10632: 9659:

Dwight J (16 June 2016). "Chest pain, breathlessness, fatigue". In Warrell D, Cox T, Firth J, Dwight J (eds.).

9554: 2818: 2554: 2542: 794:"Silent" myocardial infarctions can happen without any symptoms at all. These cases can be discovered later on 511: 142: 6903: 1202:. Calcium seen in coronary arteries can provide predictive information beyond that of classical risk factors. 11059: 10935: 10864: 10696: 10432: 3130: 2720: 22: 6172:

Kloner R, Hale SL (15 September 2016). "Reperfusion Injury: Prevention and Management". In Morrow DA (ed.).

2063:. However, there was insufficient evidence to show an effect on mortality or actual cardio-vascular events. 1625:, measured through a blood test, are considered to be the best, and are preferred because they have greater 11307: 11054: 10847: 10830: 10763: 10683: 10062: 9280:"Risk Factors for Early Myocardial Infarction in South Asians Compared With Individuals in Other Countries" 8381:"How Much Evidence Is Needed to Conclude against the Use of Oxygen Therapy in Acute Myocardial Infarction?" 2472: 1783: 1741: 1599: 1340: 874:. Risk factors for myocardial disease are often included in risk factor stratification scores, such as the 8071:

Lassen JF, Bøtker HE, Terkelsen CJ (January 2013). "Timely and optimal treatment of patients with STEMI".

6536: 6137:

Kutty RS, Jones N, Moorjani N (November 2013). "Mechanical complications of acute myocardial infarction".

3403: 2044:

physical activity. This may be part of regional cardiovascular disease prevention programs or through the

1286:, move into affected arterial walls. Over time, they become laden with cholesterol products, particularly 1262:

supplying heart muscle. Plaques can become unstable, rupture, and additionally promote the formation of a

10897: 10342: 7801:

Bellemain-Appaix A, Kerneis M, O'Connor SA, Silvain J, Cucherat M, Beygui F, et al. (October 2014).

5512:

Charakida M, Tousoulis D (2013). "Infections and atheromatous plaque: current therapeutic implications".

2392:

There is varying evidence on the mortality benefits in NSTEMI. A 2014 review of P2Y12 inhibitors such as

2082: 1626: 826:

factors have been cited as possible explanations for the lack of symptoms. In heart transplantation, the

9448:"Low Educational Attainment is a Predictor of Adverse Outcomes in Patients With Coronary Artery Disease" 5547:

Sánchez-Manubens J, Bou R, Anton J (February 2014). "Diagnosis and classification of Kawasaki disease".

3089: 10879: 10367: 10352: 3723:"The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study" 2291: 1038: 747: 10426: 6289:

Chapman AR, Lee KK, McAllister DA, Cullen L, Greenslade JH, Parsonage W, et al. (November 2017).

1254:

can lead to a heart attack and how blocked blood flow in a coronary artery can lead to a heart attack.

897:

Many risk factors for myocardial infarction are potentially modifiable, with the most important being

486:

or shortness of breath. In a STEMI, treatments attempt to restore blood flow to the heart and include

10957: 10654: 10622: 10549: 10276: 2724: 2697: 2591:

Complications may occur immediately following the myocardial infarction or may take time to develop.

2307: 863: 665: 623: 5580:"Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis" 4600:

Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L, et al. (October 2012).

4387:

Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. (December 2008).

3177:

Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. (October 2012).

2970: 1103:

The risk of having a myocardial infarction increases with older age, low physical activity, and low

11297: 11081: 10907: 10837: 10627: 10524: 10505: 10335: 10108: 9902: 9047:

Salomaa V, Miettinen H, Niemelä M, Ketonen M, Mähönen M, Immonen-Räihä P, et al. (July 2001).

7377:"Clinical outcomes with β-blockers for myocardial infarction: a meta-analysis of randomized trials" 6345:

Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. (December 2014).

5705:

Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, et al. (January 2017).

2873: 2715:

In contrast, IHD is becoming a more common cause of death in the developing world. For example, in

2604: 2546: 2045: 1705: 1688: 1512: 1417:

infarct. The initial "wave" of infarction can take place over 3–4 hours. These changes are seen on

1258:

The most common cause of a myocardial infarction is the rupture of an atherosclerotic plaque on an

1179: 1163: 887: 878:. At any given age, men are more at risk than women for the development of cardiovascular disease. 855: 771: 408: 8753:

Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. (November 2006).

8296:"Oxygen Therapy in Patients with Acute Myocardial Infarction: A Systemic Review and Meta-Analysis" 7328:"Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis" 7238:"Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews" 7060:

Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Kandala NB, et al. (September 2013).

5707:"ESC working group position paper on myocardial infarction with non-obstructive coronary arteries" 599:, in which the pumping action of the heart is impaired. However, an MI may lead to heart failure. 11201: 11114: 11088: 11076: 11064: 11049: 10783: 10725: 10529: 10510: 10162: 10102: 10055: 9397:

Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, et al. (April 2010).

5947:"Cholesterol crystal induced arterial inflammation and destabilization of atherosclerotic plaque" 3227:

O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, et al. (November 2010).

2919: 2693: 2600: 2531: 2467:

it is not recommended. Thrombolysis involves the administration of medication that activates the

2433: 1485: 1210: 1098: 906: 883: 859: 557: 539: 380: 329:

that classically radiates to the left shoulder, arm, or jaw. The pain may occasionally feel like

185: 153: 84:

formation, totally occluding the artery and preventing blood flow downstream to the heart muscle.

9279: 8911:"Heart disease and stroke statistics--2015 update: a report from the American Heart Association" 6488:

Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. (April 2021).

3864:

Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. (October 2012).

3680:

O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. (January 2013).

612: 10703: 10669: 10612: 10590: 10412: 10394: 10330: 10197: 10150: 10078: 8909:

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. (January 2015).

8438: 6962:

Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. (January 2013).

2755:

play an important role in myocardial infarction risk and survival. Studies have shown that low

2629: 2201: 1956:. There are many different causes of fatigue, and myocardial infarction is not a common cause. 1869: 1446: 1387: 1344: 946: 10023: 9942: 9773:

Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. (March 2016).

8599:

Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS (November 2021).

8114:

Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. (November 2015).

7555:

Hazinski MF, Nolan JP, Aickin R, Bhanji F, Billi JE, Callaway CW, et al. (October 2015).

5091:

Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, et al. (July 2012).

4352: 2872:. This can create coverage issues in the administration of no-fault insurance schemes such as 2428:

into the blood vessels of the heart. The probes are then used to identify and clear blockages

10467: 10462: 10357: 10272: 9639: 8411: 8294:

Abuzaid A, Fabrizio C, Felpel K, Al Ashry HS, Ranjan P, Elbadawi A, et al. (June 2018).

8253:

Hofmann R, James SK, Jernberg T, Lindahl B, Erlinge D, Witt N, et al. (September 2017).

6864: 3721:

Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Flaxman A, et al. (April 2014).

1799: 1658: 1449:

following infarction, and rupture of the heart wall that can have catastrophic consequences.

875: 811: 420: 404: 217: 9325:"Association of Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults" 7466: 3484: 10963: 10491: 10472: 10372: 10283: 10226: 9566: 7509: 7326:

Elmariah S, Mauri L, Doros G, Galper BZ, O'Neill KE, Steg PG, et al. (February 2015).

5432: 5246:

Bally M, Dendukuri N, Rich B, Nadeau L, Helin-Salmivaara A, Garbe E, Brophy JM (May 2017).

2798: 2760: 2756: 2643: 2620: 2094: 1965: 1921: 1917: 1745: 1577: 1481: 1477: 1442: 1203: 1112: 1104: 879: 819: 767: 707:

is a common, and sometimes the only symptom, occurring when damage to the heart limits the

672: 577: 471: 440: 435:) and extreme cold, among others. Many tests are helpful to help with diagnosis, including 263: 233: 9970: 9586: 7643:

Hess EP, Agarwal D, Chandra S, Murad MH, Erwin PJ, Hollander JE, et al. (July 2010).

7375:

Bangalore S, Makani H, Radford M, Thakur K, Toklu B, Katz SD, et al. (October 2014).

6199:

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD (January 2019).

4513:

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. (July 2012).

4068:

Gupta R, Munoz R (August 2016). "Evaluation and Management of Chest Pain in the Elderly".

2158:

is recommended to be started within 24 hours, provided there is no acute heart failure or

1405:

Cells in the area with the worst blood supply, just below the inner surface of the heart (

8: 11312: 11254: 11239: 11211: 10968: 10825: 10820: 10743: 10647: 10617: 10576: 10202: 10119: 9891: 7987:

Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. (October 2010).

7011:

Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. (May 2009).

4834:

de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, et al. (August 2015).

4354:

Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty

2596: 2558: 2429: 2311: 2060: 1749: 1733: 1701: 1430: 1173: 930: 704: 653: 553: 337: 114: 8464:

Dahal K, Hendrani A, Sharma SP, Singireddy S, Mina G, Reddy P, et al. (July 2018).

7513: 6250:

Pickering JW, Than MP, Cullen L, Aldous S, Ter Avest E, Body R, et al. (May 2017).

5436: 3771: 3566:

Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. (December 2011).

2623:

is possible, particularly if the infarction causes dysfunction of the papillary muscle.

1492:

A myocardial infarction, according to current consensus, is defined by elevated cardiac

1363:

If impaired blood flow to the heart lasts long enough, it triggers a process called the

11259: 11071: 10869: 10691: 10642: 10267: 10214: 10124: 9833: 9521: 9496: 9472: 9447: 9423: 9398: 9349: 9324: 9255: 9230: 9124: 9099: 9075: 9048: 9024: 8997: 8978: 8779: 8754: 8735: 8676: 8625: 8600: 8581: 8538: 8490: 8465: 8361: 8230: 8205: 8181: 8156: 8096: 8053: 7969: 7879: 7854: 7827: 7802: 7748: 7669: 7644: 7532: 7497: 7442: 7417: 7352: 7327: 7272: 7237: 7185: 7142: 7088: 7037: 7012: 6988: 6963: 6939: 6918: 6876: 6765: 6740: 6315: 6290: 6052: 6027: 5922: 5897: 5842: 5687: 5644: 5456: 5405: 5321: 5296: 5272: 5247: 5223: 5190: 5171: 5117: 5092: 5073: 4944: 4919: 4860: 4835: 4770: 4745: 4723: 4675: 4650: 4626: 4601: 4453: 3747: 3722: 3636: 3611: 3461: 3434: 3297: 3272: 3062: 3037: 2705: 2666: 2496: 2315: 2271: 2118: 2022: 1953: 1913: 1889: 1394:. ATP is required for the maintenance of electrolyte balance, particularly through the 795: 700: 692: 688: 660:, in which a person localizes the chest pain by clenching one or both fists over their 428: 365: 162: 105: 98: 10000: 9246: 9115: 7957: 7852: 7613: 7343: 7028: 6828: 6741:"Influenza vaccine as a coronary intervention for prevention of myocardial infarction" 5830: 5189:

Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM (August 2015).

4666: 4617: 3738: 3627: 3288: 3245: 3228: 1989:

a week. Keeping a healthy weight, drinking alcohol within the recommended limits, and

11131: 10982: 10940: 10855: 10673: 10571: 10288: 10231: 10129: 9996:— Information and resources for preventing, recognizing, and treating a heart attack. 9913: 9837: 9825: 9796: 9750: 9729: 9708: 9687: 9666: 9645: 9624: 9526: 9477: 9428: 9354: 9299: 9260: 9211: 9170: 9129: 9080: 9029: 8970: 8932: 8891: 8848: 8820: 8784: 8727: 8712: 8695: 8668: 8630: 8573: 8530: 8495: 8444: 8417: 8353: 8317: 8276: 8235: 8186: 8157:"Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction" 8137: 8088: 8045: 8010: 7961: 7925: 7884: 7832: 7783: 7740: 7674: 7625: 7617: 7578: 7537: 7496:

Le HH, El-Khatib C, Mombled M, Guitarian F, Al-Gobari M, Fall M, et al. (2016).

7447: 7398: 7357: 7308: 7277: 7177: 7134: 7093: 7042: 6993: 6944: 6919:"Multiple risk factor interventions for primary prevention of coronary heart disease" 6868: 6832: 6770: 6691: 6654: 6575: 6511: 6467: 6457: 6432: 6404: 6368: 6320: 6271: 6232: 6179: 6154: 6117: 6057: 6008: 5968: 5927: 5876: 5834: 5728: 5679: 5636: 5601: 5560: 5529: 5494: 5448: 5397: 5361: 5326: 5277: 5228: 5191:"Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke" 5175: 5163: 5122: 5065: 5030: 4995: 4949: 4865: 4816: 4775: 4715: 4680: 4631: 4577: 4554:

Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. (May 2006).

4536: 4476: 4445: 4410: 4358: 4302: 4267: 4232: 4171: 4120: 4085: 4050: 4040: 3993: 3983: 3887: 3752: 3703: 3641: 3589: 3546: 3466: 3385: 3337: 3302: 3250: 3200: 3098: 3067: 2877: 2779: 2624: 2616: 2512: 2437: 2334: 2163: 2098: 1990: 1969: 1925: 1909: 1779: 1669: 1504: 1423: 847: 815: 807: 763: 518:. After an MI, lifestyle modifications, along with long-term treatment with aspirin, 483: 436: 392: 369: 310: 229: 224: 205: 166: 138: 89: 9896: 9446:

Kelli HM, Mehta A, Tahhan AS, Liu C, Kim JH, Dong TA, et al. (September 2019).

8982: 8739: 8680: 8585: 8481: 8100: 8057: 7853:

Andrade-Castellanos CA, Colunga-Lozano LE, Delgado-Figueroa N, Magee K (June 2014).

7752: 7189: 7146: 6880: 5846: 5460: 5409: 5312: 5077: 4727: 4457: 4189: 2270:, although PCI is also ideally conducted within 1–3 days for NSTEMI. In addition to 1548: 925:

in the development of myocardial infarctions. Eating polyunsaturated fat instead of

478:

may be used to help with chest pain; however, they do not improve overall outcomes.

11206: 11104: 10996: 10889: 10585: 10011: 9953: 9817: 9786: 9516: 9508: 9467: 9459: 9418: 9410: 9344: 9336: 9291: 9250: 9242: 9201: 9160: 9119: 9111: 9100:"Race, Socioeconomic Status, and Life Expectancy After Acute Myocardial Infarction" 9070: 9060: 9019: 9009: 8962: 8922: 8881: 8812: 8774: 8766: 8717: 8707: 8660: 8620: 8616: 8612: 8565: 8542: 8522: 8485: 8477: 8365: 8345: 8307: 8266: 8225: 8221: 8217: 8176: 8172: 8168: 8127: 8080: 8037: 8000: 7973: 7953: 7915: 7874: 7870: 7866: 7822: 7814: 7775: 7732: 7664: 7656: 7609: 7597: 7568: 7527: 7517: 7437: 7433: 7429: 7388: 7347: 7339: 7304: 7300: 7267: 7257: 7253: 7249: 7169: 7124: 7083: 7075: 7032: 7024: 6983: 6979: 6975: 6934: 6930: 6926: 6860: 6824: 6760: 6752: 6683: 6501: 6396: 6358: 6310: 6302: 6263: 6222: 6212: 6146: 6047: 6039: 6000: 5958: 5917: 5909: 5826: 5718: 5691: 5671: 5648: 5628: 5591: 5552: 5521: 5486: 5440: 5389: 5353: 5316: 5308: 5267: 5259: 5218: 5210: 5206: 5202: 5153: 5112: 5104: 5057: 5022: 4985: 4939: 4931: 4855: 4847: 4808: 4765: 4761: 4757: 4707: 4670: 4662: 4621: 4613: 4567: 4526: 4437: 4400: 4294: 4259: 4224: 4163: 4112: 4077: 3877: 3742: 3734: 3693: 3631: 3623: 3579: 3456: 3446: 3375: 3329: 3292: 3284: 3240: 3190: 3057: 3049: 2832: 2825: 2748: 2592: 2534:

appear to be useful in people who have had an STEMI and do not have heart failure.

2366: 2342: 2102: 1986: 1807: 1755: 1729: 1697: 1434: 1364: 1192: 1143: 1138:

is also an important modifiable risk. Short-term exposure to air pollution such as

965: 910: 902: 779: 727: 657: 396: 209: 8816: 8694:

López de Sá E, López-Sendón J, Anguera I, Bethencourt A, Bosch X (November 2002).

7920: 7903: 6400: 6004: 1972:

also appear to protect against myocardial infarction with a benefit of 15 to 45%.

838:

The most prominent risk factors for myocardial infarction are older age, actively

443:. An ECG, which is a recording of the heart's electrical activity, may confirm an 11264: 11126: 10518: 10499: 10486: 10293: 10172: 10047: 10030: 10018: 10007: 9907: 9791: 9774: 9744: 9723: 9702: 9681: 9660: 9618: 9573: 9550: 9340: 8927: 8910: 8886: 8869: 8569: 8526: 8349: 8312: 8295: 8132: 8115: 7573: 7556: 7522: 7393: 7376: 6756: 6363: 6346: 6173: 5675: 5444: 5393: 5026: 4263: 4228: 4167: 4116: 3882: 3865: 3772:"National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011" 3698: 3681: 3333: 2420:

PCI involves small probes, inserted through peripheral blood vessels such as the

2319: 2275: 2056: 1997: 1937: 1901: 1877: 1418: 1324: 1279: 1275: 1235: 1139: 898: 774:. When the brain was without oxygen for too long due to a myocardial infarction, 755: 720: 675:, but nitroglycerin may also relieve chest pain arising from non-cardiac causes. 561: 416: 412: 388: 201: 146: 77: 70: 9956: 8770: 7173: 6506: 6489: 6043: 5476: 5142:"Shifts to and from daylight saving time and incidence of myocardial infarction" 4935: 2519:

on the ECG recording after 90 minutes, then rescue PCI is indicated emergently.

1908:

and other musculoskeletal injuries. Rarer severe differential diagnoses include

1684: 1566:

Spontaneous MI related to plaque erosion and/or rupture fissuring, or dissection

1516: 1368: 905:). Smoking appears to be the cause of about 36% and obesity the cause of 20% of 11234: 11196: 11119: 11027: 10925: 10917: 10815: 10325: 10318: 10305: 9959: 9821: 9323:

Hamad R, Penko J, Kazi DS, Coxson P, Guzman D, Wei PC, et al. (May 2020).

8005: 7988: 6917:

Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G (January 2011).

6653:(21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 535, 539. 6614: 6217: 6200: 5963: 5946: 5723: 5706: 5596: 5579: 5556: 5525: 4572: 4555: 4531: 4514: 4405: 4388: 3584: 3567: 3380: 3363: 3195: 3178: 2881: 2840: 2791: 2744: 2669: 2662: 2523: 2421: 2244: 2239:

Management of acute coronary syndrome § Patient-dependent initial measures

2205: 2173: 2052: 1933: 1214: 1147: 998: 827: 751: 743: 739: 712: 708: 592: 479: 373: 174: 29: 9918: 8722: 8664: 8084: 7779: 7736: 6687: 6150: 5913: 5632: 5061: 5048:

Shaw E, Tofler GH (July 2009). "Circadian rhythm and cardiovascular disease".

4441: 4081: 3545:(21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 588–599. 3053: 1653: 1343:(CABG) may cause a myocardial infarction. Spasm of coronary arteries, such as 419:

is usually the underlying mechanism of an MI. MIs are less commonly caused by

11286: 11109: 11020: 10155: 9014: 7621: 7129: 7112: 6471: 6431:(21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 529–30. 4744:

Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS (August 2020).

4711: 4054: 3997: 2736: 2658: 2639: 2480: 2425: 2221: 2177: 2169: 2130: 2106: 2040: 1905: 1657:

A 12-lead ECG showing an inferior STEMI due to reduced perfusion through the

1307: 1303: 1299: 1135: 1129: 926: 922: 891: 661: 596: 519: 361: 158: 33: 9881: 9877: 9463: 9206: 9189: 9165: 9148: 8966: 6306: 5875:(21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 577–9. 5817:

Reed GW, Rossi JE, Cannon CP (January 2017). "Acute myocardial infarction".

5578:

Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC (March 2011).

4649:

Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT (July 2012).

4298: 1728:

can be used to explore and exclude alternate causes of a person's symptoms.

1355: 11142: 11041: 11015: 10859: 10807: 10480: 10456: 10403: 10262: 10036: 9993: 9829: 9800: 9530: 9481: 9432: 9358: 9303: 9295: 9264: 9215: 9174: 9133: 9084: 9033: 8974: 8936: 8895: 8824: 8788: 8731: 8672: 8634: 8577: 8534: 8499: 8357: 8321: 8280: 8239: 8190: 8141: 8092: 8049: 8014: 7965: 7929: 7888: 7836: 7787: 7744: 7678: 7629: 7582: 7541: 7451: 7402: 7361: 7312: 7281: 7181: 7138: 7097: 7046: 6997: 6948: 6872: 6836: 6774: 6695: 6579: 6515: 6408: 6372: 6324: 6275: 6236: 6227: 6158: 6061: 6012: 5972: 5931: 5838: 5732: 5683: 5640: 5605: 5564: 5533: 5498: 5452: 5401: 5365: 5330: 5281: 5232: 5167: 5126: 5069: 5034: 4999: 4953: 4869: 4820: 4779: 4719: 4684: 4635: 4581: 4540: 4449: 4414: 4306: 4271: 4236: 4175: 4124: 4089: 3891: 3756: 3707: 3645: 3593: 3470: 3389: 3341: 3306: 3254: 3204: 3071: 2673: 2654: 2633: 2611:

can arise as a result of ischemia, cardiac scarring, and infarct location.

2516: 2492: 2484: 2468: 2461: 2382: 2358: 2338: 2263: 2181: 2147: 2005: 1897: 1764: 1692: 1593:

Associated with stent thrombosis as documented by angiography or at autopsy

1555: 1409:), are most susceptible to damage. Ischemia first affects this region, the 1398:. This leads to an ischemic cascade of intracellular changes, necrosis and 1391: 957: 843: 783: 495: 452: 384: 322: 247: 197: 61: 9512: 9414: 9065: 8271: 8254: 7800: 6597: 6116:(4th ed.). Chichester, West Sussex: Wiley-Blackwell. pp. 88–89. 5357: 4990: 4973: 3794: 10976: 10874: 10664: 10581: 10563: 10389: 10362: 10313: 10254: 9937: 8693: 7222: 6801: 6452:

Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015).

5158: 5141: 4698:

Steptoe A, Kivimäki M (April 2012). "Stress and cardiovascular disease".

4035:

Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015).

3978:

Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015).

2752: 2740: 2608: 2571: 2449: 2393: 2346: 2295: 2159: 2110: 2034: 2010: 1803: 1791: 1768: 1725: 1438: 1406: 1395: 1332: 1320: 1271: 1188: 871: 851: 731: 684: 515: 460: 349: 192: 134: 9497:"Symptom expectations and delay in acute myocardial infarction patients" 8204:

Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T (December 2016).

7660: 4131: 2405: 2365:, particularly in the unfractionated form, act at several points in the 2029:

and mineral supplements are of no proven benefit, and neither are plant

913:, which accounts for about 3% of cases, and chronic high stress levels. 758:

can occur in myocardial infarctions due to inadequate blood flow to the

11223: 11177: 11004: 10554: 9965: 7262: 6896:"Prevention of cardiovascular disease – NICE public health guidance 25" 6385: 6028:"Why is the subendocardium more vulnerable to ischemia? A new paradigm" 5214: 4386: 2861: 2783: 2677: 2354: 2274:, risk stratification may be used to guide treatment, such as with the 2209: 2155: 2151: 1861: 1759: 1676: 1662: 1547:"STEMI" redirects here. For the Christian evangelist organization, see 1508: 1493: 1367:; the heart cells in the territory of the blocked coronary artery die ( 1283: 1184: 1158: 1108: 934: 823: 735: 644: 573: 569: 565: 549: 545: 345: 318: 254: 130: 110: 94: 9543: 8041: 7855:"Heparin versus placebo for non-ST elevation acute coronary syndromes" 7818: 7418:"Beta-blockers for suspected or diagnosed acute myocardial infarction" 5490: 5263: 5108: 5013:

Culić V (April 2007). "Acute risk factors for myocardial infarction".

4851: 830:

heart is not fully innervated by the nervous system of the recipient.

11173: 9948: 9576:. Board of Industrial Insurance Appeals. Retrieved November 22, 2006. 9146: 7079: 7061: 6267: 5093:"Shift work and vascular events: systematic review and meta-analysis" 4967: 4965: 4963: 4884:"Scientific Report of the 2015 Dietary Guidelines Advisory Committee" 4812: 2821:

are ineligible for coverage options due to their immigration status.

2805: 2787: 2768: 2476: 2448:

indefinitely and on dual antiplatelet therapy (generally aspirin and

2386: 2350: 2290:

The pain associated with myocardial infarction is often treated with

2195: 2001: 1929: 1893: 1787: 1716: 1638: 1618: 1525: 1399: 1291: 1251: 1168: 716: 696: 498:, where the blockage is removed using medications. People who have a 330: 274: 126: 9860: 5295:

Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA (May 2016).

4473:

Rubin's Pathology — Clinicopathological Foundations of Medicine

2835:, those with lower educational attainment appeared to have a higher 1645:

may be useful to rule out MI rapidly when used along with troponin.

556:, the lack of oxygen delivery to myocardial tissue. It is a type of 11271: 11185: 10930: 10087: 6895: 5991:

Buja LM (July 2005). "Myocardial ischemia and reperfusion injury".

3451: 2814: 2810: 2647: 2303: 2141: 1881: 1795: 1775: 1737: 1642: 1622: 1376: 1372: 1295: 1263: 1090: 858:

levels. Many risk factors of myocardial infarction are shared with

581: 456: 306: 122: 81: 73: 9495:

Perry K, Petrie KJ, Ellis CJ, Horne R, Moss-Morris R (July 2001).

9396: 9147:

Kilpi F, Silventoinen K, Konttinen H, Martikainen P (April 2016).

8941:

From 2001 to 2011, death rates attributable to CVD declined 30.8%.

8601:"Exercise-based cardiac rehabilitation for coronary heart disease" 4960: 2876:. In general, a heart attack is not covered; however, it may be a 2184:. Those who cannot tolerate ACE inhibitors may be treated with an 1496:

with a rising or falling trend and at least one of the following:

9231:"Disparities in cardiovascular disease risk in the United States" 7110: 6565: 3898: 3435:"Clinical review: Major consequences of illicit drug consumption" 2865: 2772: 2515:, continued severe chest pain, or less than a 50% improvement in 2445: 2362: 2330: 2136: 2129:

Following a heart attack, nitrates, when taken for two days, and

2077: 2026: 1941: 1529: 1199: 1094: 1050: 994: 867: 839: 803: 799: 649: 507: 467: 424: 400: 353: 267: 259: 213: 7722: 6032:

American Journal of Physiology. Heart and Circulatory Physiology

5188: 3004:"Heart Attack or Sudden Cardiac Arrest: How Are They Different?" 11010: 10990: 10145: 9988: 9872: 9746: