Acute myocardial infarction

commonly known as a heart attack, occurs when blood flow stops to a part of the heart causing damage to the heart muscle.

Atherosclerosis (AS) is considered one of the primary causes of cardiovascular diseases (CVDs). Unpredictable rupture of vulnerable atherosclerotic plaques triggers adverse cardiovascular events such as acute myocardial syndrome (ACS) and even sudden death (SCD). Therefore, assessing the vulnerability of atherosclerotic plaques and early intervention is significant in reducing CVD mortality. Nanomedicine possesses tremendous advantages in achieving the integration of the diagnosis and therapy of atherosclerotic plaques because of its magnetic, optical, thermal, and catalytic properties. Based on the pathological characteristics of vulnerable plaques, stimuli-responsive nanoplatforms and surface-functionalized nanoagents have been designed and drawn great attention for accomplishing the precise imaging and treatment of vulnerable atherosclerotic plaques due to their superior properties, such as high bioavailability, lesion-targeting specificity, on-demand cargo release, and low off-target damage. Zhang et al. generalized the characteristics of vulnerable plaques, and systematically summarized some targeted strategies for boosting the accuracy of plaque vulnerability evaluation by imaging and the efficacy of plaque stabilization therapy (including antioxidant therapy, macrophage depletion therapy, regulation of lipid metabolism therapy, anti-inflammation therapy, etc.). In addition, they discussed existing challenges and prospects in this field and believe it will provide new thinking for the diagnosis and treatment of CVDs in the near future 1).

The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it is in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired.

About 30% of people have atypical symptoms, with women more likely than men to present atypically.

Among those over 75 years old, about 5% have had an MI with little or no history of symptoms.

An MI may cause heart failure, an irregular heartbeat, or cardiac arrest.

Left C6 radiculopathy ocasionally presents with pain simulating an myocardial infarction.

Adding copeptin to cardiac troponin (cTn) improved the sensitivity and negative predictive value for the diagnosis of non-ST elevation myocardial infarction (NSTEMI) compared to cTn alone. Thus, adding copeptin to cTn might help to screen NSTEMI early upon admission to the emergency department (ED) 2).

Direct stenting is feasible for treating acute myocardial infarction

Bhanot et al. presented a patient with intraparenchymal hemorrhage due to cerebral arteriovenous malformation (AVM) who exhibited acute ST segment myocardial infarction (STEMI) after neurosurgery. Serial cardiac biomarkers and echocardiograms were performed which did not reveal any evidence of acute myocardial infarction. The patient was managed conservatively from cardiac stand point with no employment of anticoagulants, antiplatelet therapy, fibrinolytic agents, or angioplasty and recovered well with minimal neurological deficit. This case highlights that diffuse cardiac ischemic signs on the ECG can occur in the setting of an ICH after neurosurgery, potentially posing a difficult diagnostic and management conundrum 3).


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67: Kim H, Jo K. Laboratory Predictors of Contrast-Induced Nephropathy After Neurointervention: A Prospective 3-Year Observational Study. World Neurosurg. 2020 Mar;135:e77-e82. doi: 10.1016/j.wneu.2019.10.166. Epub 2019 Nov 4. PMID: 31698123.

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89: Zhang X, Huang LF, Hua L, Feng HK, Shen B. Resveratrol protects myocardial apoptosis induced by ischemia-reperfusion in rats with acute myocardial infarction via blocking P13K/Akt/e-NOS pathway. Eur Rev Med Pharmacol Sci. 2019 Feb;23(4):1789-1796. doi: 10.26355/eurrev_201902_17142. PMID: 30840305.

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Zhang S, Liu Y, Cao Y, Zhang S, Sun J, Wang Y, Song S, Zhang H. Targeting the Microenvironment of Vulnerable Atherosclerotic Plaques: An Emerging Diagnosis and Therapy Strategy for Atherosclerosis. Adv Mater. 2022 Mar 2:e2110660. doi: 10.1002/adma.202110660. Epub ahead of print. PMID: 35238081.
Shin H, Jang BH, Lim TH, Lee J, Kim W, Cho Y, Ahn C, Choi KS. Diagnostic accuracy of adding copeptin to cardiac troponin for non-ST-elevation myocardial infarction: A systematic review and meta-analysis. PLoS One. 2018 Jul 6;13(7):e0200379. doi: 10.1371/journal.pone.0200379. eCollection 2018. PubMed PMID: 29979797.
Bhanot RD, Kaur J, Sriwastawa S, Bell K, Suchdev K. Postoperative 'STEMI' in Intracerebral Hemorrhage due to Arteriovenous Malformation: A Case Report and Review of Literature. Case Rep Crit Care. 2019 Apr 22;2019:9048239. doi: 10.1155/2019/9048239. PMID: 31231576; PMCID: PMC6507120.
  • acute_myocardial_infarction.txt
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