Myocardial infarction

84 topics across 7 chapters

Chapter 1

Epidemiology & risk factors

Epidemiology & burden (incidence, mortality, disparities)

Modifiable risk factors

4 subtopics

Lipids, hypertension & diabetes as MI risks: what to screen and target (conceptual)

Smoking cessation counseling & pharmacotherapy (NRT/varenicline/bupropion)

Diet, obesity & physical inactivity: cardiometabolic risk fundamentals

Substance use (cocaine/stimulants) and MI risk: key mechanisms and implications

Non-modifiable & genetic risk (age, sex, family history, inherited dyslipidemias)

Prevention & risk communication (absolute risk, shared decision-making basics)

Chapter 2

Anatomy & pathophysiology

Coronary anatomy & myocardial territories

2 subtopics

Coronary dominance & key branches (LAD/LCx/RCA)

Territories and MI localization (anatomy ↔ ECG concept map)

Type 1 MI pathogenesis (plaque rupture/erosion → thrombosis)

Type 2 MI pathogenesis (supply–demand mismatch)

Infarct evolution & remodeling

3 subtopics

Time course of ischemic injury (reversible vs irreversible injury)

Reperfusion injury, stunning & no-reflow (conceptual)

Ventricular remodeling, scar & aneurysm formation (conceptual)

Chapter 3

Presentation & initial assessment

Typical presentation & physical exam clues

Atypical/silent presentations (women, elderly, diabetes)

Differential diagnosis of chest pain (PE, dissection, pericarditis, pneumothorax, esophageal causes, etc.)

Initial stabilization & triage

3 subtopics

First 10 minutes checklist (ABCs, monitoring, IV access, targeted oxygen, glucose, analgesia approach)

Serial ECGs and when to activate a STEMI pathway

Workup of the unstable patient (bedside echo/POCUS, CXR, basic labs)

Chapter 4

Diagnosis & classification

ECG interpretation for MI

3 subtopics

STEMI criteria & STEMI equivalents (posterior, RV, de Winter, etc.)

NSTEMI/ischemia patterns (ST depression, T inversion)

ECG pitfalls (LBBB/paced rhythms, pericarditis, early repolarization, hyperkalemia)

Troponin & biomarkers

3 subtopics

High-sensitivity troponin principles (99th percentile, delta change, timing)

Rule-in/rule-out pathways (0/1h, 0/2h, 0/3h concepts)

Non-ischemic causes of troponin elevation (myocarditis, CKD, PE, sepsis, tachyarrhythmia, etc.)

Imaging in suspected MI (echo/CT/MRI): when and why

MI definitions & classification (STEMI/NSTEMI, type 1/2, MINOCA)

Risk stratification & disposition (TIMI/GRACE/Killip concepts)

Chapter 5

Acute management

Antithrombotic therapy

3 subtopics

Aspirin + P2Y12 selection and timing (conceptual)

Anticoagulants (UFH/LMWH/bivalirudin): indications & basics (conceptual)

Bleeding risk, contraindications, and peri-procedural management (conceptual)

Reperfusion & invasive strategy

3 subtopics

Primary PCI workflow and timing metrics (conceptual)

Fibrinolysis: indications, contraindications, complications (conceptual)

NSTEMI: early invasive vs ischemia-guided approach (conceptual)

Adjunct acute medications (nitrates, beta-blockers, statins, ACEi/ARB; analgesia/antiemetics; oxygen strategy)

Cardiogenic shock & cardiac arrest

3 subtopics

Initial cardiogenic shock management (hemodynamics, vasopressors/inotropes concepts, early cath)

Mechanical circulatory support overview (IABP/Impella/VA-ECMO): indications & tradeoffs (conceptual)

Post–cardiac arrest care in suspected MI (TTM concepts, cath lab decisions)

Systems of care (STEMI activation, transfers, door-to-balloon / door-to-needle concepts)

Chapter 6

Complications & inpatient course

Arrhythmias after MI

3 subtopics

VT/VF recognition and defibrillation fundamentals

Bradyarrhythmias/AV block and pacing approach (conceptual)

Atrial fibrillation after MI: rate/rhythm control & anticoag considerations (conceptual)

Mechanical complications

4 subtopics

Papillary muscle rupture & acute mitral regurgitation: recognition and urgent steps (conceptual)

Ventricular septal rupture: recognition and urgent steps (conceptual)

Free-wall rupture & tamponade: recognition and urgent steps (conceptual)

Pseudoaneurysm vs true aneurysm: key distinctions (conceptual)

Heart failure & thromboembolism

3 subtopics

Acute heart failure/pulmonary edema management after MI (conceptual)

LV thrombus detection and anticoagulation basics (conceptual)

Right ventricular infarct recognition and management (preload, nitrates caution)

Pericarditis & post-MI inflammatory syndromes (early pericarditis, Dressler)

Chapter 7

Secondary prevention & rehabilitation

Discharge planning

2 subtopics

Discharge checklist (meds, EF, cardiac rehab referral, follow-up timing)

Patient education: red flags, medication reconciliation, and an action plan

Secondary prevention medications

4 subtopics

Antiplatelet strategy after MI (DAPT duration, de-escalation concepts)

Lipid lowering intensification (ezetimibe/PCSK9 concepts, LDL targets and monitoring)

Beta-blocker + RAAS/MRA therapy: who benefits and for how long (conceptual)

Vaccination & inflammation-modifying therapies (flu shot; colchicine concepts)

Lifestyle & cardiac rehabilitation

3 subtopics

Exercise prescription & rehab phases (early mobilization → supervised rehab → maintenance)

Diet/weight/BP goals & cardiometabolic risk (practical targets and tracking)

↗ Smoking cessation counseling & pharmacotherapy (NRT/varenicline/bupropion) (see Chapter 1)

Long-term follow-up (EF reassessment, ICD/WCD concepts, return to work/driving/sex)

Psychosocial, adherence & health equity (depression screening, cost barriers, support systems)