"ischaemia in the absence of chest pain can occur in those with poor visceral sensation (diabetics, post-cardiothoracic surgery)"
"post-systolic thickening"
"In patients who have established coronary artery narrowing, CT perfusion can be used to predict the significance of the luminal narrowing as well as predict post-infarction myocardial viability/salvageability 3-4."
"delayed enhancement (7-15 minutes post-CT contrast dose) 4"
"One study has assessed the utility of a non-ECG-gated 16-slice CT pulmonary angiogram in detecting myocardial infarction. This method suffers from a few problems. First, the relatively early (cf. with CT aortogram/coronary angiogram) phase results in non-homogeneous enhancement of the myocardium. Second, streak artifact (consider saline chaser) from the undiluted contrast in the superior vena cava/right atrium caused "pseudo-areas" of reduced myocardial attenuation. Third, movement artifacts from the beating heart caused areas of increased/decreased attenuation. Despite these problems, this study published optimistic figures of 67% sensitivity and 91% specificity 5. "
"type I: spontaneous myocardial infarction related to ischaemia from a primary coronary event (e.g. plaque rupture, thrombotic occlusion)"
"type II: secondary to ischaemia from a supply-and-demand mismatch (e.g. sepsis, hypotension, tachyarrhythmia, anaemia)"
"type III: myocardial infarction resulting in sudden cardiac death"
"type IV:"
"type IVa: myocardial infarction associated with percutaneous coronary intervention"
"type IVb: myocardial infarction associated with in-stent thrombosis"
"type V: myocardial infarction associated with coronary artery bypass surgery"
"In patients who have established coronary artery narrowing, CT perfusion can be used to predict the significance of the luminal narrowing as well as predict post-infarction myocardial viability/salvageability 3-4."
"produces an "extensive anterior MI" pattern, with ST-segment elevation in precordial leads V1-6 and limb leads I and aVL"
"reciprocal ST-segment depression in lead III"
"produces an "apical MI" pattern, with ST-segment elevation in precordial leads V3-6 and most of the limb leads"
"reciprocal ST-segment depression in lead aVR"
"usually produces an "inferior MI" pattern, with ST-segment elevation in limb leads II, III, and aVF"
"reciprocal ST-segment depression in lead I and aVL"
"associated right ventricular MI denoted by elevation of the ST segment in III>II and V1>V2"
"associated posterior MI pattern has tall right (V1-3) precordial R waves with horizontal ST depression and tall, upright T waves"
"usually produces a "high lateral wall MI" pattern, with ST-segment elevation in limb leads I and aVL"
"reciprocal ST-segment depression in lead III"
"Digital subtraction angiography will show luminal arterial compromise. Primary percutaneous coronary intervention (primary PCI) with angioplasty and stenting is the gold standard for the treatment of ST-elevation myocardial infarction. Patients with non-ST-elevation myocardial infarction also commonly undergo coronary angiography as inpatients."
"Digital subtraction angiography will show luminal arterial compromise. Primary percutaneous coronary intervention (primary PCI) with angioplasty and stenting is the gold standard for the treatment of ST-elevation myocardial infarction. Patients with non-ST-elevation myocardial infarction also commonly undergo coronary angiography as inpatients."
"Digital subtraction angiography will show luminal arterial compromise. Primary percutaneous coronary intervention (primary PCI) with angioplasty and stenting is the gold standard for the treatment of ST-elevation myocardial infarction. Patients with non-ST-elevation myocardial infarction also commonly undergo coronary angiography as inpatients."
Expected headings
"ECG"
"Echocardiography"
"CT coronary angiogram"
""Triple rule-out” coronary CT angiography"
"CT perfusion"
"cardiovascular risk factors: smoking, hypertension, low-density lipoprotein (LDL) cholesterol, hyperlipidaemia, diabetes, obesity, physical inactivity, air pollution"
"supplies the lateral and posterior aspect of the left ventricle; in 10% of patients, this artery is dominant, meaning that it supplies the inferior heart and posterior interventricular septum"
"The mainstay of laboratory diagnosis revolves around the measurement of a cardiac troponin level; elevation above the 99th percentile (defining myocardial injury) with a dynamic rise and/or fall (implying an acute change) associated with clinical evidence of acute myocardial ischaemia defines an acute myocardial infarction 16. Creatine kinase (specifically, CK-MB) is of historical use in this context."
"Infarct scars can mimic acute myocardial infarcts as they demonstrate a similar enhancement pattern; however, old infarcts are often associated with myocardial thinning and contour abnormality (bulges away from the ventricle), useful distinguishing features. Subendocardial fat may be present in some cases."
"type I: spontaneous myocardial infarction related to ischaemia from a primary coronary event (e.g. plaque rupture, thrombotic occlusion)"
"type II: secondary to ischaemia from a supply-and-demand mismatch (e.g. sepsis, hypotension, tachyarrhythmia, anaemia)"