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  • Chest discomfort, usually described as “pressure,” “dull,” “squeezing,” or “aching.”
  • Characteristic electrocardiographic changes.
  • Elevated biomarkers, such as troponin.
  • Imaging may show new regional wall motion abnormality with preserved wall thickness.
  • The elderly, women, and diabetics may have atypical presentation.


Acute myocardial infarction (MI) is a clinical syndrome that results from occlusion of a coronary artery, with resultant death of cardiac myocytes in the region supplied by that artery. Depending on the distribution of the affected coronary artery, acute MI can produce a wide range of clinical sequelae, varying from a small, clinically silent region of necrosis to a large overwhelming area of infarcted tissue resulting in cardiogenic shock and death. About 1.2 million people experience MI in the United States each year; every minute, one American will die of coronary artery disease.


The risk of having an acute MI increases with age, male gender, smoking, dyslipidemia, diabetes, hypertension, abdominal obesity, a lack of physical activity, low daily fruit and vegetable consumption, alcohol overconsumption, and psychosocial index. As much as 90% of the risk of acute MI has been attributed to the modifiable risk factors. The diagnostic criteria for acute MI are listed in Table 8–1.

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Table 8–1. ESC/ACC Definition of Myocardial Infarction

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