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  • Non-ST elevation myocardial infarction (NSTEMI)
  • ST elevation myocardial infarction (STEMI)
  • Subendocardial myocardial infarction (SEMI)
  • Non-Q wave myocardial infarction
  • Acute coronary syndrome (ACS)

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  • 410 Acute myocardial infarction
    • See entire list under 410
  • 412 Old myocardial infarction
    • See entire list under 412

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  • I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
  • I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
  • I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
  • I21.29 ST elevation (STEMI) myocardial infarction involving other sites
  • I21.4 Non-ST elevation (NSTEMI) myocardial infarction
  • I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
  • I25.2 Old myocardial infarction

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Description

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  • Blood flow to a region of the heart is blocked
  • Supply does not equal demand, resulting in myocardial ischemia
  • Coronary arteries supply oxygen2
  • Without oxygen, heart cells die
  • Chest pain with or without left shoulder, jaw, neck, and teeth pain

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Essentials of Diagnosis

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  • Acute MI
    • Amount and time of blockage
      • Within 18 to 24 hours after MI: inflammatory response occurs because of necrosis
      • Visible necrosis is present in 2 to 4 days
    • EKG/ECG3
    • Cardiac enzymes
  • Old MI

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General Considerations

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  • MI can result in
    • Sudden death
    • Permanent myocardium damage
    • Valve dysfunction
    • Cardiac arrhythmias
    • Respiratory failure
    • Heart failure
    • Cardiogenic shock
    • Minimal to no myocardium damage
  • Stratification for risk of event (not specific solely to exercise)
  • Patients may have an MI without experiencing signs or symptoms (silent MI may be seen in patients who have diabetes)
  • Vital signs should be monitored before, during, and after exercise
  • Greater emphasis has been placed on wellness and prevention

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Demographics

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  • Heart disease is the number one cause of death in both women and men
  • Women are more likely to present with atypical symptoms compared to men

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Signs and Symptoms

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  • Acute MI
    • Chest pain, discomfort, pressure, tightness, or squeezing
    • Radiating pain, discomfort, pressure, tightness, or squeezing to the neck, throat, jaw, back, or right or left upper extremity
    • Shortness of breath
    • Excessive fatigue
    • Diaphoresis
    • Nausea/vomiting
    • Anxiety
    • Fainting
    • Wheezing
    • Abdominal bloating
    • Palpitations
    • Cough
    • Light headedness
    • Sweating, cold feeling
    • Rapid pulse
    • Complications associated following MI

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Functional Implications

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  • Depending on the amount of myocardial damage
    • Decreased activity tolerance
    • Decreased exercise tolerance
    • Dyspnea on ...

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