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15: MYOCARDIAL INFARCTION

Eric Shamus, PhD, DPT, PT, CSCS; Lisa Ward McVey, DPT, PT, CCS

CONDITION/DISORDER SYNONYMS

  • Non-ST-elevation myocardial infarction (NSTEMI)

  • ST-elevation myocardial infarction (STEMI)

  • Subendocardial myocardial infarction (SEMI)

  • Non–Q-wave myocardial infarction

  • Acute coronary syndrome (ACS)

ICD-9-CM CODES

  • 410 Acute myocardial infarction

    • See entire list under 410

  • 412 Old myocardial infarction

    • See entire list under 412

ICD-10-CM CODES

  • 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

  • I21.3 ST-elevation (STEMI) myocardial infarction of unspecified site

  • I21.4 Non–ST-elevation (NSTEMI) myocardial infarction

  • I25.2 Old myocardial infarction

PREFERRED PRACTICE PATTERNS1

  • 6A: Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning

  • 6D: Impaired Aerobic Capacity/Endurance Associated With Cardiovascular Pump Dysfunction or Failure

  • 6E: Impaired Ventilation and Respiration/Gas Exchange Associated With Ventilatory Pump Dysfunction or Failure

  • 6F: Impaired Ventilation and Respiration/Gas Exchange Associated With Respiratory Failure

  • 6G: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated With Respiratory Failure in the Neonate

PATIENT PRESENTATION

A 51-year-old male presents to the emergency center with chest pain. He states that he has had chest discomfort or pressure intermittently over the last year especially with increased activity. He describes the chest pain as a pressure behind his breastbone that spreads to the left side of his neck. Unlike previous episodes, he was lying down, watching television. The chest pain lasted approximately 15 minutes then subsided on its own. He also noticed that he was nauseated and sweating during the pain episode. He has no medical problems that he is aware of and has not been to a physician for several years. On examination, he is in no acute distress with normal vital signs. His lungs were clear to auscultation bilaterally, and his heart had a regular rate and rhythm with no murmurs. An electrocardiogram (ECG) revealed ST-segment elevation and peaked T waves in leads II, III, and aVF. Serum troponin I and T levels are elevated.2

KEY FEATURES

Description

  • Blood flow to a region of the heart is blocked.

  • Supply does not equal demand, resulting in myocardial ischemia.

  • Coronary arteries supply oxygen.

  • Without oxygen, heart cells die.

  • Chest pain with or without left shoulder, jaw, neck, and teeth pain.

Essentials of Diagnosis

  • Acute myocardial infarction (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

    • EKG/ECG3

    • Echocardiogram to assess left ventricular function and ejection fraction (EF)

    • Cardiolite to assess for myocardial perfusion

    • Cardiac catheterization to assess for EF

General Considerations

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