Myocardial infarction (MI)

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

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

• 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

• 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 Venilatory 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

Description

• 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

Essentials of Diagnosis

• 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
  • EKG/ECG3
  • Echocardiogram to assess left ventricular function and ejection fraction
  • Cardiolite to assess for myocardial perfusion
  • Cardiac catheterization to assess for ejection fraction

General Considerations

• 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

Demographics

• 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

Signs and Symptoms

• 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

Functional Implications

• Depending on the amount of myocardial damage
  • Decreased activity ...