TY  - CHAP
M1  - Book, Section
TI  - Chapter 25. Myocardial Ischemia
A1  - Hollenberg, Steven M.
A1  - Parrillo, Joseph E.
A2  - Hall, Jesse B.
A2  - Schmidt, Gregory A.
A2  - Wood, Lawrence D.H.
PY  - 2005
T2  - Principles of Critical Care, 3e
AB  - Myocardial  ischemia  results  from  an  imbalance  between  myocardial  oxygen  demand  and  supply.The  major  determinants  of  myocardial  oxygen  requirements  are  heart  rate,  contractility,  and  wall  stress  (afterload).Patients  with  myocardial  ischemia  are  categorized  by  presentation  with  or  without  ST  elevation,  in  accordance  with  treatment  strategies.  Patients  with  ST  elevation  benefit  from  immediate  reperfusion  with  thrombolytic  agents  or  direct  angioplasty.All  patients  with  suspected  myocardial  ischemia  should  be  given  aspirin  at  presentation.Myocardial  infarction  is  diagnosed  by  a  compatible  clinical  history,  evolution  of  characteristic  electrocardiographic  changes,  and  an  increase  and  subsequent  decrease  in  cardiac  enzymes.Acute  reperfusion  of  the  occluded  coronary  artery  is  the  key  to  achieving  a  good  outcome.  The  promptness  of  reperfusion  is  more  important  than  the  mode  by  which  it  is  accomplished.Prognosis  after  myocardial  infarction  is  most  closely  related  to  the  degree  of  left  ventricular  impairment.Risk  stratification  is  the  key  to  initial  management  of  patients  with  non–ST-elevation  acute  coronary  syndromes.In  patients  with  high-risk  non–ST-elevation  acute  coronary  syndromes,  use  of  low-molecular-weight  heparin,  glycoprotein  IIb/IIIa  inhibition,  and  an  early  invasive  approach  is  preferred.Aspirin,  β  blockers,  angiotensin-converting  enzyme  inhibitors,  and  statins  have  been  shown  to  decrease  mortality  rate  after  myocardial  infarction.Echocardiography  is  extremely  useful  for  the  diagnosis  of  complications  after  myocardial  infarction.Patients  with  cardiogenic  shock  should  be  stabilized  with  an  intra-aortic  balloon  pump  and  promptly  revascularized,  if  possible,  by  angioplasty  or  bypass  surgery.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2023/05/31
UR  - accesssurgery.mhmedical.com/content.aspx?aid=2285041
ER  -