Cardioogy -Acute Coronary Syndrome with ST Medicine school

Acute Coronary Syndrome with ST-segment
elevation




Introduction:
• Acute Coronary Syndrome with persistent ST-segment elevation (STEMI): Combination of anginal
pain with persistent ST-segment elevation progressing to transmural myocardial infarction (STEMI)

• Myocardial Infarction (MI) = myocardial necrosis due to prolonged myocardial ischemia

• STEMI is the clinical manifestation of thrombotic occlusion of a coronary artery

• Failure to achieve urgent reperfusion results in significant myocardial damage

• Restoration of blood flow in the occluded artery is a major therapeutic advancement in the
management of MI

, II-Epidemiology:
• In France: 120,000 new cases per year, accounting for 12% of total annual adult mortality

• Male predominance

• Hospital mortality is 7%, which has decreased in recent years due to:



Diagnostic and therapeutic management

Secondary prevention

Coronary Blood Flow Interruption



III-Pathophysiology:
• Thrombosis of the coronary artery causing MI results from rupture of an atherosclerotic plaque

• The initially non-occlusive platelet thrombus becomes fibrin-rich (red thrombus) and occlusive

• Thrombotic coronary occlusion leads to acute myocardial anoxia progressing to myocardial necrosis

• The process is progressive, and necrosis becomes complete after 12 hours of coronary obstruction

• Consequences of necrosis:



Impairment of left ventricular contractility leading to decreased left ventricular function

Ventricular rhythm disturbances

Ventricular aneurysm and thrombosis

III-Diagnosis:
Form of description: Uncomplicated MI