====== Acute myocardial infarction ======

===== In Neurosurgery =====
{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1N3QNDYjRmvpmEiDWZQaHdiS_BRtjObM7BMQcAjk51Re49wsk1/?limit=15&utm_campaign=pubmed-2&fc=20240207184850}}


commonly known as a heart attack, occurs when blood flow stops to a part of the heart causing damage to the heart muscle. 
----
C7 [[cervical radiculopathy]] might present with cervicogenic angina and pose a clinical diagnosis challenge given its similarity in clinical presentation with other clinical conditions like [[myocardial infarction]]. Clinicians should have a high index of suspicion to differentiate the two conditions. Nevertheless, ruling out firstly myocardial infarction and [[pulmonary embolism]] among patients presenting with chest pain is of clinical benefit in terms of [[morbidity]] and [[mortality]] of a patient. Furthermore, proper and timely physical examination should be emphasized to be conducted to every patient so as to avoid delayed diagnosis and management
((Mashauri HL, Makunga FJ, Luhwago EC, Ndale E, Kilonzo KG. Is it myocardial infarction? A case report of C7 cervical radiculopathy with cervical angina. SAGE Open Med Case Rep. 2024 Jan 3;12:2050313X231223434. doi: 10.1177/2050313X231223434. PMID: 38187813; PMCID: PMC10768626.)).

===== Etiology =====

[[Atherosclerosis]] (AS) is considered one of the primary causes of [[cardiovascular disease]]s (CVDs). Unpredictable rupture of vulnerable atherosclerotic plaques triggers adverse cardiovascular events such as acute myocardial syndrome (ACS) and even [[sudden death]] (SCD). Therefore, assessing the vulnerability of atherosclerotic plaques and early intervention is significant in reducing CVD mortality. [[Nanomedicine]] possesses tremendous advantages in achieving the integration of the diagnosis and therapy of atherosclerotic plaques because of its magnetic, optical, thermal, and catalytic properties. Based on the pathological characteristics of vulnerable plaques, stimuli-responsive nanoplatforms and surface-functionalized nanoagents have been designed and drawn great attention for accomplishing the precise imaging and treatment of vulnerable atherosclerotic plaques due to their superior properties, such as high bioavailability, lesion-targeting specificity, on-demand cargo release, and low off-target damage. Zhang et al. generalized the characteristics of vulnerable plaques, and systematically summarized some targeted strategies for boosting the accuracy of plaque vulnerability evaluation by imaging and the efficacy of plaque stabilization therapy (including antioxidant therapy, macrophage depletion therapy, regulation of lipid metabolism therapy, anti-inflammation therapy, etc.). In addition, they discussed existing challenges and prospects in this field and believe it will provide new thinking for the diagnosis and treatment of CVDs in the near future
((Zhang S, Liu Y, Cao Y, Zhang S, Sun J, Wang Y, Song S, Zhang H. Targeting the Microenvironment of Vulnerable Atherosclerotic Plaques: An Emerging Diagnosis and Therapy Strategy for Atherosclerosis. Adv Mater. 2022 Mar 2:e2110660. doi: 10.1002/adma.202110660. Epub ahead of print. PMID: 35238081.)).

===== Clinical features =====


The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it is in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired.

About 30% of people have atypical symptoms, with women more likely than men to present atypically.

Among those over 75 years old, about 5% have had an MI with little or no history of symptoms.

An MI may cause heart failure, an irregular heartbeat, or cardiac arrest.
----
Left [[C6 radiculopathy]] ocasionally presents with pain simulating an [[myocardial infarction]].
----
Adding [[copeptin]] to cardiac [[troponin]] (cTn) improved the [[sensitivity]] and [[negative predictive value]] for the diagnosis of non-ST elevation [[myocardial infarction]] (NSTEMI) compared to cTn alone. Thus, adding copeptin to cTn might help to screen NSTEMI early upon admission to the [[emergency department]] (ED)
((Shin H, Jang BH, Lim TH, Lee J, Kim W, Cho Y, Ahn C, Choi KS. Diagnostic
accuracy of adding copeptin to cardiac troponin for non-ST-elevation myocardial
infarction: A systematic review and meta-analysis. PLoS One. 2018 Jul
6;13(7):e0200379. doi: 10.1371/journal.pone.0200379. eCollection 2018. PubMed
PMID: 29979797.
)).
----
Direct [[stenting]] is feasible for treating acute [[myocardial infarction]]
----

===== Case reports =====
Bhanot et al. presented a patient with [[intraparenchymal hemorrhage]] due to [[cerebral arteriovenous malformation]] (AVM) who exhibited acute [[ST segment]] [[myocardial infarction]] (STEMI) after neurosurgery. Serial cardiac biomarkers and [[echocardiogram]]s were performed which did not reveal any evidence of [[acute myocardial infarction]]. The patient was managed conservatively from cardiac stand point with no employment of [[anticoagulant]]s, [[antiplatelet therapy]], [[fibrinolytic]] agents, or [[angioplasty]] and recovered well with minimal neurological deficit. This case highlights that diffuse cardiac ischemic signs on the ECG can occur in the setting of an ICH after neurosurgery, potentially posing a difficult diagnostic and management conundrum
((Bhanot RD, Kaur J, Sriwastawa S, Bell K, Suchdev K. Postoperative 'STEMI' in [[Intracerebral Hemorrhage]] due to [[Arteriovenous Malformation]]: A [[Case Report]] and [[Review]] of [[Literature]]. Case Rep Crit Care. 2019 Apr 22;2019:9048239. doi: 10.1155/2019/9048239. PMID: 31231576; PMCID: PMC6507120.)).

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