“We are a divided species – head running ahead of heart. It is not surprise that coronary thrombosis is the characteristic death of our time. The heart literally chokes up on the impossibility of keeping up.”
Definition
Sudden occlusion of a coronary artery leading to myocardial death. The acute coronary syndromes consist of two groups – Unstable angina and non-Q myocardial infarction, and ST segment elevation myocardial infarction.
Prognosis
About 10% die during the acute phase in the hospital, but in the elderly over 60 years, the mortality may be as high as 25%. 80% of all deaths due to MI are in patients > 65 years. An additional 10-20% die during the first year after attack. Poorer prognosis in patients with cardiac failure, pulmonary oedema, low BP, signs of poor systemic perfusion, and cardiogenic shock. Total occlusion of the left main coronary is catastrophic and leads to death within minutes to hours. Patients at high risk are those over 70 years, have ST segment depression onthe initial ECG, have raised treponin T or I concentrations with or without haemodynamic complications. Thrombolysis reduces mortality in 30 patients out of a 1000 cases treated. Thrombolysis and aspirin within 4 hours after onset of MI reduces the 1 monthmortality by 50%
