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Unformatted text preview: romatous plaques. ► Plaque rupture with subsequent exposure of the basement membrane results in platelet aggregation, thrombus formation, fibrin accumulation, hemorrhage into the plaque, and varying degrees of vasospasm. ► This can result in partial or complete occlusion of the vessel and subsequent myocardial ischemia. ► Total occlusion of the vessel for more than 4­6 hours results in irreversible myocardial necrosis ► Reperfusion within this period can salvage the myocardium and reduce morbidity and mortality. Nonatherosclerotic causes of MI Nonatherosclerotic causes of MI include • • • • • coronary vasospasm as seen in variant angina patients using cocaine and amphetamines; coronary emboli from sources such as an infected heart valve; occlusion of the coronaries due to vasculitis, other causes leading to mismatch of oxygen supply and demand, • such as acute anemia from GI bleeding. Trauma Trauma ►MI induced by chest trauma has also been reported, usually following severe chest trauma such as motor vehicle accidents and sports injuries. Mortality/Morbidity Mortality/Morbidity ► Approximately 500,000­700,000 deaths are caused by ischemic heart disease annually in the United States. ► One third of patients will die within 24 hours of the onset of ischemia and many of the survivors will suffer significant morbidity. ► For many patients, the first manifestation of coronary artery disease is sudden death likely from malignant ventricular dysrhythmia. In the US In the US ► MI is a leading cause of morbidity and mortality in the United States. ► Approximately 1.3 million cases of nonfatal MI are reported each year, for an annual incidence of approximately 600...
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