The presentation of an apical myocardial infarction patient depends on whether the disease is acute or chronic. Acute patients have the usual complaints of cardiac ischemia patients. A strictly apical location implies that the mass of the affected myocardial tissue is relatively small, therefore the patient is unlikely to present in cardiogenic shock, but rather be a Killip class I case, with no evidence of heart failure. Pulmonary edema presentation is also unlikely. In return, the patient complains of chest pain that often radiates to the epigastrium or malaise. The pain is severe and lasts for 30 to 60 minutes. The character of the disease is different in different individuals, being described as a squeezing, burning, pressure, aching or sharp sensation. In other cases, myocardial ischemia can go unrecognized, as the patient believes he or she is suffering from indigestion or has no complaints whatsoever. This latter situation is more frequently seen in diabetes, dementia or elderly patients. Symptoms are more frequent during the early morning hours [1].

Patients with a previous apical myocardial infarction may have heart failure signs if the acute event was not strictly apical, but involved significant parts of neighboring walls and was complicated by aneurysm formation that occupies a significant ventricular territory. The anterior wall is more frequently implicated than the inferior and posterior ones.

• Coronary Atherosclerosis

  Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. [emedicine.medscape.com]

• Chest Pain

  Case Presentation: A 29 year old African American male presented with non-radiating, mid-sternal chest pain, which was relieved by sitting up. His vital signs and physical examination were unremarkable. [shmabstracts.com]

  A 66-year-old female presented to the emergency room with an episode of chest pain that lasted for a few minutes before resolving spontaneously. [hindawi.com]

  A 51-year-old Japanese woman consulted the emergency room complaining of the sudden onset of anterior chest pain while shopping. [ncbi.nlm.nih.gov]

  During stress electrocardiography, he developed chest pain at nine minutes of a standard Bruce protocol, but no significant ST changes. [bjcardio.co.uk]

• Heart Disease

  […] ischaemic heart disease, unspecified Ischaemic heart disease (chronic) NOS Processed on 29.10.2004 M.S. [apps.who.int]

  disease) 관상동맥 부전(Coronary failure) 관상동맥 기능부전(Coronary insufficiency) I24.9 상세불명의 급성 허혈성 심장 질환(Acute ischaemic heart disease, unspecified) 제외：허혈성 심장 질환(만성)(ischaemic heart disease (chronic)) NOS(I25.9) I25 만성 허혈성 심장 질환(Chronic ischaemic heart disease) [dic.impact.pe.kr]

  Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1297-316 2017 American College of Cardiology Foundation [onlinejacc.org]

  This test examines blood flow to the heart during exertion, and can be used as a diagnostic tool in ischemic heart disease, coronary artery disease, and heart failure. [courses.lumenlearning.com]

  Our Specialty Centers The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease takes a multidisciplinary approach to helping you prevent heart disease and stroke—and that includes getting your cholesterol in check. [hopkinsmedicine.org]

• Retrosternal Chest Pain

  The overall incidence is unknown, although it may be more prevalent than currently reported.(2) Although retrosternal chest pain is the most common symptom, some patients exhibit dyspnea, shock, or electrocardiographic alterations.(3) By definition, Takotsubo [scielo.br]

• Short Neck

  It was first described by Satoh et al. (1) and Dote et al. (2) and was named “Takotsubo”-shaped cardiomyopathy due to its unique “short neck round-flask”-like LV apical ballooning resembling the tako-tsubo (Japanese for octopus pot or trap) of Japan. [onlinejacc.org]

The first step in addressing a non-critical myocardial infarction patient should be obtaining the history of the disease and assessing risk factors [2] [3]. Clinical examination should assess the skin (color and presence of diaphoresis), blood pressure, pulse (frequency, rhythm and equality in similar territories), heart and breathing sounds, the presence of gastrointestinal symptoms such as nausea and vomiting, neck vein aspect, temperature (fever is present during the first two days of evolution [4]) and urinary output.

Once the suspicion of an acute myocardial infarction is raised, electrocardiography is usually the first investigation performed. As discussed above, the apical localization is rather difficult to define by this method, but modifications do appear in contiguous leads.

The electrocardiogram also detects newly installed branch blocks, also an indicator of ischemia, and potentially life-threatening arrhythmias [5] [6].

The protocol states that cardiac enzymes (troponin, myoglobin and creatine kinase) should be measured in a serial manner [7] [8]. Recent guidelines advise that high-sensitive troponin I or troponin T assays should be used [9] [2]. Brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide is only useful in chronic myocardial infarction patients for risk stratification and heart failure prognosis [10] [11].

The exact localization of the infarction area is stated by imaging methods. Echocardiography is a useful, readily available and reliable method that helps to evaluate wall motion abnormalities. Multidetector computed tomography and single-photon emission CT (SPECT) or positron emission tomography (PET) scanning, although viable methods, are not routinely used in triage settings, but are useful in detecting ventricular aneurysms [12]. Classic coronary catheterization has the advantage of offering clear diagnosis and being a therapeutic procedure, as well.

• Inferior Q Wave

  The terms “transmural,” “non-transmural,” “Q wave MI” and “non-Q wave MI” are no longer recommended. The differences between the types of acute coronary syndromes are discussed below. [healio.com]

• ST Elevation

  ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.1 ST elevation (STEMI) myocardial infarction of inferior wall I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery I21.19 ST [icd10data.com]

  I21.0 ST elevation (STEMI) myocardial infarction of anterior wall Inclusion term(s): Type 1 ST elevation myocardial infarction of anterior wall I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery I21.02 ST elevation [icd10coded.com]

  In the acute period (6 ± 9 h; range, 1 to 48 h), ST elevation was observed in 79 (90%) of the patients, including four patients with solitary ST elevation of limb-lead and 13 patients without right precordial (V 1, V 2 ) ST elevation. [onlinejacc.org]

  Initial electrocardiogram showed sinus tachycardia and ST elevation in leads II, III, and aVF compatible with an inferior ST-elevation myocardial infarction. [ceemjournal.org]

  The aim of the work was to assess apical rotation in acute ST-elevation MI. [mmj.eg.net]

However, it was demonstrated that there was no additional effect of spironolactone treatment to these improvements. [acikerisimarsiv.selcuk.edu.tr]

The goals of treatment are to preserve the heart muscle and to relieve pain, as the pain forces the heart to work harder. [hopkinsmedicine.org]

The treatment of ASMI should be like any other acute coronary syndrome. [statpearls.com]

Treatment requires emergency surgery for mitral valve repair and revascularization. Medical treatment, without surgery, is associated with poor long-term survival [ 5 ]. [ceemjournal.org]

A high incidence of aborted infarction in a population of AMI patients is certainly a marker of treatment success. [ecrjournal.com]

Results: Main hypothesis of the present study is that can application of the management plans improve prognosis of the patients with AMI based on the results of prospective study model for AMI prognosis and surveillance index. [ndsl.kr]

Brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide is only useful in chronic myocardial infarction patients for risk stratification and heart failure prognosis. [symptoma.com]

[…] is dependent on the adequacy of the residual left ventricular function, patients with severe left ventricular dysfunction having higher mortality rates. 25 In this case the early prognosis was favorable, but on the long term, the prognosis still remains [tmj.ro]

Time to treatment influences the impact of STsegment resolution on one-year prognosis, Circulation, 2001;104:2653–9. [ecrjournal.com]

The prognosis of anteroseptal MI has not been the object of research as a separate entity. [statpearls.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Although the etiology of tako-tsubo-like ventricular dysfunction is still unknown, our findings are compatible with a common etiology of tako-tsubo syndrome and acute myocardial infarction. See editorial Correspondence: Prof. J. Farré. [revespcardiol.org]

Therefore, the precise clinical features and the etiologic basis of this syndrome remain unclear. [onlinejacc.org]

We performed tridimensional (3D) transthoracic echocardiography to study the etiology of MR. [tmj.ro]

Non-ischemic CM has a variable etiology, i.e. genetic, toxic, metabolic, infectious and idiopathic. [radiologyassistant.nl]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

Contemporary epidemiologic data suggest the incidence of LV thrombus, detected using optimal imaging modalities, may be as high as 15% in patients with ST-segment elevation MI (STEMI) and up to 25% in patients with anterior MI. [acc.org]

Silent myocardial ischemia: Epidemiology, diagnosis, treatment, and prognosis. https://www.uptodate.com/contents/search. Accessed Jan. 31, 2019. Jameson JL, et al., eds. Chest discomfort. In: Harrison's Principles of Internal Medicine. 20th ed. [mayoclinic.org]

Non-obstructive: This is also called myocardial infarction with non-obstructive coronary arteries (MINCOA) which includes atheromatous lesion, coronary spasm, myocardial bridging or coronary artery dissection, etc.[7] Epidemiology Epidemiology of anteroseptal [statpearls.com]

We think this case may promote discussion regarding the pathophysiology of left ventricular apical ballooning syndrome. [ncbi.nlm.nih.gov]

The AHA/American Stroke Association 2014 stroke prevention guidelines recommend a similar duration, targeting a higher INR of 2.5. [acc.org]

Our Specialty Centers The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease takes a multidisciplinary approach to helping you prevent heart disease and stroke—and that includes getting your cholesterol in check. [hopkinsmedicine.org]

Prevention The same lifestyle habits that can help treat myocardial ischemia can also help prevent it from developing in the first place. [mayoclinic.org]

The main aim of treatment strategies for LV thrombus is to prevent systemic embolisation. Oral anticoagulation with vitamin K antagonists is the mainstay of treatment for LV thrombus to prevent systemic embolisation [1, 2]. [smw.ch]

1. Wijnbergen I, Van't Veer M, Pijls NH, et al. Circadian and weekly variation and the influence of environmental variables in acute myocardial infarction. Neth Heart J. 2012; 20 (9):354-9.
2. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130 (25):e344-426.
3. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37 (3):267-315.
4. Kacprzak M, Kidawa M, Zielińska M. Fever in myocardial infarction: is it still common, is it still predictive?. Cardiol J. 2012;19 (4):369-73.
5. O'Gara PT, Kushner FG, Ascheim DD, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127 (4):e362-425.
6. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC); Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012; 33 (20):2569-619.
7. Storrow AB, Nowak RM, Diercks DB, et al. Absolute and relative changes (delta) in troponin I for early diagnosis of myocardial infarction: Results of a prospective multicenter trial. Clin Biochem. 2015;48 (4-5):260-7.
8. Storrow AB, Christenson RH, Nowak RM, et al. Diagnostic performance of cardiac troponin I for early rule-in and rule-out of acute myocardial infarction: Results of a prospective multicenter trial. Clin Biochem. 2015;48 (4-5):254-9.
9. Reichlin T, Irfan A, Twerenbold R, et al. Utility of absolute and relative changes in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction. Circulation. 2011; 12. 124(2):136-45.
10. Haaf P, Reichlin T, Corson N, et al. B-type natriuretic peptide in the early diagnosis and risk stratification of acute chest pain. Am J Med. 2011;124 (5):444-52.
11. Thygesen K, Mair J, Mueller C, et al. Recommendations for the use of natriuretic peptides in acute cardiac care: a position statement from the Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care. Eur Heart J. 2012; 33 (16):2001-6.
12. Cremer PC, Khalaf S, Agarwal S, et al. Myocardial perfusion imaging in emergency department patients with negative cardiac biomarkers: yield for detecting ischemia, short-term events, and impact of downstream revascularization on mortality. Circ Cardiovasc Imaging. 2014; 7 (6):912-9.