ST elevation myocardial infarction causes: Difference between revisions

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Revision as of 15:34, 9 October 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The most common proximate cause of ST elevation myocardial infarction is plaque rupture. There are risk factors for plaque rupture and triggers of plaque rupture. A full discussion regarding the chronic risk factors and acute triggers of ST elevation MI can be found in other chapters. While plaque rupture is the most common cause of ST segment elevation MI, other conditions can cause ST elevation and myocardial necrosis. In order to expeditiously treat an alternate underlying cause of myonecrosis, it is important to rapidly identify conditions other than plaque rupture that may also cause ST elevation and myonecrosis. Indeed, the management of some of these conditions might differ substantially from that of plaque rupture: cocaine induced STEMI would not be treated with beta-blockers, and myocardial contusion would not be treated with an antithrombin. These conditions include the following:

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Plaque rupture

Causes by Organ System

Cardiovascular	Acute coronary syndrome, amyloidosis, anaphylactic shock, aortic dissection, aortic stenosis, arrhythmias, atherosclerosis, bradyarrhythmias, broken heart syndrome, commotio cordis, coronary artery aneurysm, coronary artery dissection, coronary artery vasospasm, coronary heart disease, coronary stent thrombosis, coronary thrombosis, dissecting aortic aneurysm, dyslipidemia, Hurler disease hypertension, hypotension, idiopathic hypertrophic subaortic stenosis, infectious endocarditis, Kawasaki disease, malignant hypertension, myocardial contusion, plaque rupture, prinzmetal angina, pseudoxanthoma elasticum, stress cardiomyopathy, tachyarrhythmias, Takayasu arteritis, Takotsubo cardiomyopathy
Chemical / poisoning	Carbon monoxide poisoning
Dermatologic	Kawasaki disease, pseudoxanthoma elasticum
Drug Side Effect	Amphetamines, anabolic steroids, cocaine, combined oral contraceptive pill, ephedrine, marijuana, sudden withdrawal of beta blockers, sudden withdrawal of nitrates, testosterone
Ear Nose Throat	Thyrotoxicosis
Endocrine	Amyloidosis, diabetes mellitus, pheochromocytoma, thyrotoxicosis
Environmental	Triggers of MI
Gastroenterologic	Hurler disease, pseudoxanthoma elasticum
Genetic	Fabry's disease, familial hypercholesterolemia, homocystinuria, Hurler disease, mucopolysaccharidoses
Hematologic	Disseminated intravascular coagulation, hypercoagulable states, polycythemia vera, thrombocytosis
Iatrogenic	Coronary stent thrombosis, sudden withdrawal of beta blockers, sudden withdrawal of nitrates, transluminal percutaneous coronary angioplasty
Infectious Disease	Infectious endocarditis
Musculoskeletal / Ortho	Homocystinuria
Neurologic	No underlying causes
Nutritional / Metabolic	Amyloidosis, dyslipidemia, electrolyte imbalance, Fabry's disease, familial hypercholesterolemia, homocystinuria, Hurler disease, mucopolysaccharidoses, thiamine deficiency
Obstetric/Gynecologic	Combined oral contraceptive pill, nuvaring
Oncologic	Radiation therapy can accelerate atherosclerosis particularly in the distribution of the left anterior descending artery;
Opthalmologic	No underlying causes
Overdose / Toxicity	Cocaine ingestion which may result in direct myocyte injury due to an adrendergic surge, vasoconstriction of the microvasculature or plaque rupture and thrombus formation; Marijuana ingestion has been identified as a trigger of MI.
Psychiatric	Anger, anxiety, bereavement, work-related stress, earthquakes, bombings and other psychosocial stressors have been identified as triggers of MI, and it is not clear if the mechanism is plaque rupture or hyperadrenergic tone; Stress cardiomyopathy or Broken heart syndrome causes ST segment elevation most often in the anterior precordium and is thought to be due to direct myocyte injury from a hyperadrenergic stimulation emanating from the central nervous system.
Pulmonary	A recent upper respiratory tract infections has been associated with a 4.9 fold rise in the risk of MI
Renal / Electrolyte	Homocystinuria
Rheum / Immune / Allergy	Takayasus
Sexual	Sexual activity has been identified as a trigger of MI
Trauma	Both penetrating and non-penetrating trauma to the heart or myocardial contusion, commotio cordis can be associated with ST elevation and myonecrosis.
Urologic	No underlying causes
Miscellaneous	Hypotension particularly if it is prolonged

Causes in Alphabetical Order

References

↑ Subramanyam S, Kreisberg RA (2012). "Pheochromocytoma: a cause of ST-segment elevation myocardial infarction, transient left ventricular dysfunction, and takotsubo cardiomyopathy". Endocr Pract. 18 (4): e77–80. doi:10.4158/EP11346.CR. PMID 22441003.
↑ Kawano H, Koide Y, Toda G, Yano K (2005). "ST-segment elevation of electrocardiogram in a patient with Shoshin beriberi". Intern. Med. 44 (6): 578–85. PMID 16020883. Unknown parameter |month= ignored (help)
↑ Hundley JM, Ashburn LL, Sebrell WH. The electrocardiogram in chronic thiamine deficiency in rats. Am J Physiol 144: 404–414, 1954.

Template:WH Template:WS

[pmid22441003-1] Subramanyam S, Kreisberg RA (2012). "Pheochromocytoma: a cause of ST-segment elevation myocardial infarction, transient left ventricular dysfunction, and takotsubo cardiomyopathy". Endocr Pract. 18 (4): e77–80. doi:10.4158/EP11346.CR. PMID 22441003.

[pmid16020883-2] Kawano H, Koide Y, Toda G, Yano K (2005). "ST-segment elevation of electrocardiogram in a patient with Shoshin beriberi". Intern. Med. 44 (6): 578–85. PMID 16020883. Unknown parameter |month= ignored (help)

[3] Hundley JM, Ashburn LL, Sebrell WH. The electrocardiogram in chronic thiamine deficiency in rats. Am J Physiol 144: 404–414, 1954.

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@@ Line 34: / Line 34: @@
 |-bgcolor="LightSteelBlue"
 | '''Drug Side Effect'''
-|bgcolor="Beige"| [[Oral contraceptive pills]], [[nuvaring]] ([[etonogestrel]] and [[ethinyl estradiol]] vaginal ring), particularly among women who smoke
+|bgcolor="Beige"| [[Amphetamines]], [[anabolic steroids]], [[cocaine]], [[combined oral contraceptive pill]], [[ephedrine]], [[marijuana]], [[beta blockers|sudden withdrawal of beta blockers]], [[nitrates|sudden withdrawal of nitrates]], [[testosterone]]
-[[Anabolic steroids]]
-[[Testosterone]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Ear Nose Throat'''
-|bgcolor="Beige"| A recent [[upper respiratory tract infection]]s has been associated with a 4.9 fold rise in the risk of [[trigger of MI|MI]]
+|bgcolor="Beige"| [[Thyrotoxicosis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Endocrine'''
-|bgcolor="Beige"| [[Thyrotoxicosis]],
+|bgcolor="Beige"| [[Amyloidosis]], [[diabetes mellitus]], [[pheochromocytoma]], [[thyrotoxicosis]]
-[[Adrenal myocarditis]], where elevated levels of [[catecholamine]]s due to [[pheochromocytoma]] cause [[myocarditis]] and STEMI.<ref name="pmid21223554">{{cite journal| author=Roghi A, Pedrotti P, Milazzo A, Bonacina E, Bucciarelli-Ducci C| title=Adrenergic myocarditis in pheochromocytoma. | journal=J Cardiovasc Magn Reson | year= 2011 | volume= 13 | issue=  | pages= 4 | pmid=21223554 | doi=10.1186/1532-429X-13-4 | pmc=PMC3025878 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21223554  }} </ref><ref name="pmid21393076">{{cite journal| author=Navarro I, Molina M, Civera M, Ascaso JF, Real JT, Carmena R| title=[Catecholamine-induced cardiomyopathy triggered by pheochromocytoma]. | journal=Endocrinol Nutr | year= 2011 | volume= 58 | issue= 4 | pages= 204-6 | pmid=21393076 | doi=10.1016/j.endonu.2010.11.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21393076  }} </ref>
 |-
 |-bgcolor="LightSteelBlue"
 | '''Environmental'''
-|bgcolor="Beige"| Blizzards and snow shoveling, and inhalation of fine particulate matter in areas with air pollution and high traffic have been identified as [[triggers of MI]].
+|bgcolor="Beige"| [[Triggers of MI]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Gastroenterologic'''
-|bgcolor="Beige"| A heavy meal has been associated with a 4 fold rise in the risk of [[trigger of MI|MI]], and it is not clear if this is mediated by hyperadrenergic tone<ref name="pmid15609883">{{cite journal |author=Lipovetzky N, Hod H, Roth A, Kishon Y, Sclarovsky S, Green MS |title=Heavy meals as a trigger for a first event of the acute coronary syndrome: a case-crossover study |journal=Isr. Med. Assoc. J. |volume=6 |issue=12 |pages=728–31 |year=2004 |month=December |pmid=15609883 |doi= |url=}}</ref>;
+|bgcolor="Beige"| [[Hurler disease]], [[pseudoxanthoma elasticum]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Genetic'''
-|bgcolor="Beige"| [[Familial hypercholesterolemia]]
+|bgcolor="Beige"| [[Fabry's disease]], [[familial hypercholesterolemia]], [[homocystinuria]], [[Hurler disease]], [[mucopolysaccharidoses]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Hematologic'''
-|bgcolor="Beige"| [[Disseminated intravascular coagulation]] ([[DIC]])
+|bgcolor="Beige"| [[Disseminated intravascular coagulation]], [[hypercoagulable states]], [[polycythemia vera]], [[thrombocytosis]]
-[[Hypercoagulable states]]
-[[Polycythemia vera]]
-[[Thrombocytosis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Iatrogenic'''
-|bgcolor="Beige"| [[Epinephrine]] overdose
+|bgcolor="Beige"| [[Coronary  stent thrombosis]], [[beta blockers|sudden withdrawal of beta blockers]], [[nitrates|sudden withdrawal of nitrates]], [[transluminal percutaneous coronary angioplasty]]
-Sudden withdrawal of [[Beta blockers]] or [[nitrates]]
-[[Stent thrombosis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Infectious Disease'''
-|bgcolor="Beige"| A recent [[upper respiratory tract infection]]s has been associated with a 4.9 fold rise in the risk of [[trigger of MI|MI]]
+|bgcolor="Beige"| [[Infectious endocarditis]]
-[[Infectious endocarditis]] may STEMI as a result of embolization
 |-
 |-bgcolor="LightSteelBlue"
 | '''Musculoskeletal / Ortho'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"|[[Homocystinuria]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 96: / Line 78: @@
 |-bgcolor="LightSteelBlue"
 | '''Nutritional / Metabolic'''
-|bgcolor="Beige"| A heavy meal has been associated with a 4 fold rise in the risk of [[trigger of MI|MI]] and it is not clear if this is mediated by hyperadrenergic tone<ref name="pmid15609883">{{cite journal |author=Lipovetzky N, Hod H, Roth A, Kishon Y, Sclarovsky S, Green MS |title=Heavy meals as a trigger for a first event of the acute coronary syndrome: a case-crossover study |journal=Isr. Med. Assoc. J. |volume=6 |issue=12 |pages=728–31 |year=2004 |month=December |pmid=15609883 |doi= |url=}}</ref>;
+|bgcolor="Beige"|[[Amyloidosis]], [[dyslipidemia]], [[electrolyte imbalance]], [[Fabry's disease]], [[familial hypercholesterolemia]], [[homocystinuria]], [[Hurler disease]], [[mucopolysaccharidoses]], [[thiamine deficiency]]
-[[Amyloidosis]]
-[[Fabry disease]]
-[[homocystinuria]]
-[[mucopolysaccharidoses]], [[Hurler disease]],
-[[pseudoxanthoma elasticum]]
-[[thiamine deficiency]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Obstetric/Gynecologic'''
-|bgcolor="Beige"| Spontaneous coronary [[dissection]] in the setting of [[pregnancy]]
+|bgcolor="Beige"| [[Combined oral contraceptive pill]], [[nuvaring]]
 |-
 |-bgcolor="LightSteelBlue"