ℹ️ Skipped - page is already crawled
| Filter | Status | Condition | Details |
|---|---|---|---|
| HTTP status | PASS | download_http_code = 200 | HTTP 200 |
| Age cutoff | PASS | download_stamp > now() - 6 MONTH | 0.3 months ago (distributed domain, exempt) |
| History drop | PASS | isNull(history_drop_reason) | No drop reason |
| Spam/ban | PASS | fh_dont_index != 1 AND ml_spam_score = 0 | ml_spam_score=0 |
| Canonical | PASS | meta_canonical IS NULL OR = '' OR = src_unparsed | Not set |
| Property | Value |
|---|---|
| URL | https://en.wikipedia.org/wiki/Myocardial_infarction |
| Last Crawled | 2026-04-01 18:32:57 (8 days ago) |
| First Indexed | 2013-08-08 16:21:53 (12 years ago) |
| HTTP Status Code | 200 |
| Meta Title | Myocardial infarction - Wikipedia |
| Meta Description | null |
| Meta Canonical | null |
| Boilerpipe Text | Myocardial infarction
Other names
Acute myocardial infarction (AMI), heart attack
A myocardial infarction occurs when an
atherosclerotic
plaque
slowly builds up in the inner lining of a
coronary artery
and then suddenly ruptures, causing catastrophic
thrombus
formation, totally occluding the artery and preventing blood flow downstream to the heart muscle.
Specialty
Cardiology
,
emergency medicine
Symptoms
Chest pain
,
shortness of breath
,
nausea
/
vomiting
,
dizziness
or
lightheadedness
,
cold sweat
,
feeling tired
; arm, neck, back, jaw, or stomach pain,
[
1
]
[
2
]
decreased level
or
total loss of consciousness
Complications
Heart failure
,
irregular heartbeat
,
cardiogenic shock
,
coma
,
cardiac arrest
[
3
]
[
4
]
Causes
Angina
or
coronary artery disease
usually
[
3
]
Risk factors
High blood pressure
,
smoking
,
diabetes
,
lack of exercise
,
obesity
,
high blood cholesterol
[
5
]
[
6
]
Diagnostic method
Electrocardiograms
(ECGs), blood tests,
coronary angiography
[
7
]
Treatment
Percutaneous coronary intervention
,
thrombolysis
[
8
]
Medication
Aspirin
,
nitroglycerin
,
heparin
[
8
]
[
9
]
Prognosis
STEMI 10% risk of death (developed world)
[
8
]
Frequency
15.9 million (2015)
[
10
]
A
myocardial infarction
(
MI
), commonly known as a
heart attack
, occurs when
blood flow decreases
or stops in one of the
arteries of the heart
, causing
infarction
(tissue death) to the
heart muscle
.
[
1
]
The most common symptom is retrosternal
chest pain or discomfort
that classically radiates to the left shoulder, arm, or jaw.
[
1
]
The pain may occasionally feel like
heartburn
.
[
1
]
This is the dangerous type of
acute coronary syndrome
.
Other symptoms may include
shortness of breath
,
nausea
,
feeling faint
, a
cold sweat
,
feeling tired
, and
decreased level of consciousness
.
[
1
]
About 30% of people have atypical symptoms.
[
8
]
Women more often present without chest pain and instead have neck pain, arm pain or feel tired.
[
11
]
Among those over 75 years old, about 5% have had an MI with little or no history of symptoms.
[
12
]
An MI may cause
heart failure
, an
irregular heartbeat
,
cardiogenic shock
or
cardiac arrest
.
[
3
]
[
4
]
Most MIs occur due to
coronary artery disease
.
[
3
]
Risk factors include
high blood pressure
,
smoking
,
diabetes
,
lack of exercise
,
obesity
,
high blood cholesterol
, poor diet, and
excessive alcohol intake
.
[
5
]
[
6
]
The complete blockage of a
coronary artery
caused by a rupture of an
atherosclerotic plaque
is usually the underlying mechanism of an MI.
[
3
]
MIs are less commonly caused by
coronary artery spasms
, which may be due to
cocaine
, significant emotional stress (often known as
Takotsubo syndrome
or
broken heart syndrome
) and extreme cold, among others.
[
13
]
[
14
]
Many tests are helpful with diagnosis, including
electrocardiograms
(ECGs), blood tests and
coronary angiography
.
[
7
]
An ECG, which is a recording of the heart's electrical activity, may confirm an
ST elevation MI
(
STEMI
), if
ST elevation
is present.
[
8
]
[
15
]
Commonly used blood tests include
troponin
and less often
creatine kinase MB
.
[
7
]
Treatment of an MI is time-critical.
[
16
]
Aspirin
is an appropriate immediate treatment for a suspected MI.
[
9
]
Nitroglycerin
or
opioids
may be used to help with chest pain; however, they do not improve overall outcomes.
[
8
]
[
9
]
Supplemental oxygen
is recommended in those with
low oxygen levels
or shortness of breath.
[
9
]
In a STEMI, treatments attempt to restore blood flow to the
heart
and include
percutaneous coronary intervention
(PCI), where the arteries are pushed open and may be
stented
, or
thrombolysis
, where the blockage is removed using medications.
[
8
]
People who have a
non-ST elevation myocardial infarction
(
NSTEMI
) are often managed with the blood thinner
heparin
, with the additional use of PCI in those at high risk.
[
9
]
In people with blockages of multiple coronary arteries and diabetes,
coronary artery bypass surgery
(CABG) may be recommended rather than
angioplasty
.
[
17
]
After an MI, lifestyle modifications, along with long-term treatment with aspirin,
beta blockers
and
statins
, are typically recommended.
[
8
]
Worldwide, about 15.9 million myocardial infarctions occurred in 2015.
[
10
]
More than 3 million people had an ST elevation MI, and more than 4 million had an NSTEMI.
[
18
]
STEMIs occur about twice as often in men as women.
[
19
]
About one million people have an MI each year in the United States.
[
3
]
In the developed world, the risk of death in those who have had a STEMI is about 10%.
[
8
]
Rates of MI for a given age have decreased globally between 1990 and 2010.
[
20
]
In 2011, an MI was one of the top five most expensive conditions during inpatient hospitalizations in the US, with a cost of about $11.5 billion for 612,000 hospital stays.
[
21
]
Terminology
Myocardial infarction (MI) refers to tissue death (
infarction
) of a part of the heart muscle (
myocardium
), caused by
ischemia
, the lack of oxygen delivery to myocardial tissue. It is a type of
acute coronary syndrome
, which describes a sudden or short-term change in symptoms related to blood flow to the heart.
[
22
]
Unlike the other type of acute coronary syndrome,
unstable angina
, a myocardial
infarction
occurs when there is
cell death
, which can be estimated by measuring a
blood test
for
biomarkers
(the cardiac protein
troponin
).
[
23
]
When there is evidence of an MI, it may be classified as an ST elevation myocardial infarction (STEMI) or Non-ST elevation myocardial infarction (NSTEMI) based on the results of an
ECG
.
[
24
]
The phrase "heart attack" is often used non-specifically to refer to myocardial infarction. An MI is different from — but can cause —
cardiac arrest
, where the heart is not contracting at all or so poorly that all vital organs cease to function, thus leading to death.
[
25
]
It is also distinct from
heart failure
, in which the pumping action of the heart is impaired. However, an MI may lead to heart failure.
[
26
]
Signs and symptoms
Areas where pain is experienced in myocardial infarction, showing common (dark red) and less common (light red) areas on the chest (top) and back (bottom).
Chest pain that may or may not radiate to other parts of the body is the most typical and significant symptom of myocardial infarction. It might be accompanied by other symptoms such as sweating.
[
27
]
Pain
Chest pain
is one of the most common symptoms of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper
abdomen
.
[
28
]
[
29
]
The pain most suggestive of an acute MI, with the highest
likelihood ratio
, is pain radiating to the right arm and shoulder.
[
30
]
[
29
]
Similarly, chest pain similar to a previous heart attack is also suggestive.
[
31
]
The pain associated with MI is usually diffuse, does not change with position, and lasts for more than 20 minutes.
[
24
]
It might be described as pressure, tightness, knifelike, tearing, burning sensation (all these are also manifested during other diseases). It could be felt as an unexplained anxiety, and pain might be absent altogether.
[
29
]
Levine's sign
, in which a person localizes the chest pain by clenching one or both fists over their
sternum
, has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed it had a poor
positive predictive value
.
[
32
]
Typically, chest pain because of ischemia, be it unstable angina or myocardial infarction, lessens with the use of
nitroglycerin
, but nitroglycerin may also relieve chest pain arising from non-cardiac causes.
[
33
]
Other
Chest pain may be accompanied by
sweating
, nausea or vomiting, and
fainting
,
[
24
]
[
30
]
and these symptoms may also occur without any pain at all.
[
28
]
Dizziness or lightheadedness is common and occurs due to reduction in oxygen and blood to the brain. In females, the most common symptoms of myocardial infarction include shortness of breath, weakness, and
fatigue
.
[
34
]
Females are more likely to have unusual or unexplained tiredness and nausea or vomiting as symptoms.
[
35
]
Females having heart attacks are more likely to have palpitations, back pain, labored breath, vomiting, and left arm pain than males, although the studies showing these differences had high variability.
[
36
]
Females are less likely to report chest pain during a heart attack and more likely to report nausea, jaw pain, neck pain, cough, and fatigue, although these findings are inconsistent across studies.
[
37
]
Females with heart attacks also had more indigestion,
dizziness
,
loss of appetite
, and loss of consciousness.
[
38
]
Shortness of breath
is a common, and sometimes the only symptom, occurring when damage to the heart limits the
output
of the
left ventricle
, with breathlessness arising either from
low oxygen in the blood
or
pulmonary edema
.
[
28
]
[
39
]
Other less common symptoms include weakness,
light-headedness
,
palpitations
, and abnormalities in
heart rate
or
blood pressure
.
[
16
]
These symptoms are likely induced by a massive surge of
catecholamines
from the
sympathetic nervous system
, which occurs in response to pain and, where present, low
blood pressure
.
[
40
]
Loss of consciousness
can occur in myocardial infarctions due to inadequate blood flow to the
brain
and
cardiogenic shock
, and
sudden death
, frequently due to the development of
ventricular fibrillation
.
[
41
]
When the brain was without oxygen for too long due to a myocardial infarction,
coma
and
persistent vegetative state
can occur. Cardiac arrest, and atypical symptoms such as
palpitations
, occur more frequently in females, the elderly, those with diabetes, in people who have just had surgery, and in critically ill patients.
[
24
]
Absence
"Silent" myocardial infarctions can happen without any symptoms at all.
[
12
]
These cases can be discovered later on
electrocardiograms
, using blood enzyme tests, or at
autopsy
after a person has died. Such silent myocardial infarctions represent between 22 and 64% of all infarctions,
[
12
]
and are more common in the
elderly
,
[
12
]
in those with
diabetes mellitus
[
16
]
and after
heart transplantation
. In people with diabetes, differences in
pain threshold
,
autonomic neuropathy
, and
psychological
factors have been cited as possible explanations for the lack of symptoms.
[
42
]
In heart transplantation, the
donor
heart is not fully innervated by the nervous system of the recipient.
[
43
]
Risk factors
The most prominent risk factors for myocardial infarction are older age, actively
smoking
,
high blood pressure
,
diabetes mellitus
, and total
cholesterol
and
high-density lipoprotein
levels.
[
44
]
Many risk factors of myocardial infarction are shared with
coronary artery disease
, the primary cause of myocardial infarction,
[
16
]
with other risk factors including male sex, low levels of physical activity, a past
family history
,
obesity
, and
alcohol use
.
[
16
]
Risk factors for myocardial disease are often included in risk factor stratification scores, such as the
Framingham Risk Score
.
[
19
]
At any given age, men are more at risk than women for the development of cardiovascular disease.
[
45
]
High levels of blood cholesterol
is a known risk factor, particularly high
low-density lipoprotein
, low
high-density lipoprotein
, and high
triglycerides
.
[
46
]
Many risk factors for myocardial infarction are potentially modifiable, with the most important being
tobacco smoking
(including
secondhand smoke
).
[
16
]
Smoking appears to be the cause of about 36% and obesity the cause of 20% of
coronary artery disease
.
[
47
]
Lack of physical activity has been linked to 7–12% of cases.
[
47
]
[
48
]
Less common causes include stress-related causes such as
job stress
, which accounts for about 3% of cases,
[
47
]
and chronic high stress levels.
[
49
]
Diet
There is varying evidence about the importance of
saturated fat
in the development of myocardial infarctions. Eating polyunsaturated fat instead of
saturated fats
has been shown in studies to be associated with a decreased risk of myocardial infarction,
[
50
]
while other studies find little evidence that reducing dietary saturated fat or increasing
polyunsaturated fat
intake affects heart attack risk.
[
51
]
[
52
]
Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed.
[
53
]
Trans fats
do appear to increase risk.
[
51
]
Acute and prolonged intake of high quantities of alcoholic drinks (3–4 or more daily) increases the risk of a heart attack.
[
54
]
Genetics
Family history of
ischemic heart disease
or MI, particularly if one has a male first-degree relative (father, brother) who had a myocardial infarction before age 55 years, or a female first-degree relative (mother, sister) less than age 65 increases a person's risk of MI.
[
45
]
Genome-wide association studies
have found 27 genetic variants that are associated with an increased risk of myocardial infarction.
[
55
]
The strongest association of MI has been found with
chromosome 9
on the short arm
p
at
locus
21, which contains genes CDKN2A and 2B, although the
single nucleotide polymorphisms
that are implicated are within a non-coding region.
[
55
]
The majority of these variants are in regions that have not been previously implicated in coronary artery disease. The following genes have an association with MI:
PCSK9
,
SORT1
,
MIA3
,
WDR12
,
MRAS
,
PHACTR1
,
LPA
,
TCF21
,
MTHFDSL
,
ZC3HC1
,
CDKN2A
,
2B
,
ABO
,
PDGF0
,
APOA5
,
MNF1ASM283
,
COL4A1
,
HHIPC1
,
SMAD3
,
ADAMTS7
,
RAS1
,
SMG6
,
SNF8
,
LDLR
,
SLC5A3
,
MRPS6
,
KCNE2
.
[
55
]
Other
The risk of having a myocardial infarction increases with older age, low physical activity, and low
socioeconomic status
.
[
45
]
Heart attacks appear to occur more commonly in the morning hours, especially between 6AM and noon.
[
56
]
Evidence suggests that heart attacks are at least three times more likely to occur in the morning than in the late evening.
[
57
]
Shift work
is also associated with a higher risk of MI.
[
58
]
One analysis has found an increase in heart attacks immediately following the start of
daylight saving time
.
[
59
]
Women who use
combined oral contraceptive pills
have a modestly increased risk of myocardial infarction, especially in the presence of other risk factors.
[
60
]
The use of
non-steroidal anti inflammatory drugs
(NSAIDs), even for as short as a week, increases risk.
[
61
]
Endometriosis
in women under the age of 40 is an identified risk factor.
[
62
]
Air pollution
is also an important modifiable risk. Short-term exposure to air pollution such as
carbon monoxide
,
nitrogen dioxide
, and
sulfur dioxide
(but not
ozone
) has been associated with MI and other acute cardiovascular events.
[
63
]
For sudden cardiac deaths, every increment of 30 units in Pollutant Standards Index correlated with an 8% increased risk of out-of-hospital cardiac arrest on the day of exposure.
[
64
]
Extremes of temperature are also associated.
[
65
]
A number of acute and chronic
infections
including
Chlamydophila pneumoniae
,
influenza
,
Helicobacter pylori
, and
Porphyromonas gingivalis
among others have been linked to atherosclerosis and myocardial infarction.
[
66
]
Myocardial infarction can also occur as a late consequence of
Kawasaki disease
.
[
67
]
Calcium deposits in the coronary arteries can be detected with
CT scans
. Calcium seen in coronary arteries can provide predictive information beyond that of classical risk factors.
[
68
]
High blood levels of the amino acid homocysteine
is associated with premature atherosclerosis;
[
69
]
whether elevated homocysteine in the normal range is causal is controversial.
[
70
]
In people without evident
coronary artery disease
, possible causes for the myocardial infarction are
coronary spasm
or
coronary artery dissection
.
[
71
]
Mechanism
Atherosclerosis
The animation shows plaque buildup or a
coronary artery spasm
can lead to a heart attack and how blocked blood flow in a coronary artery can lead to a heart attack.
The most common cause of a myocardial infarction is the rupture of an atherosclerotic plaque on an
artery
supplying heart muscle.
[
41
]
[
72
]
Plaques can become unstable, rupture, and additionally promote the formation of a
blood clot
that blocks the artery; this can occur in minutes. Blockage of an artery can lead to tissue death in tissue being supplied by that artery.
[
73
]
Atherosclerotic plaques are often present for decades before they result in symptoms.
[
73
]
The gradual buildup of
cholesterol
and fibrous tissue in plaques in the wall of the
coronary arteries
or other arteries, typically over decades, is termed
atherosclerosis
.
[
74
]
Atherosclerosis is characterized by progressive inflammation of the walls of the arteries.
[
73
]
Inflammatory cells, particularly
macrophages
, move into affected arterial walls. Over time, they become laden with cholesterol products, particularly
LDL
, and become
foam cells
. A
cholesterol core
forms as foam cells die. In response to
growth factors
secreted by macrophages,
smooth muscle
and other cells move into the plaque and act to stabilize it. A stable plaque may have a thick fibrous cap with
calcification
. If there is ongoing inflammation, the cap may be thin or ulcerate. Exposed to the pressure associated with blood flow, plaques, especially those with a thin lining, may rupture and trigger the formation of a blood clot (thrombus).
[
73
]
The cholesterol crystals have been associated with plaque rupture through mechanical injury and inflammation.
[
75
]
Other causes
Atherosclerotic disease is not the only cause of myocardial infarction, but it may exacerbate or contribute to other causes. A myocardial infarction may result from a heart with a limited blood supply subject to increased oxygen demands, such as in fever,
a fast heart rate
,
hyperthyroidism
,
too few red blood cells in the bloodstream
, or
low blood pressure
. Damage or failure of procedures such as
percutaneous coronary intervention
(PCI) or
coronary artery bypass grafts
(CABG) may cause a myocardial infarction. Spasm of coronary arteries, such as
Prinzmetal's angina
may cause blockage.
[
24
]
[
28
]
Tissue death
Cross section showing anterior left ventricle wall infarction
If impaired blood flow to the heart lasts long enough, it triggers a process called the
ischemic cascade
; the heart cells in the territory of the blocked coronary artery die (
infarction
), chiefly through
necrosis
, and do not grow back. A
collagen
scar
forms in their place.
[
73
]
When an artery is blocked, cells lack
oxygen
, needed to produce
ATP
in
mitochondria
. ATP is required for the maintenance of electrolyte balance, particularly through the
Na/K ATPase
. This leads to an ischemic cascade of intracellular changes, necrosis and
apoptosis
of affected cells.
[
76
]
Cells in the area with the worst blood supply, just below the inner surface of the heart (
endocardium
), are most susceptible to damage.
[
77
]
[
78
]
Ischemia first affects this region, the
subendocardial
region, and tissue begins to die within 15–30 minutes of loss of blood supply.
[
79
]
The dead tissue is surrounded by a zone of potentially reversible ischemia that progresses to become a full-thickness
transmural
infarct.
[
76
]
[
79
]
The initial "wave" of infarction can take place over 3–4 hours.
[
73
]
[
76
]
These changes are seen on
gross pathology
and cannot be predicted by the presence or absence of Q waves on an ECG.
[
78
]
The position, size and extent of an infarct depends on the affected artery, totality of the blockage, duration of the blockage, the presence of
collateral blood vessels
, oxygen demand, and success of interventional procedures.
[
28
]
[
72
]
Tissue death and
myocardial scarring
alter the normal conduction pathways of the heart and weaken affected areas. The size and location put a person at risk of
abnormal heart rhythms (arrhythmias)
or
heart block
,
aneurysm of the heart ventricles
,
inflammation of the heart wall
following infarction, and rupture of the heart wall that can have catastrophic consequences.
[
72
]
[
80
]
Injury to the myocardium also occurs during re-perfusion. This might manifest as ventricular arrhythmia. The re-perfusion injury is a consequence of the calcium and sodium uptake from the cardiac cells and the release of oxygen radicals during reperfusion. No-reflow phenomenon—when blood is still unable to be distributed to the affected myocardium despite clearing the occlusion—also contributes to myocardial injury. Topical endothelial swelling is one of many factors contributing to this phenomenon.
[
81
]
Diagnosis
Criteria
Topographic distribution of MI
A myocardial infarction, according to established consensus, is defined by elevated cardiac
biomarkers
with a rising or falling trend and at least one of the following:
[
82
]
Symptoms relating to ischemia
Changes on an
electrocardiogram
(ECG), such as
ST segment
changes, new
left bundle branch block
, or pathologic
Q waves
Changes in the motion of the heart wall on imaging
Demonstration of a thrombus on
angiogram
or at
autopsy
.
Types
"STEMI" redirects here. For the Christian evangelist organization, see
Stephen Tong § Ministry
.
A myocardial infarction is usually clinically classified as an ST-elevation MI (STEMI) or a non-ST elevation MI (NSTEMI). These are based on
ST elevation
, a portion of a heartbeat graphically recorded on an
ECG
.
[
24
]
STEMIs make up about 25–40% of myocardial infarctions.
[
19
]
A more explicit classification system, based on international consensus in 2012, also exists. This classifies myocardial infarctions into five types:
[
24
]
Spontaneous MI related to plaque erosion and/or rupture fissuring, or dissection
MI related to ischemia, such as from increased oxygen demand or decreased supply, e.g., coronary artery spasm, coronary embolism, anemia, arrhythmias, high blood pressure, or low blood pressure
Sudden unexpected cardiac death, including cardiac arrest, where symptoms may suggest MI, an ECG may be taken with suggestive changes, or a blood clot is found in a coronary artery by angiography and/or at autopsy, but where blood samples could not be obtained, or at a time before the appearance of cardiac biomarkers in the blood
Associated with
coronary angioplasty
or
stents
Associated with
percutaneous coronary intervention
(PCI)
Associated with stent thrombosis as documented by angiography or at autopsy
Associated with
CABG
Associated with
spontaneous coronary artery dissection
in young, fit women
Cardiac biomarkers
There are many different
biomarkers
used to determine the presence of cardiac muscle damage.
Troponins
, measured through a blood test, are considered to be the best,
[
19
]
and are preferred because they have greater
sensitivity and specificity
for measuring injury to the heart muscle than other tests.
[
72
]
A rise in troponin occurs within 2–3 hours of injury to the heart muscle, and peaks within 1–2 days. The level of the troponin, as well as a change over time, are useful in measuring and diagnosing or excluding myocardial infarctions, and the diagnostic accuracy of troponin testing is improving over time.
[
72
]
One high-sensitivity cardiac troponin can rule out a heart attack as long as the ECG is normal.
[
83
]
[
84
]
Other tests, such as
CK-MB
or
myoglobin
, are discouraged.
[
85
]
CK-MB is not as specific as troponins for acute myocardial injury, and may be elevated with past cardiac surgery, inflammation or electrical cardioversion; it rises within 4–8 hours and returns to normal within 2–3 days.
[
28
]
Copeptin
may be useful to rule out MI rapidly when used along with troponin.
[
86
]
Electrocardiogram
A 12-lead ECG showing an inferior STEMI due to reduced perfusion through the
right coronary artery
. Elevation of the
ST segment
can be seen in leads II, III and aVF.
An
electrocardiogram
(ECGs) is a series of electrodes placed on a person's chest that measure electrical activity associated with contraction of the heart muscle.
[
87
]
The taking of an ECG is an important part of the workup of an AMI,
[
24
]
and ECGs are often not just taken once but may be repeated over minutes to hours, or in response to changes in signs or symptoms.
[
24
]
ECG readouts produce a waveform with different labeled features.
[
87
]
In addition to a rise in biomarkers, a rise in the
ST segment
, changes in the shape or flipping of
T waves
, new
Q waves
, or a new
left bundle branch block
can be used to diagnose an AMI.
[
24
]
In addition,
ST elevation
can be used to diagnose an ST segment myocardial infarction (STEMI). A rise must be new in V2 and V3 ≥2 mm (0,2 mV) for males or ≥1.5 mm (0.15 mV) for females or ≥1 mm (0.1 mV) in two other
adjacent chest or limb leads
.
[
19
]
[
24
]
ST elevation is associated with infarction, and may be preceded by changes indicating ischemia, such as ST depression or inversion of the T waves.
[
87
]
Abnormalities can help differentiate the location of an infarct, based on the leads that are affected by changes.
[
16
]
Early STEMIs may be preceded by peaked T waves.
[
19
]
Other ECG abnormalities relating to complications of acute myocardial infarctions may also be evident, such as
atrial
or
ventricular fibrillation
.
[
88
]
Imaging
ECG: AMI with ST elevation in V2-4
Noninvasive imaging plays an important role in the diagnosis and characterisation of myocardial infarction.
[
24
]
Tests such as
chest X-rays
can be used to explore and exclude alternate causes of a person's symptoms.
[
24
]
Echocardiography
may assist in modifying clinical suspicion of ongoing myocardial infarction in patients that can't be ruled out or ruled in following initial
ECG
and
Troponin
testing.
[
89
]
Myocardial perfusion imaging
has no role in the acute diagnostic algorithm; however, it can confirm a clinical suspicion of Chronic Coronary Syndrome when the patient's history,
physical examination
(including
cardiac examination
) ECG, and cardiac biomarkers suggest coronary artery disease.
[
90
]
Echocardiography
, an
ultrasound
scan of the heart, is able to visualize the heart, its size, shape, and any abnormal motion of the heart walls as they beat that may indicate a myocardial infarction. The flow of blood can be imaged, and
contrast dyes
may be given to improve image.
[
24
]
Other scans using
radioactive
contrast include
SPECT
CT-scans
using
thallium
,
sestamibi
(
MIBI scans
) or
tetrofosmin
; or a
PET scan
using
Fludeoxyglucose
or
rubidium-82
.
[
24
]
These
nuclear medicine
scans can visualize the perfusion of heart muscle.
[
24
]
SPECT may also be used to determine viability of tissue, and whether areas of ischemia are inducible.
[
24
]
[
91
]
Medical societies and professional guidelines recommend that the physician confirm a person is at high risk for Chronic Coronary Syndrome before conducting diagnostic non-invasive imaging tests to make a diagnosis,
[
90
]
[
92
]
[
89
]
as such tests are unlikely to change management and result in increased costs.
[
90
]
Patients who have a normal ECG and who are able to exercise, for example, most likely do not merit routine imaging.
[
90
]
Poor movement of the heart due to an MI as seen on ultrasound
[
93
]
Pulmonary edema due to an MI as seen on ultrasound
[
93
]
Differential diagnosis
There are many causes of
chest pain
, which can originate from the heart,
lungs
,
gastrointestinal tract
,
aorta
, and other muscles, bones and nerves surrounding the chest.
[
94
]
In addition to myocardial infarction, other causes include
angina
, insufficient blood supply (
ischemia
) to the heart muscles without evidence of cell death,
gastroesophageal reflux disease
;
pulmonary embolism
, tumors of the lungs,
pneumonia
,
rib fracture
,
costochondritis
,
heart failure
and other musculoskeletal injuries.
[
94
]
[
24
]
Rarer severe differential diagnoses include
aortic dissection
,
esophageal rupture
,
tension pneumothorax
, and
pericardial effusion
causing
cardiac tamponade
.
[
95
]
The chest pain in an MI may mimic
heartburn
.
[
41
]
Causes of sudden-onset
breathlessness
generally involve the lungs or heart – including
pulmonary edema
, pneumonia,
allergic
reactions and
asthma
, and pulmonary embolus,
acute respiratory distress syndrome
and
metabolic acidosis
.
[
94
]
There are many different causes of fatigue, and myocardial infarction is not a common cause.
[
96
]
Prevention
There is a large crossover between the lifestyle and activity recommendations to prevent a myocardial infarction, and those that may be adopted as
secondary prevention
after an initial myocardial infarction,
[
72
]
because of shared risk factors and an aim to reduce atherosclerosis affecting heart vessels.
[
28
]
The
influenza vaccine
also appears to protect against myocardial infarction with a benefit of 15 to 45%.
[
97
]
Primary prevention
Lifestyle
Physical activity can reduce the risk of cardiovascular disease, and people at risk are advised to engage in 150 minutes of moderate or 75 minutes of vigorous intensity
aerobic exercise
a week.
[
98
]
Keeping a healthy weight, drinking alcohol within the recommended limits, and
quitting smoking
reduce the risk of cardiovascular disease.
[
98
]
Substituting
unsaturated fats
such as
olive oil
and
rapeseed oil
instead of saturated fats may reduce the risk of myocardial infarction,
[
50
]
although there is not universal agreement.
[
51
]
Dietary modifications are recommended by some national authorities, with recommendations including increasing the intake of wholegrain starch, reducing sugar intake (particularly of refined sugar), consuming five portions of fruit and vegetables daily, consuming two or more portions of fish per week, and consuming 4–5 portions of unsalted
nuts
,
seeds
, or
legumes
per week.
[
98
]
The dietary pattern with the greatest support is the
Mediterranean diet
.
[
99
]
Vitamins
and mineral supplements are of no proven benefit,
[
100
]
and neither are plant
stanols
or
sterols
.
[
98
]
Public health
measures may also act at a population level to reduce the risk of myocardial infarction, for example by reducing unhealthy diets (excessive salt, saturated fat, and trans-fat) including food labeling and marketing requirements as well as requirements for catering and restaurants and stimulating physical activity. This may be part of regional cardiovascular disease prevention programs or through the
health impact assessment
of regional and local plans and policies.
[
101
]
Most guidelines recommend combining different preventive strategies. A 2015 Cochrane Review found some evidence that such an approach might help with
blood pressure
,
body mass index
and
waist circumference
. However, there was insufficient evidence to show an effect on mortality or actual cardio-vascular events.
[
102
]
Medication
Statins
, drugs that act to lower blood cholesterol, decrease the incidence and mortality rates of myocardial infarctions.
[
103
]
They are often recommended in those at an elevated risk of cardiovascular diseases.
[
98
]
Aspirin
has been studied extensively in people considered at increased risk of myocardial infarction. Based on numerous studies in different groups (e.g. people with or without diabetes), there does not appear to be a benefit strong enough to outweigh the risk of excessive bleeding.
[
104
]
[
105
]
Nevertheless, many
clinical practice guidelines
continue to recommend aspirin for primary prevention,
[
106
]
and some researchers feel that those with very high cardiovascular risk but low risk of bleeding should continue to receive aspirin.
[
107
]
Secondary prevention
There is a large crossover between the lifestyle and activity recommendations to prevent a myocardial infarction, and those that may be adopted as
secondary prevention
after an initial myocardial infarct.
[
72
]
Recommendations include
stopping smoking
, a gradual return to exercise, eating a healthy
diet
, low in
saturated fat
and low in
cholesterol
,
drinking alcohol within recommended limits
, exercising, and trying to achieve a healthy weight.
[
72
]
[
108
]
Exercise is both safe and effective even if people have had stents or heart failure,
[
109
]
and is recommended to start gradually after 1–2 weeks.
[
72
]
Counselling should be provided relating to medications used, and for warning signs of depression.
[
72
]
Previous studies suggested a benefit from
omega-3 fatty acid
supplementation but this has not been confirmed.
[
108
]
Medications
Following a heart attack, nitrates, when taken for two days, and
ACE-inhibitors
decrease the risk of death.
[
110
]
Other medications include:
Aspirin
is continued indefinitely, as well as another antiplatelet agent such as clopidogrel or ticagrelor ("dual antiplatelet therapy" or DAPT) for up to twelve months.
[
108
]
If someone has another medical condition that requires anticoagulation (e.g. with
warfarin
) this may need to be adjusted based on risk of further cardiac events as well as bleeding risk.
[
108
]
In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death.
[
111
]
Beta blocker
therapy such as
metoprolol
or
carvedilol
is recommended to be started within 24 hours, provided there is no acute heart failure or
heart block
.
[
19
]
[
85
]
The dose should be increased to the highest tolerated.
[
108
]
Contrary to most guidelines, the use of beta blockers does not appear to affect the risk of death,
[
112
]
[
113
]
possibly because other treatments for MI have improved. When beta blocker medication is given within the first 24–72 hours of a STEMI no lives are saved. However, 1 in 200 people were prevented from a repeat heart attack, and another 1 in 200 from having an abnormal heart rhythm. Additionally, for 1 in 91 the medication causes a
temporary decrease in the heart's ability to pump blood
.
[
114
]
ACE inhibitor
therapy should be started within 24 hours and continued indefinitely at the highest tolerated dose. This is provided there is no evidence of worsening
kidney failure
,
high potassium
, low blood pressure, or known narrowing of the
renal arteries
.
[
72
]
Those who cannot tolerate ACE inhibitors may be treated with an
angiotensin II receptor antagonist
.
[
108
]
Statin
therapy has been shown to reduce mortality and subsequent cardiac events and should be commenced to lower LDL cholesterol. Other medications, such as
ezetimibe
, may also be added with this goal in mind.
[
72
]
Aldosterone antagonists
(
spironolactone
or
eplerenone
) may be used if there is evidence of left ventricular dysfunction after an MI, ideally after beginning treatment with an ACE inhibitor.
[
108
]
[
115
]
Other
A
defibrillator
, an electric device connected to the heart and surgically inserted under the skin, may be recommended. This is particularly if there are any ongoing signs of heart failure, with a low
left ventricular ejection fraction
and a New York Heart Association grade II or III after 40 days of the infarction.
[
72
]
Defibrillators detect potentially fatal arrhythmia and deliver an electrical shock to the person to depolarize a critical mass of the heart muscle.
[
116
]
Management
A myocardial infarction requires immediate medical attention. Treatment aims to preserve as much heart muscle as possible, and to prevent further complications.
[
28
]
Treatment depends on whether the myocardial infarction is a STEMI or NSTEMI.
[
72
]
Treatment in general aims to unblock blood vessels, reduce blood clot enlargement, reduce ischemia, and modify risk factors with the aim of preventing future MIs.
[
28
]
In addition, the main treatment for myocardial infarctions with ECG evidence of ST elevation (STEMI) include
thrombolysis
or
percutaneous coronary intervention
, although PCI is also ideally conducted within 1–3 days for NSTEMI.
[
72
]
In addition to
clinical judgement
, risk stratification may be used to guide treatment, such as with the
TIMI
and
GRACE
scoring systems.
[
16
]
[
72
]
[
117
]
Pain
The pain associated with myocardial infarction is often treated with
nitroglycerin
, a
vasodilator
, or
opioid
medications such as
morphine
.
[
28
]
Nitroglycerin (given
under the tongue
or
injected into a vein
) may improve blood supply to the heart.
[
28
]
It is an important part of therapy for its pain relief effects, though there is no proven benefit to
mortality
.
[
28
]
[
118
]
Morphine or other opioid medications may also be used, and are effective for the pain associated with STEMI.
[
28
]
There is poor evidence that morphine shows any benefit to
overall outcomes
, and there is some evidence of potential harm.
[
119
]
[
120
]
Antithrombotics
Aspirin
, an
antiplatelet drug
, is given as a
loading dose
to reduce the clot size and reduce further clotting in the affected artery.
[
28
]
[
72
]
It is known to decrease mortality associated with acute myocardial infarction by at least 50%.
[
72
]
P2Y12 inhibitors
such as
clopidogrel
,
prasugrel
and
ticagrelor
are given concurrently, also as a loading dose, with the dose depending on whether further surgical management or fibrinolysis is planned.
[
72
]
Prasugrel and ticagrelor are recommended in European and American guidelines, as they are active more quickly and consistently than clopidogrel.
[
72
]
P2Y12 inhibitors are recommended in both NSTEMI and STEMI, including in PCI, with evidence also to suggest improved mortality.
[
72
]
Heparins
, particularly in the unfractionated form, act at several points in the
clotting cascade
, help to prevent the enlargement of a clot, and are also given in myocardial infarction, owing to evidence suggesting improved mortality rates.
[
72
]
In very high-risk scenarios,
inhibitors of the platelet glycoprotein α
IIb
β
3a
receptor
such as
eptifibatide
or
tirofiban
may be used.
[
72
]
There is varying evidence on the mortality benefits in NSTEMI. A 2014 review of P2Y12 inhibitors such as
clopidogrel
found they do not change the risk of death when given to people with a suspected NSTEMI prior to PCI,
[
121
]
nor do heparins change the risk of death.
[
122
]
They do decrease the risk of having a further myocardial infarction.
[
72
]
[
122
]
Angiogram
Inserting a stent to widen the artery
Primary
percutaneous coronary intervention
(PCI) is the treatment of choice for STEMI if it can be performed in a timely manner, ideally within 90–120 minutes of contact with a medical provider.
[
72
]
[
123
]
Some recommend it is also done in NSTEMI within 1–3 days, particularly when considered high-risk.
[
72
]
A 2017 review, however, did not find a difference between early versus later PCI in NSTEMI.
[
124
]
PCI involves small probes, inserted through peripheral blood vessels such as the
femoral artery
or
radial artery
into the blood vessels of the heart. The probes are then used to identify and clear blockages
using small balloons
, which are dragged through the blocked segment,
dragging away the clot
, or
the insertion of stents
.
[
28
]
[
72
]
Coronary artery bypass grafting
is only considered when the affected area of heart muscle is large, and PCI is unsuitable, for example with difficult cardiac anatomy.
[
125
]
After PCI, people are generally placed on
aspirin
indefinitely and on dual antiplatelet therapy (generally aspirin and
clopidogrel
) for at least a year.
[
19
]
[
72
]
[
126
]
Fibrinolysis
If PCI cannot be performed within 90 to 120 minutes in STEMI then fibrinolysis, preferably within 30 minutes of arrival to hospital, is recommended.
[
72
]
[
127
]
If a person has had symptoms for 12 to 24 hours evidence for effectiveness of thrombolysis is less and if they have had symptoms for more than 24 hours it is not recommended.
[
128
]
Thrombolysis involves the administration of medication that activates the
enzymes that normally dissolve blood clots
. These medications include
tissue plasminogen activator
,
reteplase
,
streptokinase
, and
tenecteplase
.
[
28
]
Thrombolysis is not recommended in a number of situations, particularly when associated with a high risk of bleeding or the potential for problematic bleeding, such as active bleeding, past
strokes
or bleeds into the brain, or severe
hypertension
. Situations in which thrombolysis may be considered, but with caution, include recent surgery, use of anticoagulants, pregnancy, and proclivity to bleeding.
[
28
]
Major risks of thrombolysis are major bleeding and
intracranial bleeding
.
[
28
]
Pre-hospital thrombolysis reduces time to thrombolytic treatment, based on studies conducted in higher income countries; however, it is unclear whether this has an impact on mortality rates.
[
129
]
Other
In the past, high flow oxygen was recommended for everyone with a possible myocardial infarction.
[
85
]
More recently, no evidence was found for routine use in those with normal oxygen levels and there is potential harm from the intervention.
[
130
]
[
131
]
[
132
]
[
133
]
[
134
]
Therefore, oxygen is currently only recommended if oxygen levels are found to be low or if someone is in respiratory distress.
[
28
]
[
85
]
If despite thrombolysis there is significant
cardiogenic shock
, continued severe chest pain, or less than a 50% improvement in
ST elevation
on the ECG recording after 90 minutes, then rescue PCI is indicated emergently.
[
135
]
[
136
]
Those who have had
cardiac arrest
may benefit from
targeted temperature management
with evaluation for implementation of hypothermia protocols. Furthermore, those with cardiac arrest, and ST elevation at any time, should usually have angiography.
[
19
]
Aldosterone antagonists
appear to be useful in people who have had an STEMI and do not have heart failure.
[
137
]
Rehabilitation and exercise
Cardiac rehabilitation
benefits many who have experienced myocardial infarction,
[
72
]
even if there has been substantial heart damage and resultant
left ventricular failure
. It should start soon after discharge from the hospital. The program may include lifestyle advice, exercise, social support, as well as recommendations about driving, flying, sports participation, stress management, and sexual intercourse.
[
108
]
Returning to sexual activity after myocardial infarction is a major concern for most patients, and is an important area to be discussed in the provision of holistic care.
[
138
]
[
139
]
In the short-term, exercise-based cardiovascular rehabilitation programs may reduce the risk of a myocardial infarction, reduces a large number of hospitalizations from all causes, reduces hospital costs, improves
health-related quality of life
, and has a small effect on
all-cause mortality
.
[
140
]
Longer-term studies indicate that exercise-based cardiovascular rehabilitation programs may reduce cardiovascular mortality and myocardial infarction.
Prognosis
The prognosis after myocardial infarction varies greatly depending on the extent and location of the affected heart muscle, and the development and management of complications.
[
16
]
Prognosis is worse with older age and social isolation.
[
16
]
Anterior infarcts, persistent ventricular tachycardia or fibrillation, development of
heart blocks
, and left ventricular impairment are all associated with poorer prognosis.
[
16
]
Without treatment, about a quarter of those affected by MI die within minutes and about forty percent within the first month.
[
16
]
Morbidity and mortality from myocardial infarction has, however, improved over the years due to earlier and better treatment:
[
30
]
in those who have a STEMI in the United States, between 5 and 6 percent die before leaving the hospital and 7 to 18 percent die within a year.
[
19
]
It is unusual for babies to experience a myocardial infarction, but when they do, about half die.
[
141
]
In the short-term, neonatal survivors seem to have a normal quality of life.
[
141
]
Complications
Complications may occur immediately following the myocardial infarction or may take time to develop.
Disturbances of heart rhythms
, including
atrial fibrillation
,
ventricular tachycardia
and
fibrillation
and
heart block
can arise as a result of ischemia, cardiac scarring, and infarct location.
[
16
]
[
72
]
Stroke
is also a risk, either as a result of
clots
transmitted from the heart during PCI, as a result of bleeding following anticoagulation, or as a result of disturbances in the heart's ability to pump effectively as a result of the infarction.
[
72
]
Regurgitation of blood through the mitral valve
is possible, particularly if the infarction causes dysfunction of the papillary muscle.
[
72
]
Cardiogenic shock
as a result of the heart being unable to adequately pump blood may develop, dependent on infarct size, and is most likely to occur within the days following an acute myocardial infarction. Cardiogenic shock is the largest cause of in-hospital mortality.
[
30
]
[
72
]
Rupture of the ventricular dividing wall or left ventricular wall may occur within the initial weeks.
[
72
]
Dressler's syndrome
, a reaction following larger infarcts and a cause of
pericarditis
is also possible.
[
72
]
Heart failure
may develop as a long-term consequence, with an impaired ability of heart muscle to pump, scarring, and an increase in the size of the existing muscle.
Aneurysm of the left ventricle myocardium
develops in about 10% of MI and is itself a risk factor for heart failure, ventricular arrhythmia, and the development of
clots
.
[
16
]
Risk factors for complications and death include age,
hemodynamic
parameters (such as
heart failure
,
cardiac arrest
on admission,
systolic
blood pressure
, or
Killip class
of two or greater), ST-segment deviation, diabetes, serum
creatinine
,
peripheral vascular disease
, and elevation of cardiac markers.
[
142
]
[
143
]
[
144
]
Epidemiology
Myocardial infarction is a common presentation of
coronary artery disease
. The
World Health Organization
estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease;
[
145
]
with it being the leading cause of death in high- or middle-income countries and second only to
lower respiratory infections
in
lower-income countries
.
[
145
]
Worldwide, more than 3 million people have STEMIs and 4 million have NSTEMIs a year.
[
18
]
STEMIs occur about twice as often in men as women.
[
19
]
Rates of death from ischemic heart disease (IHD) have slowed or declined in most high-income countries, although cardiovascular disease still accounted for one in three of all deaths in the US in 2008.
[
146
]
For example, rates of death from cardiovascular disease have decreased almost a third between 2001 and 2011 in the United States.
[
147
]
In contrast, IHD is becoming a more common cause of death in the developing world. For example, in
India
, IHD had become the leading cause of death by 2004, accounting for 1.46 million deaths (14% of total deaths) and deaths due to IHD were expected to double during 1985–2015.
[
148
]
Globally,
disability adjusted life years
(DALYs) lost to ischemic heart disease are predicted to account for 5.5% of total DALYs in 2030, making it the second-most-important cause of disability (after
unipolar depressive disorder
), as well as the leading cause of death by this date.
[
145
]
Social determinants such as
neighborhood
disadvantage,
immigration
status, lack of
social support
,
social isolation
, and access to
health services
play an important role in myocardial infarction risk and survival.
[
149
]
[
150
]
[
151
]
[
152
]
Studies have shown that low
socioeconomic status
is associated with an increased risk of poorer survival. There are well-documented disparities in myocardial infarction survival by socioeconomic status,
race
,
education
, and census-tract-level
poverty
.
[
153
]
Race: In the U.S.
African Americans
have a greater burden of myocardial infarction and other cardiovascular events. On a population level, there is a higher overall
prevalence
of risk factors that are unrecognized and therefore not treated, which places these individuals at a greater likelihood of experiencing adverse outcomes and therefore potentially higher
morbidity
and
mortality
.
[
154
]
Similarly, South Asians (including South Asians that have migrated to other countries around the world) experience higher rates of acute myocardial infarctions at younger ages, which can be largely explained by a higher prevalence of risk factors at younger ages.
[
155
]
Socioeconomic status: Among individuals who live in the low-socioeconomic (SES) areas, which is close to 25% of the US population, myocardial infarctions (MIs) occurred twice as often compared with people who lived in higher SES areas.
[
156
]
Immigration status: In 2018 many lawfully present
immigrants
who were eligible for coverage remained uninsured because immigrant families faced a range of enrollment barriers, including fear, confusion about eligibility policies, difficulty navigating the enrollment process, and
language
and
literacy
challenges. Uninsured
undocumented immigrants
are ineligible for coverage options due to their immigration status.
[
157
]
Health care access: Lack of
health insurance
and financial concerns about accessing care were associated with delays in seeking emergency care for acute myocardial infarction which can have significant, adverse consequences on patient outcomes.
[
158
]
Education: Researchers found that compared to people with
graduate degrees
, those with lower educational attainment appeared to have a higher
risk
of heart attack, dying from a
cardiovascular
event, and overall death.
[
159
]
Society and culture
Depictions of heart attacks in popular media often include collapsing or loss of consciousness which are not common symptoms; these depictions contribute to widespread misunderstanding about the symptoms of myocardial infarctions, which in turn contributes to people not getting care when they should.
[
160
]
Legal implications
At
common law
, in general, a myocardial infarction is a
disease
but may sometimes be an
injury
. This can create coverage issues in the administration of no-fault insurance schemes such as
workers' compensation
. In general, a heart attack is not covered;
[
161
]
however, it may be a
work-related injury
if it results, for example, from unusual emotional stress or unusual exertion.
[
162
]
In addition, in some jurisdictions, heart attacks had by persons in particular occupations such as
police officers
may be classified as line-of-duty injuries by statute or policy.
[
163
]
In some countries or states, a person having had an MI may be prevented from participating in activity that puts other people's lives at risk, for example driving a car or flying an airplane.
[
164
]
References
^
a
b
c
d
e
"What Are the Signs and Symptoms of Coronary Heart Disease?"
.
www.nhlbi.nih.gov
. September 29, 2014. Archived from
the original
on 24 February 2015
. Retrieved
23 February
2015
.
^
"Heart Attack Symptoms in Women"
.
American Heart Association
.
^
a
b
c
d
e
f
"What Is a Heart Attack?"
.
www.nhlbi.nih.gov
. December 17, 2013.
Archived
from the original on 19 February 2015
. Retrieved
24 February
2015
.
^
a
b
"Heart Attack or Sudden Cardiac Arrest: How Are They Different?"
.
www.heart.org
. Jul 30, 2014.
Archived
from the original on 24 February 2015
. Retrieved
24 February
2015
.
^
a
b
Mehta PK, Wei J, Wenger NK (February 2015).
"Ischemic heart disease in women: a focus on risk factors"
.
Trends in Cardiovascular Medicine
.
25
(2):
140–
51.
doi
:
10.1016/j.tcm.2014.10.005
.
PMC
4336825
.
PMID
25453985
.
^
a
b
Mendis S, Puska P, Norrving B (2011).
Global atlas on cardiovascular disease prevention and control
(PDF)
(1st ed.). Geneva: World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization. pp.
3–
18.
ISBN
978-92-4-156437-3
.
Archived
(PDF)
from the original on 2014-08-17.
^
a
b
c
"How Is a Heart Attack Diagnosed?"
.
www.nhlbi.nih.gov
. December 17, 2013.
Archived
from the original on 24 February 2015
. Retrieved
24 February
2015
.
^
a
b
c
d
e
f
g
h
i
Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. (October 2012).
"ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation"
.
European Heart Journal
.
33
(20):
2569–
619.
doi
:
10.1093/eurheartj/ehs215
.
PMID
22922416
.
^
a
b
c
d
e
O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, et al. (November 2010).
"Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care"
.
Circulation
.
122
(18 Suppl 3): S787–817.
doi
:
10.1161/CIRCULATIONAHA.110.971028
.
PMID
20956226
.
^
a
b
Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease Injury Incidence Prevalence Collaborators) (October 2016).
"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015"
.
Lancet
.
388
(10053):
1545–
1602.
doi
:
10.1016/S0140-6736(16)31678-6
.
PMC
5055577
.
PMID
27733282
.
^
Coventry LL, Finn J, Bremner AP (2011). "Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis".
Heart & Lung
.
40
(6):
477–
91.
doi
:
10.1016/j.hrtlng.2011.05.001
.
PMID
22000678
.
^
a
b
c
d
Valensi P, Lorgis L, Cottin Y (March 2011).
"Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: a review of the literature"
.
Archives of Cardiovascular Diseases
.
104
(3):
178–
88.
doi
:
10.1016/j.acvd.2010.11.013
.
PMID
21497307
.
^
"What Causes a Heart Attack?"
.
www.nhlbi.nih.gov
. December 17, 2013. Archived from
the original
on 18 February 2015
. Retrieved
24 February
2015
.
^
Devlin RJ, Henry JA (2008).
"Clinical review: Major consequences of illicit drug consumption"
.
Critical Care
.
12
(1): 202.
doi
:
10.1186/cc6166
.
PMC
2374627
.
PMID
18279535
.
^
"Electrocardiogram"
.
NHLBI, NIH
. 9 December 2016. Archived from
the original
on 11 April 2017
. Retrieved
10 April
2017
.
^
a
b
c
d
e
f
g
h
i
j
k
l
m
n
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010).
Davidson's principles and practice of medicine
(21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp.
588–
599.
ISBN
978-0-7020-3085-7
.
^
Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. (December 2011).
"ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)"
.
European Heart Journal
.
32
(23):
2999–
3054.
doi
:
10.1093/eurheartj/ehr236
.
PMID
21873419
.
^
a
b
White HD, Chew DP (August 2008).
"Acute myocardial infarction"
.
Lancet
.
372
(9638):
570–
84.
doi
:
10.1016/S0140-6736(08)61237-4
.
PMC
1931354
.
PMID
18707987
.
^
a
b
c
d
e
f
g
h
i
j
k
O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. (January 2013).
"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
.
127
(4): e362–425.
doi
:
10.1161/CIR.0b013e3182742cf6
.
PMID
23247304
.
^
Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Flaxman A, et al. (April 2014).
"The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study"
.
Circulation
.
129
(14):
1493–
501.
doi
:
10.1161/circulationaha.113.004046
.
PMC
4181601
.
PMID
24573351
.
^
Torio C (August 2013).
"National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011"
.
HCUP
.
Archived
from the original on 14 March 2017
. Retrieved
1 May
2017
.
^
Morrow & Braunwald 2016
, pp. 1–3;
Dwight 2016
, p. 41.
^
Morrow & Braunwald 2016
, pp. 1–3.
^
a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
q
r
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. (October 2012).
"Third universal definition of myocardial infarction"
.
Circulation
.
126
(16):
2020–
35.
doi
:
10.1161/CIR.0b013e31826e1058
.
PMID
22923432
.
^
Blumenthal & Margolis 2007
, pp. 4–5.
^
Morrow & Bohula 2016
, p. 295.
^
Morrow 2016
, pp. 59–61.
^
a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
q
r
s
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015).
Harrison's principles of internal medicine
. McGraw Hill Education. pp.
1593–
1610.
ISBN
978-0-07-180215-4
.
OCLC
923181481
.
^
a
b
c
Morrow 2016
, pp. 59–60.
^
a
b
c
d
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015).
Harrison's Principles of Internal Medicine
. McGraw Hill Education. pp.
98–
99.
ISBN
978-0-07-180215-4
.
OCLC
923181481
.
^
Gupta R, Munoz R (August 2016). "Evaluation and Management of Chest Pain in the Elderly".
Emergency Medicine Clinics of North America
.
34
(3):
523–
42.
doi
:
10.1016/j.emc.2016.04.006
.
PMID
27475013
.
^
Marcus GM, Cohen J, Varosy PD, Vessey J, Rose E, Massie BM, et al. (January 2007). "The utility of gestures in patients with chest discomfort".
The American Journal of Medicine
.
120
(1):
83–
9.
doi
:
10.1016/j.amjmed.2006.05.045
.
PMID
17208083
.
^
Allison & Murphy 2012
, p. 197;
Morrow 2016
, p. 60.
^
Canto JG, Goldberg RJ, Hand MM, Bonow RO, Sopko G, Pepine CJ, Long T (December 2007). "Symptom presentation of females with acute coronary syndromes: myth vs reality".
Archives of Internal Medicine
.
167
(22):
2405–
2413.
doi
:
10.1001/archinte.167.22.2405
.
PMID
18071161
.
^
"Heart Attack Symptoms, Risk, and Recovery"
.
CDC.gov
. U.S. Department of Health & Human Services
. Retrieved
July 20,
2021
.
^
Coventry LL, Finn J, Bremner AP (November–December 2011). "Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis".
Heart & Lung
.
40
(6):
477–
491.
doi
:
10.1016/j.hrtlng.2011.05.001
.
PMID
22000678
.
^
Chen W, Woods SL, Puntillo KA (July–August 2005). "Sex differences in symptoms associated with acute myocardial infarction: a review of the research".
Heart & Lung
.
34
(4):
240–
247.
doi
:
10.1016/j.hrtlng.2004.12.004
.
PMID
16027643
.
^
DeVon HA, Zerwic JJ (July–August 2002). "Symptoms of acute coronary syndromes: are there gender differences? A review of the literature".
Heart & Lung
.
31
(4):
235–
245.
doi
:
10.1067/mhl.2002.126105
.
PMID
12122387
.
^
Ashton R, Raman D.
"Dyspnea"
.
www.clevelandclinicmeded.com
. Cleveland Clinic.
Archived
from the original on 11 July 2017
. Retrieved
24 May
2017
.
^
Lilly LS (2012).
Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty
. Lippincott Williams & Wilkins. p. 172.
ISBN
978-1-4698-1668-5
.
Archived
from the original on 2017-07-28.
^
a
b
c
Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. (December 2008).
"Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology"
.
European Heart Journal
.
29
(23):
2909–
2945.
doi
:
10.1093/eurheartj/ehn416
.
PMID
19004841
.
^
Davis TM, Fortun P, Mulder J, Davis WA, Bruce DG (March 2004). "Silent myocardial infarction and its prognosis in a community-based cohort of Type 2 diabetic patients: the Fremantle Diabetes Study".
Diabetologia
.
47
(3):
395–
399.
doi
:
10.1007/s00125-004-1344-4
.
PMID
14963648
.
S2CID
12567614
.
^
Rubin E, Gorstein F, Rubin R, Schwarting R, Strayer D (2001).
Rubin's Pathology — Clinicopathological Foundations of Medicine
. Maryland: Lippincott Williams & Wilkins. p. 549.
ISBN
978-0-7817-4733-2
.
^
Gaziano & Gaziano 2016
, p. 11-22.
^
a
b
c
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. (July 2012).
"European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts)"
.
European Heart Journal
.
33
(13):
1635–
701.
doi
:
10.1093/eurheartj/ehs092
.
PMID
22555213
.
^
Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. (May 2006).
"AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute"
.
Journal of the American College of Cardiology
.
47
(10):
2130–
9.
doi
:
10.1016/j.jacc.2006.04.026
.
PMID
16697342
.
^
a
b
c
Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L, et al. (October 2012).
"Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data"
.
Lancet
.
380
(9852):
1491–
7.
doi
:
10.1016/S0140-6736(12)60994-5
.
PMC
3486012
.
PMID
22981903
.
^
Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT (July 2012).
"Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy"
.
Lancet
.
380
(9838):
219–
29.
doi
:
10.1016/S0140-6736(12)61031-9
.
PMC
3645500
.
PMID
22818936
.
^
Steptoe A, Kivimäki M (April 2012). "Stress and cardiovascular disease".
Nature Reviews. Cardiology
.
9
(6):
360–
70.
doi
:
10.1038/nrcardio.2012.45
.
PMID
22473079
.
S2CID
27925226
.
^
a
b
Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS (August 2020).
"Reduction in saturated fat intake for cardiovascular disease"
.
The Cochrane Database of Systematic Reviews
.
2020
(8) CD011737.
doi
:
10.1002/14651858.CD011737.pub3
.
PMC
8092457
.
PMID
32827219
.
^
a
b
c
Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. (March 2014). "Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis".
Annals of Internal Medicine
.
160
(6):
398–
406.
doi
:
10.7326/M13-1788
.
PMID
24723079
.
^
de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, et al. (August 2015).
"Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies"
.
BMJ
.
351
h3978.
doi
:
10.1136/bmj.h3978
.
PMC
4532752
.
PMID
26268692
.
^
"Scientific Report of the 2015 Dietary Guidelines Advisory Committee"
(PDF)
.
health.gov
. Feb 2015. p. 17. Archived from
the original
(PDF)
on 2016-05-03
. Retrieved
2015-03-05
.
^
Krenz M, Korthuis RJ (January 2012).
"Moderate ethanol ingestion and cardiovascular protection: from epidemiologic associations to cellular mechanisms"
.
Journal of Molecular and Cellular Cardiology
.
52
(1):
93–
104.
doi
:
10.1016/j.yjmcc.2011.10.011
.
PMC
3246046
.
PMID
22041278
.
^
a
b
c
O'Donnell CJ, Nabel EG (December 2011).
"Genomics of cardiovascular disease"
.
The New England Journal of Medicine
.
365
(22):
2098–
109.
doi
:
10.1056/NEJMra1105239
.
PMID
22129254
.
^
Culić V (April 2007). "Acute risk factors for myocardial infarction".
International Journal of Cardiology
.
117
(2):
260–
9.
doi
:
10.1016/j.ijcard.2006.05.011
.
PMID
16860887
.
^
Shaw E, Tofler GH (July 2009). "Circadian rhythm and cardiovascular disease".
Current Atherosclerosis Reports
.
11
(4):
289–
95.
doi
:
10.1007/s11883-009-0044-4
.
PMID
19500492
.
S2CID
43626425
.
^
Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, et al. (July 2012).
"Shift work and vascular events: systematic review and meta-analysis"
.
BMJ
.
345
e4800.
doi
:
10.1136/bmj.e4800
.
PMC
3406223
.
PMID
22835925
.
^
Janszky I, Ljung R (October 2008).
"Shifts to and from daylight saving time and incidence of myocardial infarction"
.
The New England Journal of Medicine
.
359
(18):
1966–
8.
doi
:
10.1056/NEJMc0807104
.
PMID
18971502
.
S2CID
205040478
.
^
Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM (August 2015).
"Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke"
.
The Cochrane Database of Systematic Reviews
.
2015
(8) CD011054.
doi
:
10.1002/14651858.CD011054.pub2
.
hdl
:
1874/340787
.
PMC
6494192
.
PMID
26310586
.
^
Bally M, Dendukuri N, Rich B, Nadeau L, Helin-Salmivaara A, Garbe E, Brophy JM (May 2017).
"Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data"
.
BMJ
.
357
j1909.
doi
:
10.1136/bmj.j1909
.
PMC
5423546
.
PMID
28487435
.
^
Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA (May 2016).
"Endometriosis and Risk of Coronary Heart Disease"
.
Circulation: Cardiovascular Quality and Outcomes
.
9
(3):
257–
64.
doi
:
10.1161/CIRCOUTCOMES.115.002224
.
PMC
4940126
.
PMID
27025928
.
^
Mustafic H, Jabre P, Caussin C, Murad MH, Escolano S, Tafflet M, et al. (February 2012). "Main air pollutants and myocardial infarction: a systematic review and meta-analysis".
JAMA
.
307
(7):
713–
21.
doi
:
10.1001/jama.2012.126
.
PMID
22337682
.
^
Ho AF, Wah W, Earnest A, Ng YY, Xie Z, Shahidah N, et al. (November 2018). "Health impacts of the Southeast Asian haze problem – A time-stratified case crossover study of the relationship between ambient air pollution and sudden cardiac deaths in Singapore".
International Journal of Cardiology
.
271
:
352–
358.
doi
:
10.1016/j.ijcard.2018.04.070
.
PMID
30223374
.
S2CID
52282745
.
^
Sun Z, Chen C, Xu D, Li T (October 2018). "Effects of ambient temperature on myocardial infarction: A systematic review and meta-analysis".
Environmental Pollution
.
241
:
1106–
1114.
Bibcode
:
2018EPoll.241.1106S
.
doi
:
10.1016/j.envpol.2018.06.045
.
PMID
30029319
.
S2CID
51705159
.
^
Chatzidimitriou D, Kirmizis D, Gavriilaki E, Chatzidimitriou M, Malisiovas N (October 2012). "Atherosclerosis and infection: is the jury still not in?".
Future Microbiology
.
7
(10):
1217–
30.
doi
:
10.2217/fmb.12.87
.
PMID
23030426
.
^
Sánchez-Manubens J, Bou R, Anton J (February 2014). "Diagnosis and classification of Kawasaki disease".
Journal of Autoimmunity
.
48–
49:
113–
7.
doi
:
10.1016/j.jaut.2014.01.010
.
PMID
24485156
.
^
Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC (March 2011).
"Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis"
.
Journal of the American College of Cardiology
.
57
(10):
1237–
47.
doi
:
10.1016/j.jacc.2010.10.011
.
PMID
21145688
.
^
Clarke R, Halsey J, Bennett D, Lewington S (February 2011). "Homocysteine and vascular disease: review of published results of the homocysteine-lowering trials".
Journal of Inherited Metabolic Disease
.
34
(1):
83–
91.
doi
:
10.1007/s10545-010-9235-y
.
PMID
21069462
.
S2CID
8714058
.
^
Lonn E (September 2007). "Homocysteine in the prevention of ischemic heart disease, stroke and venous thromboembolism: therapeutic target or just another distraction?".
Current Opinion in Hematology
.
14
(5):
481–
7.
doi
:
10.1097/MOH.0b013e3282c48bd8
.
PMID
17934354
.
S2CID
8734056
.
^
Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, et al. (January 2017).
"ESC working group position paper on myocardial infarction with non-obstructive coronary arteries"
.
European Heart Journal
.
38
(3):
143–
153.
doi
:
10.1093/eurheartj/ehw149
.
hdl
:
11577/3304417
.
PMID
28158518
.
^
a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
q
r
s
t
u
v
w
x
y
z
aa
ab
ac
ad
ae
af
ag
ah
ai
aj
Reed GW, Rossi JE, Cannon CP (January 2017). "Acute myocardial infarction".
Lancet
.
389
(10065):
197–
210.
doi
:
10.1016/S0140-6736(16)30677-8
.
PMID
27502078
.
S2CID
33523662
.
^
a
b
c
d
e
f
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010).
Davidson's principles and practice of medicine
(21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp.
577–
9.
ISBN
978-0-7020-3085-7
.
^
Woollard KJ, Geissmann F (February 2010).
"Monocytes in atherosclerosis: subsets and functions"
.
Nature Reviews. Cardiology
.
7
(2):
77–
86.
doi
:
10.1038/nrcardio.2009.228
.
PMC
2813241
.
PMID
20065951
.
^
Janoudi A, Shamoun FE, Kalavakunta JK, Abela GS (July 2016).
"Cholesterol crystal induced arterial inflammation and destabilization of atherosclerotic plaque"
.
European Heart Journal
.
37
(25):
1959–
67.
doi
:
10.1093/eurheartj/ehv653
.
PMID
26705388
.
^
a
b
c
Buja LM (July 2005). "Myocardial ischemia and reperfusion injury".
Cardiovascular Pathology
.
14
(4):
170–
5.
doi
:
10.1016/j.carpath.2005.03.006
.
PMID
16009313
.
^
Algranati D, Kassab GS, Lanir Y (March 2011).
"Why is the subendocardium more vulnerable to ischemia? A new paradigm"
.
American Journal of Physiology. Heart and Circulatory Physiology
.
300
(3): H1090–100.
doi
:
10.1152/ajpheart.00473.2010
.
PMC
3064294
.
PMID
21169398
.
^
a
b
Bolooki HM, Askari A (August 2010).
"Acute Myocardial Infarction"
.
www.clevelandclinicmeded.com
.
Archived
from the original on 28 April 2017
. Retrieved
24 May
2017
.
^
a
b
Aaronson PI, Ward JP, Connolly MJ (2013).
The cardiovascular system at a glance
(4th ed.). Chichester, West Sussex: Wiley-Blackwell. pp.
88–
89.
ISBN
978-0-470-65594-8
.
^
Kutty RS, Jones N, Moorjani N (November 2013). "Mechanical complications of acute myocardial infarction".
Cardiology Clinics
(Review).
31
(4):
519–
31,
vii–
viii.
doi
:
10.1016/j.ccl.2013.07.004
.
PMID
24188218
.
^
Kloner R, Hale SL (15 September 2016). "Reperfusion Injury: Prevention and Management". In Morrow DA (ed.).
Myocardial Infarction: A Companion to Braunwald's Heart Disease
. Elsevier. pp.
286–
288.
ISBN
978-0-323-35943-6
.
^
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD (January 2019).
"Fourth universal definition of myocardial infarction (2018)"
.
European Heart Journal
.
40
(3):
237–
269.
doi
:
10.1093/eurheartj/ehy462
.
hdl
:
10044/1/73052
.
PMID
30165617
.
^
Pickering JW, Than MP, Cullen L, Aldous S, Ter Avest E, Body R, et al. (May 2017).
"Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis"
.
Annals of Internal Medicine
.
166
(10):
715–
724.
doi
:
10.7326/M16-2562
.
PMID
28418520
.
^
Chapman AR, Lee KK, McAllister DA, Cullen L, Greenslade JH, Parsonage W, et al. (November 2017).
"Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome"
.
JAMA
.
318
(19):
1913–
1924.
doi
:
10.1001/jama.2017.17488
.
PMC
5710293
.
PMID
29127948
.
^
a
b
c
d
Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. (December 2014).
"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
.
130
(25): e344–426.
doi
:
10.1161/CIR.0000000000000134
.
PMID
25249585
.
^
Lipinski MJ, Escárcega RO, D'Ascenzo F, Magalhães MA, Baker NC, Torguson R, et al. (May 2014). "A systematic review and collaborative meta-analysis to determine the incremental value of copeptin for rapid rule-out of acute myocardial infarction".
The American Journal of Cardiology
.
113
(9):
1581–
91.
doi
:
10.1016/j.amjcard.2014.01.436
.
PMID
24731654
.
^
a
b
c
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010).
Davidson's principles and practice of medicine
(21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp.
529–
30.
ISBN
978-0-7020-3085-7
.
^
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015).
Harrison's principles of internal medicine
. McGraw Hill Education. p. 1457.
ISBN
978-0-07-180215-4
.
OCLC
923181481
.
^
a
b
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. (April 2021).
"2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation"
.
European Heart Journal
.
42
(14):
1289–
1367.
doi
:
10.1093/eurheartj/ehaa575
.
PMID
32860058
.
^
a
b
c
d
"American College of Cardiology"
.
www.choosingwisely.org
. Choosing Wisely. 28 February 2017.
Archived
from the original on 28 July 2017
. Retrieved
24 May
2017
.
^
Schinkel AF, Valkema R, Geleijnse ML, Sijbrands EJ, Poldermans D (May 2010). "Single-photon emission computed tomography for assessment of myocardial viability".
EuroIntervention
.
6
(Supplement G): G115–22.
PMID
20542817
.
^
National Institute for Health and Clinical Excellence
.
Clinical guideline cg94: Unstable angina and NSTEMI
. London, 2010.
^
a
b
"UOTW #36 – Ultrasound of the Week"
.
Ultrasound of the Week
. 5 February 2015.
Archived
from the original on 9 May 2017
. Retrieved
27 May
2017
.
^
a
b
c
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010).
Davidson's principles and practice of medicine
(21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 535, 539.
ISBN
978-0-7020-3085-7
.
^
Boie ET (November 2005). "Initial evaluation of chest pain".
Emergency Medicine Clinics of North America
.
23
(4):
937–
57.
doi
:
10.1016/j.emc.2005.07.007
.
PMID
16199332
.
^
"Assessment of fatigue"
.
BMJ Best Practice
. 17 August 2016. Archived from
the original
on 28 August 2021
. Retrieved
6 June
2017
.
^
MacIntyre CR, Mahimbo A, Moa AM, Barnes M (December 2016).
"Influenza vaccine as a coronary intervention for prevention of myocardial infarction"
.
Heart
.
102
(24):
1953–
1956.
doi
:
10.1136/heartjnl-2016-309983
.
PMC
5256393
.
PMID
27686519
.
^
a
b
c
d
e
National Institute for Health and Clinical Excellence
.
Clinical guideline 181: Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease
. London, 2014.
^
Stradling C, Hamid M, Taheri S, Thomas GN (2014). "A review of dietary influences on cardiovascular health: part 2: dietary patterns".
Cardiovascular & Hematological Disorders Drug Targets
.
14
(1):
50–
63.
doi
:
10.2174/1871529x14666140701095426
.
PMID
24993125
.
^
Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP (December 2013). "Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force".
Annals of Internal Medicine
.
159
(12):
824–
34.
doi
:
10.7326/0003-4819-159-12-201312170-00729
.
PMID
24217421
.
S2CID
17366251
.
^
McPherson K, et al. (June 2010).
"Prevention of cardiovascular disease – NICE public health guidance 25"
. London:
National Institute for Health and Care Excellence
.
Archived
from the original on 2014-03-29.
^
Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G (January 2011).
"Multiple risk factor interventions for primary prevention of coronary heart disease"
.
The Cochrane Database of Systematic Reviews
.
2013
(1) CD001561.
doi
:
10.1002/14651858.cd001561.pub3
.
PMC
4160097
.
PMID
21249647
.
^
Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. (January 2013).
"Statins for the primary prevention of cardiovascular disease"
.
The Cochrane Database of Systematic Reviews
.
1
(1) CD004816.
doi
:
10.1002/14651858.CD004816.pub5
.
PMC
6481400
.
PMID
23440795
.
^
Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. (May 2009).
"Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials"
.
Lancet
.
373
(9678):
1849–
60.
doi
:
10.1016/S0140-6736(09)60503-1
.
PMC
2715005
.
PMID
19482214
.
^
Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Kandala NB, et al. (September 2013).
"Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews"
.
Health Technology Assessment
.
17
(43):
1–
253.
doi
:
10.3310/hta17430
.
PMC
4781046
.
PMID
24074752
.
^
Matthys F, De Backer T, De Backer G, Stichele RV (March 2014).
"Review of guidelines on primary prevention of cardiovascular disease with aspirin: how much evidence is needed to turn a tanker?"
.
European Journal of Preventive Cardiology
.
21
(3):
354–
65.
doi
:
10.1177/2047487312472077
.
PMID
23610452
.
S2CID
28350632
.
^
Hodis HN, Mack WJ (July 2014). "Hormone replacement therapy and the association with coronary heart disease and overall mortality: clinical application of the timing hypothesis".
The Journal of Steroid Biochemistry and Molecular Biology
.
142
:
68–
75.
doi
:
10.1016/j.jsbmb.2013.06.011
.
PMID
23851166
.
S2CID
30838065
.
^
a
b
c
d
e
f
g
h
National Institute for Health and Clinical Excellence
.
Clinical guideline 172: Secondary prevention in primary and secondary care for patients following a myocardial infarction
. London, 2013.
^
Anderson L, Taylor RS (December 2014).
"Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews"
.
The Cochrane Database of Systematic Reviews
.
2021
(12) CD011273.
doi
:
10.1002/14651858.CD011273.pub2
.
hdl
:
10871/19152
.
PMC
7087435
.
PMID
25503364
.
^
Perez MI, Musini VM, Wright JM (October 2009). "Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event".
The Cochrane Database of Systematic Reviews
(4) CD006743.
doi
:
10.1002/14651858.CD006743.pub2
.
PMID
19821384
.
^
Elmariah S, Mauri L, Doros G, Galper BZ, O'Neill KE, Steg PG, et al. (February 2015).
"Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis"
.
Lancet
.
385
(9970):
792–
8.
doi
:
10.1016/S0140-6736(14)62052-3
.
PMC
4386690
.
PMID
25467565
.
^
Bangalore S, Makani H, Radford M, Thakur K, Toklu B, Katz SD, et al. (October 2014).
"Clinical outcomes with β-blockers for myocardial infarction: a meta-analysis of randomized trials"
.
The American Journal of Medicine
.
127
(10):
939–
953.
doi
:
10.1016/j.amjmed.2014.05.032
.
PMID
24927909
.
^
Safi S, Sethi NJ, Nielsen EE, Feinberg J, Jakobsen JC, Gluud C, et al. (Cochrane Heart Group) (December 2019).
"Beta-blockers for suspected or diagnosed acute myocardial infarction"
.
The Cochrane Database of Systematic Reviews
.
12
(12) CD012484.
doi
:
10.1002/14651858.CD012484.pub2
.
PMC
6915833
.
PMID
31845756
.
^
Newman D (19 August 2010).
"Beta Blockers for Acute Heart Attack (Myocardial Infarction)"
.
TheNNT.com
.
Archived
from the original on 22 December 2015
. Retrieved
11 December
2015
.
^
Le HH, El-Khatib C, Mombled M, Guitarian F, Al-Gobari M, Fall M, et al. (2016).
"Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"
.
PLOS ONE
.
11
(2) e0145958.
Bibcode
:
2016PLoSO..1145958L
.
doi
:
10.1371/journal.pone.0145958
.
PMC
4758660
.
PMID
26891235
.
^
Hazinski MF, Nolan JP, Aickin R, Bhanji F, Billi JE, Callaway CW, et al. (October 2015).
"Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations"
.
Circulation
(Review).
132
(16 Suppl 1): S2–39.
doi
:
10.1161/CIR.0000000000000270
.
PMID
26472854
.
^
Hess EP, Agarwal D, Chandra S, Murad MH, Erwin PJ, Hollander JE, et al. (July 2010).
"Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis"
.
CMAJ
.
182
(10):
1039–
44.
doi
:
10.1503/cmaj.092119
.
PMC
2900327
.
PMID
20530163
.
^
Reeder G (27 December 2016).
"Nitrates in the management of acute coronary syndrome"
.
www.uptodate.com
.
Archived
from the original on 28 July 2017
. Retrieved
24 May
2017
.
^
Yadlapati A, Gajjar M, Schimmel DR, Ricciardi MJ, Flaherty JD (December 2016). "Contemporary management of ST-segment elevation myocardial infarction".
Internal and Emergency Medicine
.
11
(8):
1107–
1113.
doi
:
10.1007/s11739-016-1550-3
.
PMID
27714584
.
S2CID
23759756
.
^
McCarthy CP, Mullins KV, Sidhu SS, Schulman SP, McEvoy JW (June 2016). "The on- and off-target effects of morphine in acute coronary syndrome: A narrative review".
American Heart Journal
.
176
:
114–
21.
doi
:
10.1016/j.ahj.2016.04.004
.
PMID
27264228
.
^
Bellemain-Appaix A, Kerneis M, O'Connor SA, Silvain J, Cucherat M, Beygui F, et al. (October 2014).
"Reappraisal of thienopyridine pretreatment in patients with non-ST elevation acute coronary syndrome: a systematic review and meta-analysis"
.
BMJ
.
349
g6269.
doi
:
10.1136/bmj.g6269
.
PMC
4208629
.
PMID
25954988
.
^
a
b
Andrade-Castellanos CA, Colunga-Lozano LE, Delgado-Figueroa N, Magee K (June 2014).
"Heparin versus placebo for non-ST elevation acute coronary syndromes"
.
The Cochrane Database of Systematic Reviews
.
6
(6) CD003462.
doi
:
10.1002/14651858.CD003462.pub3
.
PMC
6769062
.
PMID
24972265
.
^
Bagai A, Dangas GD, Stone GW, Granger CB (June 2014).
"Reperfusion strategies in acute coronary syndromes"
.
Circulation Research
.
114
(12):
1918–
28.
doi
:
10.1161/CIRCRESAHA.114.302744
.
PMID
24902975
.
^
Jobs A, Mehta SR, Montalescot G, Vicaut E, Van't Hof AW, Badings EA, et al. (August 2017). "Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials".
Lancet
.
390
(10096):
737–
746.
doi
:
10.1016/S0140-6736(17)31490-3
.
PMID
28778541
.
S2CID
4489347
.
^
Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. (October 2010).
"Guidelines on myocardial revascularization"
.
European Heart Journal
.
31
(20):
2501–
55.
doi
:
10.1093/eurheartj/ehq277
.
PMID
20802248
.
^
Dalal F, Dalal HM, Voukalis C, Gandhi MM (July 2017). "Management of patients after primary percutaneous coronary intervention for myocardial infarction".
BMJ
.
358
j3237.
doi
:
10.1136/bmj.j3237
.
PMID
28729460
.
S2CID
46847680
.
^
Lassen JF, Bøtker HE, Terkelsen CJ (January 2013). "Timely and optimal treatment of patients with STEMI".
Nature Reviews. Cardiology
. 1.
10
(1):
41–
8.
doi
:
10.1038/nrcardio.2012.156
.
PMID
23165072
.
S2CID
21955018
.
^
Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. (November 2015).
"Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care"
.
Circulation
.
132
(18 Suppl 2): S315–67.
doi
:
10.1161/cir.0000000000000252
.
PMID
26472989
.
^
McCaul M, Lourens A, Kredo T (September 2014).
"Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction"
.
The Cochrane Database of Systematic Reviews
.
2014
(9) CD010191.
doi
:
10.1002/14651858.CD010191.pub2
.
PMC
6823254
.
PMID
25208209
.
^
Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T (December 2016).
"Oxygen therapy for acute myocardial infarction"
.
The Cochrane Database of Systematic Reviews
.
2016
(12) CD007160.
doi
:
10.1002/14651858.CD007160.pub4
.
PMC
6463792
.
PMID
27991651
.
^
Hofmann R, James SK, Jernberg T, Lindahl B, Erlinge D, Witt N, et al. (September 2017).
"Oxygen Therapy in Suspected Acute Myocardial Infarction"
.
The New England Journal of Medicine
.
377
(13):
1240–
1249.
doi
:
10.1056/nejmoa1706222
.
PMID
28844200
.
^
Abuzaid A, Fabrizio C, Felpel K, Al Ashry HS, Ranjan P, Elbadawi A, et al. (June 2018).
"Oxygen Therapy in Patients with Acute Myocardial Infarction: A Systemic Review and Meta-Analysis"
.
The American Journal of Medicine
.
131
(6):
693–
701.
doi
:
10.1016/j.amjmed.2017.12.027
.
PMID
29355510
.
^
Sepehrvand N, James SK, Stub D, Khoshnood A, Ezekowitz JA, Hofmann R (October 2018). "Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials".
Heart
.
104
(20):
1691–
1698.
doi
:
10.1136/heartjnl-2018-313089
.
PMID
29599378
.
S2CID
4472549
.
^
Singh A, Hussain S, Antony B (2020).
"How Much Evidence Is Needed to Conclude against the Use of Oxygen Therapy in Acute Myocardial Infarction?"
.
Res Pract Thromb Haemost
.
4
(Suppl 1)
. Retrieved
28 July
2020
.
[
permanent dead link
]
^
Ardehali R, Perez M, Wang P (2011).
A practical approach to cardiovascular medicine
. Chichester, West Sussex, UK: Wiley-Blackwell. p. 57.
ISBN
978-1-4443-9387-3
.
^
Jindal SK, ed. (2011).
Textbook of pulmonary and critical care medicine
. New Delhi: Jaypee Brothers Medical Publishers. p. 1758.
ISBN
978-93-5025-073-0
.
^
Dahal K, Hendrani A, Sharma SP, Singireddy S, Mina G, Reddy P, et al. (July 2018).
"Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis"
.
JAMA Internal Medicine
.
178
(7):
913–
920.
doi
:
10.1001/jamainternmed.2018.0850
.
PMC
6145720
.
PMID
29799995
.
^
Rahim L, Allana S, Steinke EE, Ali F, Khan AH (November 2017). "Level of knowledge among cardiac nurses regarding sexual counseling of post-MI patients in three tertiary care hospitals in Pakistan".
Heart & Lung
.
46
(6):
412–
416.
doi
:
10.1016/j.hrtlng.2017.09.002
.
PMID
28988654
.
S2CID
4277993
.
^
Jaarsma T, Steinke EE, Gianotten WL (2010). "Sexual problems in cardiac patients: how to assess, when to refer".
The Journal of Cardiovascular Nursing
.
25
(2):
159–
64.
doi
:
10.1097/JCN.0b013e3181c60e7c
.
PMID
20168196
.
S2CID
25806176
.
^
Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS (November 2021).
"Exercise-based cardiac rehabilitation for coronary heart disease"
.
The Cochrane Database of Systematic Reviews
.
2021
(11) CD001800.
doi
:
10.1002/14651858.CD001800.pub4
.
PMC
8571912
.
PMID
34741536
.
^
a
b
Papneja K, Chan AK, Mondal TK, Paes B (March 2017). "Myocardial Infarction in Neonates: A Review of an Entity with Significant Morbidity and Mortality".
Pediatric Cardiology
.
38
(3):
427–
441.
doi
:
10.1007/s00246-016-1556-7
.
PMID
28238152
.
S2CID
20779415
.
^
López de Sá E, López-Sendón J, Anguera I, Bethencourt A, Bosch X (November 2002).
"Prognostic value of clinical variables at presentation in patients with non-ST-segment elevation acute coronary syndromes: results of the Proyecto de Estudio del Pronóstico de la Angina (PEPA)"
.
Medicine
.
81
(6):
434–
42.
doi
:
10.1097/00005792-200211000-00004
.
hdl
:
20.500.13003/14561
.
PMID
12441900
.
S2CID
10268606
.
^
Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. (November 2006).
"Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE)"
.
BMJ
.
333
(7578): 1091.
doi
:
10.1136/bmj.38985.646481.55
.
PMC
1661748
.
PMID
17032691
.
^
Weir RA, McMurray JJ, Velazquez EJ (May 2006). "Epidemiology of heart failure and left ventricular systolic dysfunction after acute myocardial infarction: prevalence, clinical characteristics, and prognostic importance".
The American Journal of Cardiology
.
97
(10A):
13F–
25F.
doi
:
10.1016/j.amjcard.2006.03.005
.
PMID
16698331
.
^
a
b
c
World Health Organization (2008).
The Global Burden of Disease: 2004 Update
. Geneva: World Health Organization.
ISBN
978-92-4-156371-0
.
^
Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. (American Heart Association Statistics Committee and Stroke Statistics Subcommittee) (January 2012).
"Executive summary: heart disease and stroke statistics--2012 update: a report from the American Heart Association"
.
Circulation
.
125
(1):
188–
97.
doi
:
10.1161/CIR.0b013e3182456d46
.
PMID
22215894
.
^
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. (January 2015).
"Heart disease and stroke statistics--2015 update: a report from the American Heart Association"
.
Circulation
.
131
(4): e29–322.
doi
:
10.1161/cir.0000000000000152
.
PMID
25520374
.
From 2001 to 2011, death rates attributable to CVD declined 30.8%.
^
Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S (January 2008). "Epidemiology and causation of coronary heart disease and stroke in India".
Heart
.
94
(1):
16–
26.
doi
:
10.1136/hrt.2007.132951
.
PMID
18083949
.
S2CID
27117207
.
^
Coady SA, Johnson NJ, Hakes JK, Sorlie PD (July 2014).
"Individual education, area income, and mortality and recurrence of myocardial infarction in a Medicare cohort: the National Longitudinal Mortality Study"
.
BMC Public Health
.
14
(1) 705.
doi
:
10.1186/1471-2458-14-705
.
PMC
4227052
.
PMID
25011538
.
^
Salomaa V, Miettinen H, Niemelä M, Ketonen M, Mähönen M, Immonen-Räihä P, et al. (July 2001).
"Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events; the FINMONICA MI Register Study"
.
Journal of Epidemiology and Community Health
.
55
(7):
475–
82.
doi
:
10.1136/jech.55.7.475
.
PMC
1731938
.
PMID
11413176
.
^
Bucholz EM, Ma S, Normand SL, Krumholz HM (October 2015).
"Race, Socioeconomic Status, and Life Expectancy After Acute Myocardial Infarction"
.
Circulation
.
132
(14):
1338–
46.
doi
:
10.1161/circulationaha.115.017009
.
PMC
5097251
.
PMID
26369354
.
^
Kilpi F, Silventoinen K, Konttinen H, Martikainen P (April 2016).
"Disentangling the relative importance of different socioeconomic resources for myocardial infarction incidence and survival: a longitudinal study of over 300,000 Finnish adults"
.
European Journal of Public Health
.
26
(2):
260–
6.
doi
:
10.1093/eurpub/ckv202
.
PMID
26585783
.
^
Rosvall M, Gerward S, Engström G, Hedblad B (October 2008).
"Income and short-term case fatality after myocardial infarction in the whole middle-aged population of Malmö, Sweden"
.
European Journal of Public Health
.
18
(5):
533–
8.
doi
:
10.1093/eurpub/ckn059
.
PMID
18621776
.
^
Graham G (2015-05-14).
"Disparities in cardiovascular disease risk in the United States"
.
Current Cardiology Reviews
.
11
(3):
238–
45.
doi
:
10.2174/1573403X11666141122220003
.
PMC
4558355
.
PMID
25418513
.
^
Joshi P (2007-01-17).
"Risk Factors for Early Myocardial Infarction in South Asians Compared With Individuals in Other Countries"
.
JAMA
.
297
(3):
286–
294.
doi
:
10.1001/jama.297.3.286
.
PMID
17227980
. Retrieved
2023-11-16
.
^
Hamad R, Penko J, Kazi DS, Coxson P, Guzman D, Wei PC, et al. (May 2020).
"Association of Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults"
.
JAMA Cardiology
.
5
(8):
899–
908.
doi
:
10.1001/jamacardio.2020.1458
.
PMC
7254448
.
PMID
32459344
.
^
"Health Coverage of Immigrants"
.
KFF
. 2020-03-18
. Retrieved
2021-04-09
.
^
Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, et al. (April 2010).
"Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction"
.
JAMA
.
303
(14):
1392–
400.
doi
:
10.1001/jama.2010.409
.
PMC
3020978
.
PMID
20388895
.
^
Kelli HM, Mehta A, Tahhan AS, Liu C, Kim JH, Dong TA, et al. (September 2019).
"Low Educational Attainment is a Predictor of Adverse Outcomes in Patients With Coronary Artery Disease"
.
Journal of the American Heart Association
.
8
(17) e013165.
doi
:
10.1161/JAHA.119.013165
.
PMC
6755831
.
PMID
31476920
.
^
Perry K, Petrie KJ, Ellis CJ, Horne R, Moss-Morris R (July 2001).
"Symptom expectations and delay in acute myocardial infarction patients"
.
Heart
.
86
(1):
91–
3.
doi
:
10.1136/heart.86.1.91
.
PMC
1729795
.
PMID
11410572
.
^
Workers' Compensation FAQ
Archived
2007-07-11 at the
Wayback Machine
.
Prairie View A&M University
. Retrieved November 22, 2006.
^
SIGNIFICANT DECISIONS Subject Index
Archived
2006-12-06 at the
Wayback Machine
. Board of Industrial Insurance Appeals. Retrieved November 22, 2006.
^
"34 U.S. Code § 10281 - Payment of death benefits"
.
Legal Information Institute (Cornell Law School)
. Retrieved
2025-07-27
.
^
"Classification of Drivers' Licenses Regulations"
. Nova Scotia Registry of Regulations. May 24, 2000.
Archived
from the original on April 20, 2007
. Retrieved
April 22,
2007
.
Sources
Allison TG, Murphy JG (6 December 2012). "Stress Test Selection". In Murphy JG, Lloyd MA, Brady PA, Olsen LJ, Shields RC (eds.).
Mayo Clinic Cardiology: Concise Textbook
. OUP US. pp.
196–
202.
ISBN
978-0-19-991571-2
.
Blumenthal RS, Margolis S (2007).
Heart Attack Prevention 2007
. Johns Hopkins Health.
ISBN
978-1-933087-47-4
.
Dwight J (16 June 2016). "Chest pain, breathlessness, fatigue". In Warrell D, Cox T, Firth J, Dwight J (eds.).
Oxford Textbook of Medicine: Cardiovascular Disorders
. Oxford University Press. pp.
39–
47.
ISBN
978-0-19-871702-7
.
Gaziano TA, Gaziano JM (15 September 2016). "Global Evolving Epidemiology, Natural History, and Treatment Trends of Myocardial Infarction". In Morrow DA (ed.).
Myocardial Infarction: A Companion to Braunwald's Heart Disease
. Elsevier. pp.
11–
21.
ISBN
978-0-323-35943-6
.
Morrow DA, Bohula EA (15 September 2016). "Heart Failure and Cardiogenic Shock After Myocardial Infarction". In Morrow DA (ed.).
Myocardial Infarction: A Companion to Braunwald's Heart Disease
. Elsevier. pp.
295–
313.
ISBN
978-0-323-35943-6
.
Morrow DA, Braunwald E (15 September 2016). "Classification and Diagnosis of Acute Coronary Syndromes". In Morrow DA (ed.).
Myocardial Infarction: A Companion to Braunwald's Heart Disease
. Elsevier. pp.
1–
10.
ISBN
978-0-323-35943-6
.
Morrow DA (15 September 2016). "Clinical Approach to Suspected Acute Myocardial Infarction". In Morrow DA (ed.).
Myocardial Infarction: A Companion to Braunwald's Heart Disease
. Elsevier. pp.
55–
65.
ISBN
978-0-323-35943-6
.
Further reading
Min Cho S, et al. (2021). "Machine learning compared with conventional statistical models for predicting myocardial infarction readmission and mortality: a systematic review".
Canadian Journal of Cardiology
.
37
(8). Elsevier:
1207–
1214.
doi
:
10.1016/j.cjca.2021.02.020
.
PMID
33677098
.
S2CID
232141652
.
External links
American Heart Association's Heart Attack web site
— Information and resources for preventing, recognizing, and treating a heart attack.
TIMI Score for
UA/NSTEMI
Archived
2016-11-05 at the
Wayback Machine
and
STEMI
Archived
2009-03-19 at the
Wayback Machine
HEART Score for Major Cardiac Events
Archived
2016-10-28 at the
Wayback Machine
"Heart Attack"
.
MedlinePlus
. U.S. National Library of Medicine. |
| Markdown | [Jump to content](https://en.wikipedia.org/wiki/Myocardial_infarction#bodyContent)
Main menu
Main menu
move to sidebar
hide
Navigation
- [Main page](https://en.wikipedia.org/wiki/Main_Page "Visit the main page [z]")
- [Contents](https://en.wikipedia.org/wiki/Wikipedia:Contents "Guides to browsing Wikipedia")
- [Current events](https://en.wikipedia.org/wiki/Portal:Current_events "Articles related to current events")
- [Random article](https://en.wikipedia.org/wiki/Special:Random "Visit a randomly selected article [x]")
- [About Wikipedia](https://en.wikipedia.org/wiki/Wikipedia:About "Learn about Wikipedia and how it works")
- [Contact us](https://en.wikipedia.org/wiki/Wikipedia:Contact_us "How to contact Wikipedia")
Contribute
- [Help](https://en.wikipedia.org/wiki/Help:Contents "Guidance on how to use and edit Wikipedia")
- [Learn to edit](https://en.wikipedia.org/wiki/Help:Introduction "Learn how to edit Wikipedia")
- [Community portal](https://en.wikipedia.org/wiki/Wikipedia:Community_portal "The hub for editors")
- [Recent changes](https://en.wikipedia.org/wiki/Special:RecentChanges "A list of recent changes to Wikipedia [r]")
- [Upload file](https://en.wikipedia.org/wiki/Wikipedia:File_upload_wizard "Add images or other media for use on Wikipedia")
- [Special pages](https://en.wikipedia.org/wiki/Special:SpecialPages "A list of all special pages [q]")
[  ](https://en.wikipedia.org/wiki/Main_Page)
[Search](https://en.wikipedia.org/wiki/Special:Search "Search Wikipedia [f]")
Appearance
- [Donate](https://donate.wikimedia.org/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en)
- [Create account](https://en.wikipedia.org/w/index.php?title=Special:CreateAccount&returnto=Myocardial+infarction "You are encouraged to create an account and log in; however, it is not mandatory")
- [Log in](https://en.wikipedia.org/w/index.php?title=Special:UserLogin&returnto=Myocardial+infarction "You're encouraged to log in; however, it's not mandatory. [o]")
Personal tools
- [Donate](https://donate.wikimedia.org/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en)
- [Create account](https://en.wikipedia.org/w/index.php?title=Special:CreateAccount&returnto=Myocardial+infarction "You are encouraged to create an account and log in; however, it is not mandatory")
- [Log in](https://en.wikipedia.org/w/index.php?title=Special:UserLogin&returnto=Myocardial+infarction "You're encouraged to log in; however, it's not mandatory. [o]")
## Contents
move to sidebar
hide
- [(Top)](https://en.wikipedia.org/wiki/Myocardial_infarction)
- [1 Terminology](https://en.wikipedia.org/wiki/Myocardial_infarction#Terminology)
- [2 Signs and symptoms](https://en.wikipedia.org/wiki/Myocardial_infarction#Signs_and_symptoms)
Toggle Signs and symptoms subsection
- [2\.1 Pain](https://en.wikipedia.org/wiki/Myocardial_infarction#Pain)
- [2\.2 Other](https://en.wikipedia.org/wiki/Myocardial_infarction#Other)
- [2\.3 Absence](https://en.wikipedia.org/wiki/Myocardial_infarction#Absence)
- [3 Risk factors](https://en.wikipedia.org/wiki/Myocardial_infarction#Risk_factors)
Toggle Risk factors subsection
- [3\.1 Diet](https://en.wikipedia.org/wiki/Myocardial_infarction#Diet)
- [3\.2 Genetics](https://en.wikipedia.org/wiki/Myocardial_infarction#Genetics)
- [3\.3 Other](https://en.wikipedia.org/wiki/Myocardial_infarction#Other_2)
- [4 Mechanism](https://en.wikipedia.org/wiki/Myocardial_infarction#Mechanism)
Toggle Mechanism subsection
- [4\.1 Atherosclerosis](https://en.wikipedia.org/wiki/Myocardial_infarction#Atherosclerosis)
- [4\.2 Other causes](https://en.wikipedia.org/wiki/Myocardial_infarction#Other_causes)
- [4\.3 Tissue death](https://en.wikipedia.org/wiki/Myocardial_infarction#Tissue_death)
- [5 Diagnosis](https://en.wikipedia.org/wiki/Myocardial_infarction#Diagnosis)
Toggle Diagnosis subsection
- [5\.1 Criteria](https://en.wikipedia.org/wiki/Myocardial_infarction#Criteria)
- [5\.2 Types](https://en.wikipedia.org/wiki/Myocardial_infarction#Types)
- [5\.3 Cardiac biomarkers](https://en.wikipedia.org/wiki/Myocardial_infarction#Cardiac_biomarkers)
- [5\.4 Electrocardiogram](https://en.wikipedia.org/wiki/Myocardial_infarction#Electrocardiogram)
- [5\.5 Imaging](https://en.wikipedia.org/wiki/Myocardial_infarction#Imaging)
- [5\.6 Differential diagnosis](https://en.wikipedia.org/wiki/Myocardial_infarction#Differential_diagnosis)
- [6 Prevention](https://en.wikipedia.org/wiki/Myocardial_infarction#Prevention)
Toggle Prevention subsection
- [6\.1 Primary prevention](https://en.wikipedia.org/wiki/Myocardial_infarction#Primary_prevention)
- [6\.1.1 Lifestyle](https://en.wikipedia.org/wiki/Myocardial_infarction#Lifestyle)
- [6\.1.2 Medication](https://en.wikipedia.org/wiki/Myocardial_infarction#Medication)
- [6\.2 Secondary prevention](https://en.wikipedia.org/wiki/Myocardial_infarction#Secondary_prevention)
- [6\.2.1 Medications](https://en.wikipedia.org/wiki/Myocardial_infarction#Medications)
- [6\.2.2 Other](https://en.wikipedia.org/wiki/Myocardial_infarction#Other_3)
- [7 Management](https://en.wikipedia.org/wiki/Myocardial_infarction#Management)
Toggle Management subsection
- [7\.1 Pain](https://en.wikipedia.org/wiki/Myocardial_infarction#Pain_2)
- [7\.2 Antithrombotics](https://en.wikipedia.org/wiki/Myocardial_infarction#Antithrombotics)
- [7\.3 Angiogram](https://en.wikipedia.org/wiki/Myocardial_infarction#Angiogram)
- [7\.4 Fibrinolysis](https://en.wikipedia.org/wiki/Myocardial_infarction#Fibrinolysis)
- [7\.5 Other](https://en.wikipedia.org/wiki/Myocardial_infarction#Other_4)
- [7\.6 Rehabilitation and exercise](https://en.wikipedia.org/wiki/Myocardial_infarction#Rehabilitation_and_exercise)
- [8 Prognosis](https://en.wikipedia.org/wiki/Myocardial_infarction#Prognosis)
Toggle Prognosis subsection
- [8\.1 Complications](https://en.wikipedia.org/wiki/Myocardial_infarction#Complications)
- [9 Epidemiology](https://en.wikipedia.org/wiki/Myocardial_infarction#Epidemiology)
- [10 Social determinants of health](https://en.wikipedia.org/wiki/Myocardial_infarction#Social_determinants_of_health)
- [11 Society and culture](https://en.wikipedia.org/wiki/Myocardial_infarction#Society_and_culture)
- [12 Legal implications](https://en.wikipedia.org/wiki/Myocardial_infarction#Legal_implications)
- [13 References](https://en.wikipedia.org/wiki/Myocardial_infarction#References)
Toggle References subsection
- [13\.1 Sources](https://en.wikipedia.org/wiki/Myocardial_infarction#Sources)
- [14 Further reading](https://en.wikipedia.org/wiki/Myocardial_infarction#Further_reading)
- [15 External links](https://en.wikipedia.org/wiki/Myocardial_infarction#External_links)
Toggle the table of contents
# Myocardial infarction
127 languages
- [Afrikaans](https://af.wikipedia.org/wiki/Hartaanval "Hartaanval – Afrikaans")
- [Alemannisch](https://als.wikipedia.org/wiki/Myokardinfarkt "Myokardinfarkt – Alemannic")
- [Aragonés](https://an.wikipedia.org/wiki/Infarto_de_miocardio "Infarto de miocardio – Aragonese")
- [العربية](https://ar.wikipedia.org/wiki/%D9%86%D9%88%D8%A8%D8%A9_%D9%82%D9%84%D8%A8%D9%8A%D8%A9 "نوبة قلبية – Arabic")
- [অসমীয়া](https://as.wikipedia.org/wiki/%E0%A6%AE%E0%A6%BE%E0%A6%87%E0%A6%85%27%E0%A6%95%E0%A6%BE%E0%A7%B0%E0%A7%8D%E0%A6%A6%E0%A6%BF%E0%A6%AF%E0%A6%BC%E0%A7%87%E0%A6%B2_%E0%A6%87%E0%A6%A8%E0%A6%AB%E0%A6%BE%E0%A7%B0%E0%A7%8D%E0%A6%95%E0%A6%9A%E0%A6%A8 "মাইঅ'কাৰ্দিয়েল ইনফাৰ্কচন – Assamese")
- [Asturianu](https://ast.wikipedia.org/wiki/Infartu_agudu_de_miocardiu "Infartu agudu de miocardiu – Asturian")
- [Azərbaycanca](https://az.wikipedia.org/wiki/%C3%9Cr%C9%99k_tutmas%C4%B1 "Ürək tutması – Azerbaijani")
- [تۆرکجه](https://azb.wikipedia.org/wiki/%D8%A7%DB%86%D8%B1%DA%A9_%D8%AD%D9%85%D9%84%D9%87%E2%80%8C%D8%B3%DB%8C "اۆرک حملهسی – South Azerbaijani")
- [Башҡортса](https://ba.wikipedia.org/wiki/%D0%9C%D0%B8%D0%BE%D0%BA%D0%B0%D1%80%D0%B4_%D0%B8%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82%D1%8B "Миокард инфаркты – Bashkir")
- [Žemaitėška](https://bat-smg.wikipedia.org/wiki/Mijokarda_infarkts "Mijokarda infarkts – Samogitian")
- [Беларуская (тарашкевіца)](https://be-tarask.wikipedia.org/wiki/%D0%86%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82_%D0%BC%D1%96%D1%8F%D0%BA%D0%B0%D1%80%D0%B4%D0%B0 "Інфаркт міякарда – Belarusian (Taraškievica orthography)")
- [Беларуская](https://be.wikipedia.org/wiki/%D0%86%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82_%D0%BC%D1%96%D1%8F%D0%BA%D0%B0%D1%80%D0%B4%D0%B0 "Інфаркт міякарда – Belarusian")
- [Български](https://bg.wikipedia.org/wiki/%D0%98%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82_%D0%BD%D0%B0_%D0%BC%D0%B8%D0%BE%D0%BA%D0%B0%D1%80%D0%B4%D0%B0 "Инфаркт на миокарда – Bulgarian")
- [ပအိုဝ်ႏဘာႏသာႏ](https://blk.wikipedia.org/wiki/%E1%80%9E%EA%A9%BB%E1%80%9B%E1%80%AC%E1%82%8F%E1%80%9B%E1%80%B1%E1%80%AC%E1%82%8F%E1%80%82%E1%80%AB%E1%82%8F "သꩻရာႏရောႏဂါႏ – Pa'O")
- [বাংলা](https://bn.wikipedia.org/wiki/%E0%A6%B9%E0%A6%BE%E0%A6%B0%E0%A7%8D%E0%A6%9F_%E0%A6%85%E0%A7%8D%E0%A6%AF%E0%A6%BE%E0%A6%9F%E0%A6%BE%E0%A6%95 "হার্ট অ্যাটাক – Bangla")
- [བོད་ཡིག](https://bo.wikipedia.org/wiki/%E0%BD%A6%E0%BE%99%E0%BD%B2%E0%BD%84%E0%BC%8B%E0%BD%A2%E0%BE%A9%E0%BD%A0%E0%BD%B2%E0%BC%8B%E0%BD%81%E0%BE%B2%E0%BD%82%E0%BC%8B%E0%BD%A0%E0%BD%82%E0%BD%82%E0%BC%8B "སྙིང་རྩའི་ཁྲག་འགག་ – Tibetan")
- [Bosanski](https://bs.wikipedia.org/wiki/Infarkt_miokarda "Infarkt miokarda – Bosnian")
- [Català](https://ca.wikipedia.org/wiki/Infart_de_miocardi "Infart de miocardi – Catalan")
- [Нохчийн](https://ce.wikipedia.org/wiki/%D0%98%D1%80%D0%B0_%D0%BC%D0%B8%D0%BE%D0%BA%D0%B0%D1%80%D0%B4%D0%B0%D0%BD_%D0%B8%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82 "Ира миокардан инфаркт – Chechen")
- [Cebuano](https://ceb.wikipedia.org/wiki/Atake_sa_kasingkasing "Atake sa kasingkasing – Cebuano")
- [کوردی](https://ckb.wikipedia.org/wiki/%D8%AC%DB%95%DA%B5%D8%AF%DB%95%DB%8C_%D8%AF%DA%B5 "جەڵدەی دڵ – Central Kurdish")
- [Čeština](https://cs.wikipedia.org/wiki/Infarkt_myokardu "Infarkt myokardu – Czech")
- [Чӑвашла](https://cv.wikipedia.org/wiki/%D0%9C%D0%B8%D0%BE%D0%BA%D0%B0%D1%80%D0%B4_%D0%B8%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%87%C4%95 "Миокард инфаркчĕ – Chuvash")
- [Cymraeg](https://cy.wikipedia.org/wiki/Trawiad_ar_y_galon "Trawiad ar y galon – Welsh")
- [Dansk](https://da.wikipedia.org/wiki/Myokardieinfarkt "Myokardieinfarkt – Danish")
- [Deutsch](https://de.wikipedia.org/wiki/Herzinfarkt "Herzinfarkt – German")
- [Zazaki](https://diq.wikipedia.org/wiki/Kriz%C3%AA_qelbi "Krizê qelbi – Dimli")
- [ދިވެހިބަސް](https://dv.wikipedia.org/wiki/%DE%80%DE%A7%DE%83%DE%93%DE%B0_%DE%87%DE%AC%DE%93%DE%AD%DE%86%DE%B0_%DE%96%DE%AC%DE%80%DE%AA%DE%82%DE%B0 "ހާރޓް އެޓޭކް ޖެހުން – Divehi")
- [Ελληνικά](https://el.wikipedia.org/wiki/%CE%88%CE%BC%CF%86%CF%81%CE%B1%CE%B3%CE%BC%CE%B1_%CF%84%CE%BF%CF%85_%CE%BC%CF%85%CE%BF%CE%BA%CE%B1%CF%81%CE%B4%CE%AF%CE%BF%CF%85 "Έμφραγμα του μυοκαρδίου – Greek")
- [Esperanto](https://eo.wikipedia.org/wiki/Korinfarkto "Korinfarkto – Esperanto")
- [Español](https://es.wikipedia.org/wiki/Infarto_agudo_de_miocardio "Infarto agudo de miocardio – Spanish")
- [Eesti](https://et.wikipedia.org/wiki/M%C3%BCokardi_infarkt "Müokardi infarkt – Estonian")
- [Euskara](https://eu.wikipedia.org/wiki/Miokardio_infartu_akutua "Miokardio infartu akutua – Basque")
- [فارسی](https://fa.wikipedia.org/wiki/%D8%B3%DA%A9%D8%AA%D9%87_%D9%82%D9%84%D8%A8%DB%8C "سکته قلبی – Persian")
- [Suomi](https://fi.wikipedia.org/wiki/Syd%C3%A4ninfarkti "Sydäninfarkti – Finnish")
- [Français](https://fr.wikipedia.org/wiki/Infarctus_du_myocarde "Infarctus du myocarde – French")
- [Gaeilge](https://ga.wikipedia.org/wiki/Taom_cro%C3%AD "Taom croí – Irish")
- [Kriyòl gwiyannen](https://gcr.wikipedia.org/wiki/Infarctus_di_myokard "Infarctus di myokard – Guianan Creole")
- [Galego](https://gl.wikipedia.org/wiki/Infarto_agudo_de_miocardio "Infarto agudo de miocardio – Galician")
- [Avañe'ẽ](https://gn.wikipedia.org/wiki/%C3%91e%27%C3%A3soro "Ñe'ãsoro – Guarani")
- [Ghanaian Pidgin](https://gpe.wikipedia.org/wiki/Myocardial_infarction "Myocardial infarction – Ghanaian Pidgin")
- [ગુજરાતી](https://gu.wikipedia.org/wiki/%E0%AA%B9%E0%AB%83%E0%AA%A6%E0%AA%AF%E0%AA%B0%E0%AB%8B%E0%AA%97%E0%AA%A8%E0%AB%8B_%E0%AA%B9%E0%AB%81%E0%AA%AE%E0%AA%B2%E0%AB%8B "હૃદયરોગનો હુમલો – Gujarati")
- [Hausa](https://ha.wikipedia.org/wiki/Ciwon_zuciya "Ciwon zuciya – Hausa")
- [עברית](https://he.wikipedia.org/wiki/%D7%90%D7%95%D7%98%D7%9D_%D7%A9%D7%A8%D7%99%D7%A8_%D7%94%D7%9C%D7%91 "אוטם שריר הלב – Hebrew")
- [हिन्दी](https://hi.wikipedia.org/wiki/%E0%A4%B9%E0%A5%83%E0%A4%A6%E0%A4%AF%E0%A4%BE%E0%A4%98%E0%A4%BE%E0%A4%A4 "हृदयाघात – Hindi")
- [Fiji Hindi](https://hif.wikipedia.org/wiki/Dil_ke_daura "Dil ke daura – Fiji Hindi")
- [Hrvatski](https://hr.wikipedia.org/wiki/Infarkt_miokarda "Infarkt miokarda – Croatian")
- [Kreyòl ayisyen](https://ht.wikipedia.org/wiki/Kriz_kadyak "Kriz kadyak – Haitian Creole")
- [Magyar](https://hu.wikipedia.org/wiki/Sz%C3%ADvinfarktus "Szívinfarktus – Hungarian")
- [Հայերեն](https://hy.wikipedia.org/wiki/%D5%8D%D6%80%D5%BF%D5%A1%D5%B4%D5%AF%D5%A1%D5%B6%D5%AB_%D5%AB%D5%B6%D6%86%D5%A1%D6%80%D5%AF%D5%BF "Սրտամկանի ինֆարկտ – Armenian")
- [Արեւմտահայերէն](https://hyw.wikipedia.org/wiki/%D5%8D%D5%AB%D6%80%D5%BF%D5%AB_%D5%AF%D5%A1%D5%A9%D5%B8%D6%82%D5%A1%D5%AE "Սիրտի կաթուած – Western Armenian")
- [Interlingua](https://ia.wikipedia.org/wiki/Infarcto_del_myocardio "Infarcto del myocardio – Interlingua")
- [Bahasa Indonesia](https://id.wikipedia.org/wiki/Serangan_jantung "Serangan jantung – Indonesian")
- [Íslenska](https://is.wikipedia.org/wiki/Hjarta%C3%A1fall "Hjartaáfall – Icelandic")
- [Italiano](https://it.wikipedia.org/wiki/Infarto_miocardico_acuto "Infarto miocardico acuto – Italian")
- [日本語](https://ja.wikipedia.org/wiki/%E5%BF%83%E7%AD%8B%E6%A2%97%E5%A1%9E "心筋梗塞 – Japanese")
- [Patois](https://jam.wikipedia.org/wiki/Aat_atak "Aat atak – Jamaican Creole English")
- [ქართული](https://ka.wikipedia.org/wiki/%E1%83%9B%E1%83%98%E1%83%9D%E1%83%99%E1%83%90%E1%83%A0%E1%83%93%E1%83%98%E1%83%A3%E1%83%9B%E1%83%98%E1%83%A1_%E1%83%98%E1%83%9C%E1%83%A4%E1%83%90%E1%83%A0%E1%83%A5%E1%83%A2%E1%83%98 "მიოკარდიუმის ინფარქტი – Georgian")
- [Қазақша](https://kk.wikipedia.org/wiki/%D0%9C%D0%B8%D0%BE%D0%BA%D0%B0%D1%80%D0%B4_%D0%B8%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82%D1%8B "Миокард инфаркты – Kazakh")
- [ಕನ್ನಡ](https://kn.wikipedia.org/wiki/%E0%B2%B9%E0%B3%83%E0%B2%A6%E0%B2%AF%E0%B2%BE%E0%B2%98%E0%B2%BE%E0%B2%A4 "ಹೃದಯಾಘಾತ – Kannada")
- [Yerwa Kanuri](https://knc.wikipedia.org/wiki/Kwosa_karu_b%C7%9D "Kwosa karu bǝ – Central Kanuri")
- [한국어](https://ko.wikipedia.org/wiki/%EC%8B%AC%EA%B7%BC_%EA%B2%BD%EC%83%89 "심근 경색 – Korean")
- [کٲشُر](https://ks.wikipedia.org/wiki/%D8%AF%D9%90%D9%84%D9%8F%DA%A9_%D8%AF%D9%88%D8%B1%D9%95 "دِلُک دورٕ – Kashmiri")
- [Kurdî](https://ku.wikipedia.org/wiki/Mirina_mas%C3%BBlkey%C3%AAn_dil "Mirina masûlkeyên dil – Kurdish")
- [Kernowek](https://kw.wikipedia.org/wiki/Shora_kolon "Shora kolon – Cornish")
- [Кыргызча](https://ky.wikipedia.org/wiki/%D0%9C%D0%B8%D0%BE%D0%BA%D0%B0%D1%80%D0%B4%D0%B4%D1%8B%D0%BD_%D0%B8%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82%D1%8B "Миокарддын инфаркты – Kyrgyz")
- [Latina](https://la.wikipedia.org/wiki/Infarctus_cordis "Infarctus cordis – Latin")
- [Limburgs](https://li.wikipedia.org/wiki/Hertaanval "Hertaanval – Limburgish")
- [Lombard](https://lmo.wikipedia.org/wiki/Infart_del_miocardi "Infart del miocardi – Lombard")
- [ລາວ](https://lo.wikipedia.org/wiki/%E0%BA%81%E0%BA%B2%E0%BA%99%E0%BB%82%E0%BA%88%E0%BA%A1%E0%BA%95%E0%BA%B5%E0%BA%AB%E0%BA%BB%E0%BA%A7%E0%BB%83%E0%BA%88 "ການໂຈມຕີຫົວໃຈ – Lao")
- [Lietuvių](https://lt.wikipedia.org/wiki/Miokardo_infarktas "Miokardo infarktas – Lithuanian")
- [Latviešu](https://lv.wikipedia.org/wiki/Miokarda_infarkts "Miokarda infarkts – Latvian")
- [Македонски](https://mk.wikipedia.org/wiki/%D0%A1%D1%80%D1%86%D0%B5%D0%B2_%D1%83%D0%B4%D0%B0%D1%80 "Срцев удар – Macedonian")
- [മലയാളം](https://ml.wikipedia.org/wiki/%E0%B4%B9%E0%B5%83%E0%B4%A6%E0%B4%AF%E0%B4%BE%E0%B4%98%E0%B4%BE%E0%B4%A4%E0%B4%82 "ഹൃദയാഘാതം – Malayalam")
- [Монгол](https://mn.wikipedia.org/wiki/%D0%97%D2%AF%D1%80%D1%85%D0%BD%D0%B8%D0%B9_%D1%88%D0%B8%D0%B3%D0%B4%D1%8D%D1%8D%D1%81 "Зүрхний шигдээс – Mongolian")
- [मराठी](https://mr.wikipedia.org/wiki/%E0%A4%B9%E0%A5%83%E0%A4%A6%E0%A4%AF%E0%A4%BE%E0%A4%98%E0%A4%BE%E0%A4%A4 "हृदयाघात – Marathi")
- [Bahasa Melayu](https://ms.wikipedia.org/wiki/Penginfarkan_miokardium "Penginfarkan miokardium – Malay")
- [မြန်မာဘာသာ](https://my.wikipedia.org/wiki/%E1%80%94%E1%80%BE%E1%80%9C%E1%80%AF%E1%80%B6%E1%80%B8%E1%80%9B%E1%80%B1%E1%80%AC%E1%80%82%E1%80%AB "နှလုံးရောဂါ – Burmese")
- [Plattdüütsch](https://nds.wikipedia.org/wiki/Hartinfarkt "Hartinfarkt – Low German")
- [नेपाल भाषा](https://new.wikipedia.org/wiki/%E0%A4%AE%E0%A4%BE%E0%A4%AF%E0%A5%8B%E0%A4%95%E0%A4%BE%E0%A4%B0%E0%A5%8D%E0%A4%A1%E0%A4%BF%E0%A4%AF%E0%A4%B2_%E0%A4%87%E0%A4%A8%E0%A5%8D%E0%A4%AB%E0%A4%BE%E0%A4%B0%E0%A5%8D%E0%A4%95%E0%A5%8D%E0%A4%B8%E0%A4%A8 "मायोकार्डियल इन्फार्क्सन – Newari")
- [Nederlands](https://nl.wikipedia.org/wiki/Hartinfarct "Hartinfarct – Dutch")
- [Norsk nynorsk](https://nn.wikipedia.org/wiki/Hjarteattakk "Hjarteattakk – Norwegian Nynorsk")
- [Norsk bokmål](https://no.wikipedia.org/wiki/Hjerteinfarkt "Hjerteinfarkt – Norwegian Bokmål")
- [Occitan](https://oc.wikipedia.org/wiki/Infart_miocardiac "Infart miocardiac – Occitan")
- [ଓଡ଼ିଆ](https://or.wikipedia.org/wiki/%E0%AC%B9%E0%AD%83%E0%AC%A6%E0%AD%8D%E2%80%8C%E0%AC%98%E0%AC%BE%E0%AC%A4 "ହୃଦ୍ଘାତ – Odia")
- [ਪੰਜਾਬੀ](https://pa.wikipedia.org/wiki/%E0%A8%A6%E0%A8%BF%E0%A8%B2_%E0%A8%A6%E0%A8%BE_%E0%A8%A6%E0%A9%8C%E0%A8%B0%E0%A8%BE "ਦਿਲ ਦਾ ਦੌਰਾ – Punjabi")
- [Kapampangan](https://pam.wikipedia.org/wiki/Ataki_keng_pusu "Ataki keng pusu – Pampanga")
- [Polski](https://pl.wikipedia.org/wiki/Zawa%C5%82_mi%C4%99%C5%9Bnia_sercowego "Zawał mięśnia sercowego – Polish")
- [پنجابی](https://pnb.wikipedia.org/wiki/%D8%AF%D9%84_%D8%AF%D8%A7_%D8%AF%D9%88%D8%B1%DB%81 "دل دا دورہ – Western Punjabi")
- [پښتو](https://ps.wikipedia.org/wiki/%D8%AF_%D8%B2%DA%93%D9%87_%D8%AD%D9%85%D9%84%D9%87_\(%D9%86%D8%A7%D8%B1%D9%88%D8%BA%D9%8A\) "د زړه حمله (ناروغي) – Pashto")
- [Português](https://pt.wikipedia.org/wiki/Enfarte_agudo_do_mioc%C3%A1rdio "Enfarte agudo do miocárdio – Portuguese")
- [Runa Simi](https://qu.wikipedia.org/wiki/Sunqu_p%27itiy "Sunqu p'itiy – Quechua")
- [Română](https://ro.wikipedia.org/wiki/Infarct_miocardic "Infarct miocardic – Romanian")
- [Русский](https://ru.wikipedia.org/wiki/%D0%98%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82_%D0%BC%D0%B8%D0%BE%D0%BA%D0%B0%D1%80%D0%B4%D0%B0 "Инфаркт миокарда – Russian")
- [Русиньскый](https://rue.wikipedia.org/wiki/%D0%A1%D0%B5%D1%80%D0%B4%D1%86%D1%8C%D0%BE%D0%B2%D1%8B%D0%B9_%D0%BD%D0%B0%D0%BF%D0%B0%D0%B4 "Сердцьовый напад – Rusyn")
- [संस्कृतम्](https://sa.wikipedia.org/wiki/%E0%A4%B9%E0%A5%83%E0%A4%A6%E0%A4%AF%E0%A4%BE%E0%A4%98%E0%A4%BE%E0%A4%A4%E0%A4%83 "हृदयाघातः – Sanskrit")
- [Саха тыла](https://sah.wikipedia.org/wiki/%D0%98%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82 "Инфаркт – Yakut")
- [سنڌي](https://sd.wikipedia.org/wiki/%D8%AF%D9%84_%D8%AC%D9%88_%D8%AF%D9%88%D8%B1%D9%88 "دل جو دورو – Sindhi")
- [Srpskohrvatski / српскохрватски](https://sh.wikipedia.org/wiki/Sr%C4%8Dani_udar "Srčani udar – Serbo-Croatian")
- [တႆး](https://shn.wikipedia.org/wiki/%E1%80%90%E1%81%A2%E1%80%84%E1%80%BA%E1%80%B8%E1%80%95%E1%80%B5%E1%81%BC%E1%80%BA%E1%82%81%E1%80%B0%E1%80%9D%E1%80%BA%E1%81%B8%E1%82%82%E1%80%BA "တၢင်းပဵၼ်ႁူဝ်ၸႂ် – Shan")
- [සිංහල](https://si.wikipedia.org/wiki/%E0%B7%84%E0%B7%98%E0%B6%AF%E0%B6%BA%E0%B7%8F%E0%B6%B6%E0%B7%8F%E0%B6%B0%E0%B6%BA "හෘදයාබාධය – Sinhala")
- [Simple English](https://simple.wikipedia.org/wiki/Myocardial_infarction "Myocardial infarction – Simple English")
- [Slovenčina](https://sk.wikipedia.org/wiki/Infarkt_myokardu "Infarkt myokardu – Slovak")
- [Slovenščina](https://sl.wikipedia.org/wiki/Miokardni_infarkt "Miokardni infarkt – Slovenian")
- [Shqip](https://sq.wikipedia.org/wiki/Pika_n%C3%AB_Zem%C3%ABr "Pika në Zemër – Albanian")
- [Српски / srpski](https://sr.wikipedia.org/wiki/%D0%A1%D1%80%D1%87%D0%B0%D0%BD%D0%B8_%D1%83%D0%B4%D0%B0%D1%80 "Срчани удар – Serbian")
- [Svenska](https://sv.wikipedia.org/wiki/Hj%C3%A4rtinfarkt "Hjärtinfarkt – Swedish")
- [Kiswahili](https://sw.wikipedia.org/wiki/Shtuko_la_moyo "Shtuko la moyo – Swahili")
- [Ślůnski](https://szl.wikipedia.org/wiki/Hercszlag "Hercszlag – Silesian")
- [தமிழ்](https://ta.wikipedia.org/wiki/%E0%AE%AE%E0%AE%BE%E0%AE%B0%E0%AE%9F%E0%AF%88%E0%AE%AA%E0%AF%8D%E0%AE%AA%E0%AF%81 "மாரடைப்பு – Tamil")
- [తెలుగు](https://te.wikipedia.org/wiki/%E0%B0%97%E0%B1%81%E0%B0%82%E0%B0%A1%E0%B1%86%E0%B0%AA%E0%B1%8B%E0%B0%9F%E0%B1%81 "గుండెపోటు – Telugu")
- [Тоҷикӣ](https://tg.wikipedia.org/wiki/%D0%98%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82%D0%B8_%D0%BC%D0%B8%D0%BE%D0%BA%D0%B0%D1%80%D0%B4 "Инфаркти миокард – Tajik")
- [ไทย](https://th.wikipedia.org/wiki/%E0%B8%81%E0%B8%A5%E0%B9%89%E0%B8%B2%E0%B8%A1%E0%B9%80%E0%B8%99%E0%B8%B7%E0%B9%89%E0%B8%AD%E0%B8%AB%E0%B8%B1%E0%B8%A7%E0%B9%83%E0%B8%88%E0%B8%95%E0%B8%B2%E0%B8%A2%E0%B9%80%E0%B8%AB%E0%B8%95%E0%B8%B8%E0%B8%82%E0%B8%B2%E0%B8%94%E0%B9%80%E0%B8%A5%E0%B8%B7%E0%B8%AD%E0%B8%94 "กล้ามเนื้อหัวใจตายเหตุขาดเลือด – Thai")
- [Tagalog](https://tl.wikipedia.org/wiki/Atake_sa_puso "Atake sa puso – Tagalog")
- [Toki pona](https://tok.wikipedia.org/wiki/pakala_pilin "pakala pilin – Toki Pona")
- [Türkçe](https://tr.wikipedia.org/wiki/Kalp_krizi "Kalp krizi – Turkish")
- [Татарча / tatarça](https://tt.wikipedia.org/wiki/%D0%9C%D0%B8%D0%BE%D0%BA%D0%B0%D1%80%D0%B4_%D0%B8%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82%D1%8B "Миокард инфаркты – Tatar")
- [Українська](https://uk.wikipedia.org/wiki/%D0%86%D0%BD%D1%84%D0%B0%D1%80%D0%BA%D1%82_%D0%BC%D1%96%D0%BE%D0%BA%D0%B0%D1%80%D0%B4%D0%B0 "Інфаркт міокарда – Ukrainian")
- [اردو](https://ur.wikipedia.org/wiki/%D8%AF%D9%88%D8%B1%DB%81_%D9%82%D9%84%D8%A8 "دورہ قلب – Urdu")
- [Oʻzbekcha / ўзбекча](https://uz.wikipedia.org/wiki/Miokard_infarkti "Miokard infarkti – Uzbek")
- [Vèneto](https://vec.wikipedia.org/wiki/Infarto_mioc%C3%A0rdego_acuto "Infarto miocàrdego acuto – Venetian")
- [Tiếng Việt](https://vi.wikipedia.org/wiki/Nh%E1%BB%93i_m%C3%A1u_c%C6%A1_tim "Nhồi máu cơ tim – Vietnamese")
- [Winaray](https://war.wikipedia.org/wiki/Atake_ha_kasingkasing "Atake ha kasingkasing – Waray")
- [吴语](https://wuu.wikipedia.org/wiki/%E5%BF%83%E8%82%8C%E6%A2%97%E6%AD%BB "心肌梗死 – Wu")
- [ייִדיש](https://yi.wikipedia.org/wiki/%D7%94%D7%90%D7%A8%D7%A5_%D7%90%D7%98%D7%90%D7%A7%D7%A2 "הארץ אטאקע – Yiddish")
- [粵語](https://zh-yue.wikipedia.org/wiki/%E5%BF%83%E8%82%8C%E6%A2%97%E5%A1%9E "心肌梗塞 – Cantonese")
- [中文](https://zh.wikipedia.org/wiki/%E5%BF%83%E8%82%8C%E6%A2%97%E6%AD%BB "心肌梗死 – Chinese")
[Edit links](https://www.wikidata.org/wiki/Special:EntityPage/Q12152#sitelinks-wikipedia "Edit interlanguage links")
- [Article](https://en.wikipedia.org/wiki/Myocardial_infarction "View the content page [c]")
- [Talk](https://en.wikipedia.org/wiki/Talk:Myocardial_infarction "Discuss improvements to the content page [t]")
English
- [Read](https://en.wikipedia.org/wiki/Myocardial_infarction)
- [View source](https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&action=edit "This page is protected.
You can view its source [e]")
- [View history](https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&action=history "Past revisions of this page [h]")
Tools
Tools
move to sidebar
hide
Actions
- [Read](https://en.wikipedia.org/wiki/Myocardial_infarction)
- [View source](https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&action=edit)
- [View history](https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&action=history)
General
- [What links here](https://en.wikipedia.org/wiki/Special:WhatLinksHere/Myocardial_infarction "List of all English Wikipedia pages containing links to this page [j]")
- [Related changes](https://en.wikipedia.org/wiki/Special:RecentChangesLinked/Myocardial_infarction "Recent changes in pages linked from this page [k]")
- [Upload file](https://en.wikipedia.org/wiki/Wikipedia:File_Upload_Wizard "Upload files [u]")
- [Permanent link](https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&oldid=1345938649 "Permanent link to this revision of this page")
- [Page information](https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&action=info "More information about this page")
- [Cite this page](https://en.wikipedia.org/w/index.php?title=Special:CiteThisPage&page=Myocardial_infarction&id=1345938649&wpFormIdentifier=titleform "Information on how to cite this page")
- [Get shortened URL](https://en.wikipedia.org/w/index.php?title=Special:UrlShortener&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FMyocardial_infarction)
Print/export
- [Download as PDF](https://en.wikipedia.org/w/index.php?title=Special:DownloadAsPdf&page=Myocardial_infarction&action=show-download-screen "Download this page as a PDF file")
- [Printable version](https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&printable=yes "Printable version of this page [p]")
In other projects
- [Wikimedia Commons](https://commons.wikimedia.org/wiki/Category:Myocardial_infarction)
- [Wikidata item](https://www.wikidata.org/wiki/Special:EntityPage/Q12152 "Structured data on this page hosted by Wikidata [g]")
Appearance
move to sidebar
hide
[](https://en.wikipedia.org/wiki/Wikipedia:Good_articles* "This is a good article. Click here for more information.")
[](https://en.wikipedia.org/wiki/Wikipedia:Protection_policy#semi "This article is semi-protected until January 4, 2029 at 10:55 UTC.")
From Wikipedia, the free encyclopedia
Interruption of cardiac blood supply
"Heart attack" redirects here. For other uses, see [Heart attack (disambiguation)](https://en.wikipedia.org/wiki/Heart_attack_\(disambiguation\) "Heart attack (disambiguation)").
Not to be confused with [Cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest"), [Heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), or [Heart block](https://en.wikipedia.org/wiki/Heart_block "Heart block").
Medical condition
| Myocardial infarction | |
|---|---|
| Other names | Acute myocardial infarction (AMI), heart attack |
| [](https://en.wikipedia.org/wiki/File:Blausen_0463_HeartAttack.png) | |
| A myocardial infarction occurs when an [atherosclerotic](https://en.wikipedia.org/wiki/Atherosclerosis "Atherosclerosis") [plaque](https://en.wikipedia.org/wiki/Atheroma "Atheroma") slowly builds up in the inner lining of a [coronary artery](https://en.wikipedia.org/wiki/Coronary_artery "Coronary artery") and then suddenly ruptures, causing catastrophic [thrombus](https://en.wikipedia.org/wiki/Thrombus "Thrombus") formation, totally occluding the artery and preventing blood flow downstream to the heart muscle. | |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Cardiology](https://en.wikipedia.org/wiki/Cardiology "Cardiology"), [emergency medicine](https://en.wikipedia.org/wiki/Emergency_medicine "Emergency medicine") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | [Chest pain](https://en.wikipedia.org/wiki/Chest_pain "Chest pain"), [shortness of breath](https://en.wikipedia.org/wiki/Shortness_of_breath "Shortness of breath"), [nausea](https://en.wikipedia.org/wiki/Nausea "Nausea")/[vomiting](https://en.wikipedia.org/wiki/Vomiting "Vomiting"), [dizziness](https://en.wikipedia.org/wiki/Dizziness "Dizziness") or [lightheadedness](https://en.wikipedia.org/wiki/Presyncope "Presyncope"), [cold sweat](https://en.wikipedia.org/wiki/Diaphoresis "Diaphoresis"), [feeling tired](https://en.wikipedia.org/wiki/Fatigue_\(medical\) "Fatigue (medical)"); arm, neck, back, jaw, or stomach pain,[\[1\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2014-1)[\[2\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-2) [decreased level](https://en.wikipedia.org/wiki/Altered_level_of_consciousness "Altered level of consciousness") or [total loss of consciousness](https://en.wikipedia.org/wiki/Unconsciousness "Unconsciousness") |
| [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") | [Heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), [irregular heartbeat](https://en.wikipedia.org/wiki/Cardiac_arrhythmia "Cardiac arrhythmia"), [cardiogenic shock](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock"), [coma](https://en.wikipedia.org/wiki/Coma "Coma"), [cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest")[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3)[\[4\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Heart2015-4) |
| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") | [Angina](https://en.wikipedia.org/wiki/Angina "Angina") or [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease") usually[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3) |
| [Risk factors](https://en.wikipedia.org/wiki/Risk_factor "Risk factor") | [High blood pressure](https://en.wikipedia.org/wiki/Hypertension "Hypertension"), [smoking](https://en.wikipedia.org/wiki/Tobacco_smoking "Tobacco smoking"), [diabetes](https://en.wikipedia.org/wiki/Diabetes_mellitus "Diabetes mellitus"), [lack of exercise](https://en.wikipedia.org/wiki/Sedentary_lifestyle "Sedentary lifestyle"), [obesity](https://en.wikipedia.org/wiki/Obesity "Obesity"), [high blood cholesterol](https://en.wikipedia.org/wiki/Hypercholesterolaemia "Hypercholesterolaemia")[\[5\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Meh2014-5)[\[6\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WHO2011-6) |
| [Diagnostic method](https://en.wikipedia.org/wiki/Medical_diagnosis "Medical diagnosis") | [Electrocardiograms](https://en.wikipedia.org/wiki/Electrocardiogram "Electrocardiogram") (ECGs), blood tests, [coronary angiography](https://en.wikipedia.org/wiki/Coronary_angiography "Coronary angiography")[\[7\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013D-7) |
| Treatment | [Percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention"), [thrombolysis](https://en.wikipedia.org/wiki/Thrombolysis "Thrombolysis")[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8) |
| [Medication](https://en.wikipedia.org/wiki/Medication "Medication") | [Aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin"), [nitroglycerin](https://en.wikipedia.org/wiki/Nitroglycerin_\(drug\) "Nitroglycerin (drug)"), [heparin](https://en.wikipedia.org/wiki/Heparin "Heparin")[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8)[\[9\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Oc2010-9) |
| [Prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis") | STEMI 10% risk of death (developed world)[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8) |
| Frequency | 15\.9 million (2015)[\[10\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-GBD2015Pre-10) |
A **myocardial infarction** (**MI**), commonly known as a **heart attack**, occurs when [blood flow decreases](https://en.wikipedia.org/wiki/Ischemia "Ischemia") or stops in one of the [arteries of the heart](https://en.wikipedia.org/wiki/Coronary_arteries "Coronary arteries"), causing [infarction](https://en.wikipedia.org/wiki/Infarction "Infarction") (tissue death) to the [heart muscle](https://en.wikipedia.org/wiki/Heart_muscle "Heart muscle").[\[1\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2014-1) The most common symptom is retrosternal [chest pain or discomfort](https://en.wikipedia.org/wiki/Angina "Angina") that classically radiates to the left shoulder, arm, or jaw.[\[1\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2014-1) The pain may occasionally feel like [heartburn](https://en.wikipedia.org/wiki/Heartburn "Heartburn").[\[1\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2014-1) This is the dangerous type of [acute coronary syndrome](https://en.wikipedia.org/wiki/Acute_coronary_syndrome "Acute coronary syndrome").
Other symptoms may include [shortness of breath](https://en.wikipedia.org/wiki/Shortness_of_breath "Shortness of breath"), [nausea](https://en.wikipedia.org/wiki/Nausea "Nausea"), [feeling faint](https://en.wikipedia.org/wiki/Presyncope "Presyncope"), a [cold sweat](https://en.wikipedia.org/wiki/Diaphoresis "Diaphoresis"), [feeling tired](https://en.wikipedia.org/wiki/Fatigue "Fatigue"), and [decreased level of consciousness](https://en.wikipedia.org/wiki/Decreased_level_of_consciousness "Decreased level of consciousness").[\[1\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2014-1) About 30% of people have atypical symptoms.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8) Women more often present without chest pain and instead have neck pain, arm pain or feel tired.[\[11\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-11) Among those over 75 years old, about 5% have had an MI with little or no history of symptoms.[\[12\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Val2011-12) An MI may cause [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), an [irregular heartbeat](https://en.wikipedia.org/wiki/Cardiac_arrhythmia "Cardiac arrhythmia"), [cardiogenic shock](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock") or [cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest").[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3)[\[4\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Heart2015-4)
Most MIs occur due to [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease").[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3) Risk factors include [high blood pressure](https://en.wikipedia.org/wiki/Hypertension "Hypertension"), [smoking](https://en.wikipedia.org/wiki/Tobacco_smoking "Tobacco smoking"), [diabetes](https://en.wikipedia.org/wiki/Diabetes_mellitus "Diabetes mellitus"), [lack of exercise](https://en.wikipedia.org/wiki/Lack_of_exercise "Lack of exercise"), [obesity](https://en.wikipedia.org/wiki/Obesity "Obesity"), [high blood cholesterol](https://en.wikipedia.org/wiki/Hypercholesterolaemia "Hypercholesterolaemia"), poor diet, and [excessive alcohol intake](https://en.wikipedia.org/wiki/Excessive_alcohol_intake "Excessive alcohol intake").[\[5\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Meh2014-5)[\[6\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WHO2011-6) The complete blockage of a [coronary artery](https://en.wikipedia.org/wiki/Coronary_artery "Coronary artery") caused by a rupture of an [atherosclerotic plaque](https://en.wikipedia.org/wiki/Atherosclerosis "Atherosclerosis") is usually the underlying mechanism of an MI.[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3) MIs are less commonly caused by [coronary artery spasms](https://en.wikipedia.org/wiki/Coronary_artery_spasm "Coronary artery spasm"), which may be due to [cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine"), significant emotional stress (often known as [Takotsubo syndrome](https://en.wikipedia.org/wiki/Takotsubo_syndrome "Takotsubo syndrome") or *broken heart syndrome*) and extreme cold, among others.[\[13\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-13)[\[14\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-14) Many tests are helpful with diagnosis, including [electrocardiograms](https://en.wikipedia.org/wiki/Electrocardiogram "Electrocardiogram") (ECGs), blood tests and [coronary angiography](https://en.wikipedia.org/wiki/Coronary_angiography "Coronary angiography").[\[7\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013D-7) An ECG, which is a recording of the heart's electrical activity, may confirm an **ST elevation MI** ([STEMI](https://en.wikipedia.org/wiki/Myocardial_infarction#STEMI)), if [ST elevation](https://en.wikipedia.org/wiki/ST_elevation "ST elevation") is present.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8)[\[15\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-15) Commonly used blood tests include [troponin](https://en.wikipedia.org/wiki/Troponin "Troponin") and less often [creatine kinase MB](https://en.wikipedia.org/wiki/CPK-MB_test "CPK-MB test").[\[7\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013D-7)
Treatment of an MI is time-critical.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) [Aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin") is an appropriate immediate treatment for a suspected MI.[\[9\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Oc2010-9) [Nitroglycerin](https://en.wikipedia.org/wiki/Nitroglycerin_\(drug\) "Nitroglycerin (drug)") or [opioids](https://en.wikipedia.org/wiki/Opioid "Opioid") may be used to help with chest pain; however, they do not improve overall outcomes.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8)[\[9\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Oc2010-9) [Supplemental oxygen](https://en.wikipedia.org/wiki/Oxygen_therapy "Oxygen therapy") is recommended in those with [low oxygen levels](https://en.wikipedia.org/wiki/Hypoxia_\(medical\) "Hypoxia (medical)") or shortness of breath.[\[9\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Oc2010-9) In a STEMI, treatments attempt to restore blood flow to the [heart](https://en.wikipedia.org/wiki/Heart "Heart") and include [percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention") (PCI), where the arteries are pushed open and may be [stented](https://en.wikipedia.org/wiki/Stent "Stent"), or [thrombolysis](https://en.wikipedia.org/wiki/Thrombolysis "Thrombolysis"), where the blockage is removed using medications.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8) People who have a **non-ST elevation myocardial infarction** ([NSTEMI](https://en.wikipedia.org/wiki/Myocardial_infarction#NSTEMI)) are often managed with the blood thinner [heparin](https://en.wikipedia.org/wiki/Heparin "Heparin"), with the additional use of PCI in those at high risk.[\[9\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Oc2010-9) In people with blockages of multiple coronary arteries and diabetes, [coronary artery bypass surgery](https://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery "Coronary artery bypass surgery") (CABG) may be recommended rather than [angioplasty](https://en.wikipedia.org/wiki/Angioplasty "Angioplasty").[\[17\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Hamm2011-17) After an MI, lifestyle modifications, along with long-term treatment with aspirin, [beta blockers](https://en.wikipedia.org/wiki/Beta_blockers "Beta blockers") and [statins](https://en.wikipedia.org/wiki/Statin "Statin"), are typically recommended.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8)
Worldwide, about 15.9 million myocardial infarctions occurred in 2015.[\[10\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-GBD2015Pre-10) More than 3 million people had an ST elevation MI, and more than 4 million had an NSTEMI.[\[18\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Lancet08-18) STEMIs occur about twice as often in men as women.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) About one million people have an MI each year in the United States.[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3) In the developed world, the risk of death in those who have had a STEMI is about 10%.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8) Rates of MI for a given age have decreased globally between 1990 and 2010.[\[20\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-20) In 2011, an MI was one of the top five most expensive conditions during inpatient hospitalizations in the US, with a cost of about \$11.5 billion for 612,000 hospital stays.[\[21\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-21)
## Terminology
Main article: [Acute coronary syndrome](https://en.wikipedia.org/wiki/Acute_coronary_syndrome "Acute coronary syndrome")
Myocardial infarction (MI) refers to tissue death ([infarction](https://en.wikipedia.org/wiki/Infarction "Infarction")) of a part of the heart muscle ([myocardium](https://en.wikipedia.org/wiki/Myocardium "Myocardium")), caused by [ischemia](https://en.wikipedia.org/wiki/Myocardial_ischemia "Myocardial ischemia"), the lack of oxygen delivery to myocardial tissue. It is a type of [acute coronary syndrome](https://en.wikipedia.org/wiki/Acute_coronary_syndrome "Acute coronary syndrome"), which describes a sudden or short-term change in symptoms related to blood flow to the heart.[\[22\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrowBraunwald20161%E2%80%933Dwight201641-22) Unlike the other type of acute coronary syndrome, [unstable angina](https://en.wikipedia.org/wiki/Unstable_angina "Unstable angina"), a myocardial [infarction](https://en.wikipedia.org/wiki/Infarction "Infarction") occurs when there is [cell death](https://en.wikipedia.org/wiki/Cell_death "Cell death"), which can be estimated by measuring a [blood test](https://en.wikipedia.org/wiki/Blood_test "Blood test") for [biomarkers](https://en.wikipedia.org/wiki/Biomarker_\(medicine\) "Biomarker (medicine)") (the cardiac protein [troponin](https://en.wikipedia.org/wiki/Troponin "Troponin")).[\[23\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrowBraunwald20161%E2%80%933-23) When there is evidence of an MI, it may be classified as an ST elevation myocardial infarction (STEMI) or Non-ST elevation myocardial infarction (NSTEMI) based on the results of an [ECG](https://en.wikipedia.org/wiki/ECG "ECG").[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)
The phrase "heart attack" is often used non-specifically to refer to myocardial infarction. An MI is different from — but can cause — [cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest"), where the heart is not contracting at all or so poorly that all vital organs cease to function, thus leading to death.[\[25\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEBlumenthalMargolis20074%E2%80%935-25) It is also distinct from [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), in which the pumping action of the heart is impaired. However, an MI may lead to heart failure.[\[26\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrowBohula2016295-26)
## Signs and symptoms
[](https://en.wikipedia.org/wiki/File:Acute_myocardial_infarction_pain_svg_hariadhi.svg)
[](https://en.wikipedia.org/wiki/File:Acute_myocardial_infarction_pain_back_svg_hariadhi.svg)
Areas where pain is experienced in myocardial infarction, showing common (dark red) and less common (light red) areas on the chest (top) and back (bottom).
Chest pain that may or may not radiate to other parts of the body is the most typical and significant symptom of myocardial infarction. It might be accompanied by other symptoms such as sweating.[\[27\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrow201659%E2%80%9361-27)
### Pain
[Chest pain](https://en.wikipedia.org/wiki/Chest_pain "Chest pain") is one of the most common symptoms of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper [abdomen](https://en.wikipedia.org/wiki/Abdomen "Abdomen").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[29\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrow201659%E2%80%9360-29) The pain most suggestive of an acute MI, with the highest [likelihood ratio](https://en.wikipedia.org/wiki/Likelihood_function "Likelihood function"), is pain radiating to the right arm and shoulder.[\[30\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015B-30)[\[29\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrow201659%E2%80%9360-29) Similarly, chest pain similar to a previous heart attack is also suggestive.[\[31\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Gupta2016-31) The pain associated with MI is usually diffuse, does not change with position, and lasts for more than 20 minutes.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) It might be described as pressure, tightness, knifelike, tearing, burning sensation (all these are also manifested during other diseases). It could be felt as an unexplained anxiety, and pain might be absent altogether.[\[29\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrow201659%E2%80%9360-29) [Levine's sign](https://en.wikipedia.org/wiki/Levine%27s_sign "Levine's sign"), in which a person localizes the chest pain by clenching one or both fists over their [sternum](https://en.wikipedia.org/wiki/Human_sternum "Human sternum"), has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed it had a poor [positive predictive value](https://en.wikipedia.org/wiki/Positive_predictive_value "Positive predictive value").[\[32\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid17208083-32)
Typically, chest pain because of ischemia, be it unstable angina or myocardial infarction, lessens with the use of [nitroglycerin](https://en.wikipedia.org/wiki/Nitroglycerin_\(drug\) "Nitroglycerin (drug)"), but nitroglycerin may also relieve chest pain arising from non-cardiac causes.[\[33\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEAllisonMurphy2012197Morrow201660-33)
### Other
Chest pain may be accompanied by [sweating](https://en.wikipedia.org/wiki/Diaphoresis "Diaphoresis"), nausea or vomiting, and [fainting](https://en.wikipedia.org/wiki/Syncope_\(medicine\) "Syncope (medicine)"),[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)[\[30\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015B-30) and these symptoms may also occur without any pain at all.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Dizziness or lightheadedness is common and occurs due to reduction in oxygen and blood to the brain. In females, the most common symptoms of myocardial infarction include shortness of breath, weakness, and [fatigue](https://en.wikipedia.org/wiki/Fatigue_\(physical\) "Fatigue (physical)").[\[34\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-ACSwomen-34) Females are more likely to have unusual or unexplained tiredness and nausea or vomiting as symptoms.[\[35\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-35) Females having heart attacks are more likely to have palpitations, back pain, labored breath, vomiting, and left arm pain than males, although the studies showing these differences had high variability.[\[36\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-36) Females are less likely to report chest pain during a heart attack and more likely to report nausea, jaw pain, neck pain, cough, and fatigue, although these findings are inconsistent across studies.[\[37\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-37) Females with heart attacks also had more indigestion, [dizziness](https://en.wikipedia.org/wiki/Dizziness "Dizziness"), [loss of appetite](https://en.wikipedia.org/wiki/Anorexia_\(symptom\) "Anorexia (symptom)"), and loss of consciousness.[\[38\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-38) [Shortness of breath](https://en.wikipedia.org/wiki/Shortness_of_breath "Shortness of breath") is a common, and sometimes the only symptom, occurring when damage to the heart limits the [output](https://en.wikipedia.org/wiki/Cardiac_output "Cardiac output") of the [left ventricle](https://en.wikipedia.org/wiki/Left_ventricle "Left ventricle"), with breathlessness arising either from [low oxygen in the blood](https://en.wikipedia.org/wiki/Hypoxemia "Hypoxemia") or [pulmonary edema](https://en.wikipedia.org/wiki/Pulmonary_edema "Pulmonary edema").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[39\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-39)
Other less common symptoms include weakness, [light-headedness](https://en.wikipedia.org/wiki/Light-headedness "Light-headedness"), [palpitations](https://en.wikipedia.org/wiki/Palpitation "Palpitation"), and abnormalities in [heart rate](https://en.wikipedia.org/wiki/Heart_rate "Heart rate") or [blood pressure](https://en.wikipedia.org/wiki/Blood_pressure "Blood pressure").[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) These symptoms are likely induced by a massive surge of [catecholamines](https://en.wikipedia.org/wiki/Catecholamines "Catecholamines") from the [sympathetic nervous system](https://en.wikipedia.org/wiki/Sympathetic_nervous_system "Sympathetic nervous system"), which occurs in response to pain and, where present, low [blood pressure](https://en.wikipedia.org/wiki/Blood_pressure "Blood pressure").[\[40\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-40) [Loss of consciousness](https://en.wikipedia.org/wiki/Unconsciousness "Unconsciousness") can occur in myocardial infarctions due to inadequate blood flow to the [brain](https://en.wikipedia.org/wiki/Brain "Brain") and [cardiogenic shock](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock"), and [sudden death](https://en.wikipedia.org/wiki/Sudden_cardiac_death "Sudden cardiac death"), frequently due to the development of [ventricular fibrillation](https://en.wikipedia.org/wiki/Ventricular_fibrillation "Ventricular fibrillation").[\[41\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-ESC_STEMI-41) When the brain was without oxygen for too long due to a myocardial infarction, [coma](https://en.wikipedia.org/wiki/Coma "Coma") and [persistent vegetative state](https://en.wikipedia.org/wiki/Vegetative_state "Vegetative state") can occur. Cardiac arrest, and atypical symptoms such as [palpitations](https://en.wikipedia.org/wiki/Palpitations "Palpitations"), occur more frequently in females, the elderly, those with diabetes, in people who have just had surgery, and in critically ill patients.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)
### Absence
"Silent" myocardial infarctions can happen without any symptoms at all.[\[12\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Val2011-12) These cases can be discovered later on [electrocardiograms](https://en.wikipedia.org/wiki/Electrocardiograms "Electrocardiograms"), using blood enzyme tests, or at [autopsy](https://en.wikipedia.org/wiki/Autopsy "Autopsy") after a person has died. Such silent myocardial infarctions represent between 22 and 64% of all infarctions,[\[12\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Val2011-12) and are more common in the [elderly](https://en.wikipedia.org/wiki/Elderly "Elderly"),[\[12\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Val2011-12) in those with [diabetes mellitus](https://en.wikipedia.org/wiki/Diabetes_mellitus "Diabetes mellitus")[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) and after [heart transplantation](https://en.wikipedia.org/wiki/Heart_transplantation "Heart transplantation"). In people with diabetes, differences in [pain threshold](https://en.wikipedia.org/wiki/Threshold_of_pain "Threshold of pain"), [autonomic neuropathy](https://en.wikipedia.org/wiki/Autonomic_neuropathy "Autonomic neuropathy"), and [psychological](https://en.wikipedia.org/wiki/Psychology "Psychology") factors have been cited as possible explanations for the lack of symptoms.[\[42\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Diabetologica2004-David-42) In heart transplantation, the [donor](https://en.wikipedia.org/wiki/Organ_donation "Organ donation") heart is not fully innervated by the nervous system of the recipient.[\[43\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-rubin-43)
## Risk factors
The most prominent risk factors for myocardial infarction are older age, actively [smoking](https://en.wikipedia.org/wiki/Smoking "Smoking"), [high blood pressure](https://en.wikipedia.org/wiki/Hypertension "Hypertension"), [diabetes mellitus](https://en.wikipedia.org/wiki/Diabetes_mellitus "Diabetes mellitus"), and total [cholesterol](https://en.wikipedia.org/wiki/Cholesterol "Cholesterol") and [high-density lipoprotein](https://en.wikipedia.org/wiki/High-density_lipoprotein "High-density lipoprotein") levels.[\[44\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEGazianoGaziano201611-22-44) Many risk factors of myocardial infarction are shared with [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease"), the primary cause of myocardial infarction,[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) with other risk factors including male sex, low levels of physical activity, a past [family history](https://en.wikipedia.org/wiki/Family_history_\(medicine\) "Family history (medicine)"), [obesity](https://en.wikipedia.org/wiki/Obesity "Obesity"), and [alcohol use](https://en.wikipedia.org/wiki/Alcohol_use "Alcohol use").[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Risk factors for myocardial disease are often included in risk factor stratification scores, such as the [Framingham Risk Score](https://en.wikipedia.org/wiki/Framingham_Risk_Score "Framingham Risk Score").[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) At any given age, men are more at risk than women for the development of cardiovascular disease.[\[45\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-EUROPEAN2012-45) [High levels of blood cholesterol](https://en.wikipedia.org/wiki/Hypercholesterolemia "Hypercholesterolemia") is a known risk factor, particularly high [low-density lipoprotein](https://en.wikipedia.org/wiki/Low-density_lipoprotein "Low-density lipoprotein"), low [high-density lipoprotein](https://en.wikipedia.org/wiki/High-density_lipoprotein "High-density lipoprotein"), and high [triglycerides](https://en.wikipedia.org/wiki/Triglycerides "Triglycerides").[\[46\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid=16697342-46)
Many risk factors for myocardial infarction are potentially modifiable, with the most important being [tobacco smoking](https://en.wikipedia.org/wiki/Tobacco_smoking "Tobacco smoking") (including [secondhand smoke](https://en.wikipedia.org/wiki/Secondhand_smoke "Secondhand smoke")).[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Smoking appears to be the cause of about 36% and obesity the cause of 20% of [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease").[\[47\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Kivi2012-47) Lack of physical activity has been linked to 7–12% of cases.[\[47\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Kivi2012-47)[\[48\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-48) Less common causes include stress-related causes such as [job stress](https://en.wikipedia.org/wiki/Workplace_stress "Workplace stress"), which accounts for about 3% of cases,[\[47\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Kivi2012-47) and chronic high stress levels.[\[49\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid=22473079-49)
### Diet
There is varying evidence about the importance of [saturated fat](https://en.wikipedia.org/wiki/Saturated_fat "Saturated fat") in the development of myocardial infarctions. Eating polyunsaturated fat instead of [saturated fats](https://en.wikipedia.org/wiki/Saturated_fat "Saturated fat") has been shown in studies to be associated with a decreased risk of myocardial infarction,[\[50\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-:1-50) while other studies find little evidence that reducing dietary saturated fat or increasing [polyunsaturated fat](https://en.wikipedia.org/wiki/Polyunsaturated_fat "Polyunsaturated fat") intake affects heart attack risk.[\[51\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Chow2014-51)[\[52\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-52) Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed.[\[53\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-53) [Trans fats](https://en.wikipedia.org/wiki/Trans_fats "Trans fats") do appear to increase risk.[\[51\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Chow2014-51) Acute and prolonged intake of high quantities of alcoholic drinks (3–4 or more daily) increases the risk of a heart attack.[\[54\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Krenz2012-54)
### Genetics
Family history of [ischemic heart disease](https://en.wikipedia.org/wiki/Ischemic_heart_disease "Ischemic heart disease") or MI, particularly if one has a male first-degree relative (father, brother) who had a myocardial infarction before age 55 years, or a female first-degree relative (mother, sister) less than age 65 increases a person's risk of MI.[\[45\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-EUROPEAN2012-45)
[Genome-wide association studies](https://en.wikipedia.org/wiki/Genome-wide_association_studies "Genome-wide association studies") have found 27 genetic variants that are associated with an increased risk of myocardial infarction.[\[55\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Genomics_of_Cardiovascular_Disease-55) The strongest association of MI has been found with [chromosome 9](https://en.wikipedia.org/wiki/Chromosome_9 "Chromosome 9") on the short arm *p* at [locus](https://en.wikipedia.org/wiki/Locus_\(genetics\) "Locus (genetics)") 21, which contains genes CDKN2A and 2B, although the [single nucleotide polymorphisms](https://en.wikipedia.org/wiki/Single_nucleotide_polymorphisms "Single nucleotide polymorphisms") that are implicated are within a non-coding region.[\[55\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Genomics_of_Cardiovascular_Disease-55) The majority of these variants are in regions that have not been previously implicated in coronary artery disease. The following genes have an association with MI: [PCSK9](https://en.wikipedia.org/wiki/PCSK9 "PCSK9"), [SORT1](https://en.wikipedia.org/wiki/SORT1 "SORT1"), [MIA3](https://en.wikipedia.org/wiki/MIA3 "MIA3"), [WDR12](https://en.wikipedia.org/wiki/WDR12 "WDR12"), [MRAS](https://en.wikipedia.org/wiki/MRAS "MRAS"), [PHACTR1](https://en.wikipedia.org/wiki/PHACTR1 "PHACTR1"), [LPA](https://en.wikipedia.org/wiki/Lipoprotein\(a\) "Lipoprotein(a)"), [TCF21](https://en.wikipedia.org/wiki/TCF21 "TCF21"), [MTHFDSL](https://en.wikipedia.org/w/index.php?title=MTHFDSL&action=edit&redlink=1 "MTHFDSL (page does not exist)"), [ZC3HC1](https://en.wikipedia.org/wiki/ZC3HC1 "ZC3HC1"), [CDKN2A](https://en.wikipedia.org/wiki/CDKN2A "CDKN2A"), [2B](https://en.wikipedia.org/wiki/CDKN2B "CDKN2B"), [ABO](https://en.wikipedia.org/wiki/ABO "ABO"), [PDGF0](https://en.wikipedia.org/w/index.php?title=PDGF0&action=edit&redlink=1 "PDGF0 (page does not exist)"), [APOA5](https://en.wikipedia.org/wiki/APOA5 "APOA5"), [MNF1ASM283](https://en.wikipedia.org/w/index.php?title=MNF1ASM283&action=edit&redlink=1 "MNF1ASM283 (page does not exist)"), [COL4A1](https://en.wikipedia.org/wiki/Collagen,_type_IV,_alpha_1 "Collagen, type IV, alpha 1"), [HHIPC1](https://en.wikipedia.org/w/index.php?title=HHIPC1&action=edit&redlink=1 "HHIPC1 (page does not exist)"), [SMAD3](https://en.wikipedia.org/wiki/SMAD3 "SMAD3"), [ADAMTS7](https://en.wikipedia.org/wiki/ADAMTS7 "ADAMTS7"), [RAS1](https://en.wikipedia.org/w/index.php?title=RAS1&action=edit&redlink=1 "RAS1 (page does not exist)"), [SMG6](https://en.wikipedia.org/wiki/SMG6 "SMG6"), [SNF8](https://en.wikipedia.org/wiki/SNF8 "SNF8"), [LDLR](https://en.wikipedia.org/wiki/LDLR "LDLR"), [SLC5A3](https://en.wikipedia.org/wiki/SLC5A3 "SLC5A3"), [MRPS6](https://en.wikipedia.org/wiki/MRPS6 "MRPS6"), [KCNE2](https://en.wikipedia.org/wiki/KCNE2 "KCNE2").[\[55\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Genomics_of_Cardiovascular_Disease-55)
### Other
See also: [Overwork](https://en.wikipedia.org/wiki/Overwork "Overwork"), [Karoshi](https://en.wikipedia.org/wiki/Karoshi "Karoshi"), and [996 working hour system](https://en.wikipedia.org/wiki/996_working_hour_system "996 working hour system")
The risk of having a myocardial infarction increases with older age, low physical activity, and low [socioeconomic status](https://en.wikipedia.org/wiki/Socioeconomic_status "Socioeconomic status").[\[45\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-EUROPEAN2012-45) Heart attacks appear to occur more commonly in the morning hours, especially between 6AM and noon.[\[56\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Culic2007-56) Evidence suggests that heart attacks are at least three times more likely to occur in the morning than in the late evening.[\[57\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Shaw2009-57) [Shift work](https://en.wikipedia.org/wiki/Shift_work "Shift work") is also associated with a higher risk of MI.[\[58\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Vyas2012-58) One analysis has found an increase in heart attacks immediately following the start of [daylight saving time](https://en.wikipedia.org/wiki/Daylight_saving_time "Daylight saving time").[\[59\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-59)
Women who use [combined oral contraceptive pills](https://en.wikipedia.org/wiki/Combined_oral_contraceptive_pill "Combined oral contraceptive pill") have a modestly increased risk of myocardial infarction, especially in the presence of other risk factors.[\[60\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-60) The use of [non-steroidal anti inflammatory drugs](https://en.wikipedia.org/wiki/Non-steroidal_anti_inflammatory_drugs "Non-steroidal anti inflammatory drugs") (NSAIDs), even for as short as a week, increases risk.[\[61\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-61)
[Endometriosis](https://en.wikipedia.org/wiki/Endometriosis "Endometriosis") in women under the age of 40 is an identified risk factor.[\[62\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-62)
[Air pollution](https://en.wikipedia.org/wiki/Air_pollution "Air pollution") is also an important modifiable risk. Short-term exposure to air pollution such as [carbon monoxide](https://en.wikipedia.org/wiki/Carbon_monoxide "Carbon monoxide"), [nitrogen dioxide](https://en.wikipedia.org/wiki/Nitrogen_dioxide "Nitrogen dioxide"), and [sulfur dioxide](https://en.wikipedia.org/wiki/Sulfur_dioxide "Sulfur dioxide") (but not [ozone](https://en.wikipedia.org/wiki/Ozone "Ozone")) has been associated with MI and other acute cardiovascular events.[\[63\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-63) For sudden cardiac deaths, every increment of 30 units in Pollutant Standards Index correlated with an 8% increased risk of out-of-hospital cardiac arrest on the day of exposure.[\[64\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-64) Extremes of temperature are also associated.[\[65\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-65)
A number of acute and chronic [infections](https://en.wikipedia.org/wiki/Infections "Infections") including *[Chlamydophila pneumoniae](https://en.wikipedia.org/wiki/Chlamydophila_pneumoniae "Chlamydophila pneumoniae")*, [influenza](https://en.wikipedia.org/wiki/Influenza "Influenza"), *[Helicobacter pylori](https://en.wikipedia.org/wiki/Helicobacter_pylori "Helicobacter pylori")*, and *[Porphyromonas gingivalis](https://en.wikipedia.org/wiki/Porphyromonas_gingivalis "Porphyromonas gingivalis")* among others have been linked to atherosclerosis and myocardial infarction.[\[66\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Chat2012-66) Myocardial infarction can also occur as a late consequence of [Kawasaki disease](https://en.wikipedia.org/wiki/Kawasaki_disease "Kawasaki disease").[\[67\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Sanchez2014-67)
Calcium deposits in the coronary arteries can be detected with [CT scans](https://en.wikipedia.org/wiki/CT_scan "CT scan"). Calcium seen in coronary arteries can provide predictive information beyond that of classical risk factors.[\[68\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-68) [High blood levels of the amino acid homocysteine](https://en.wikipedia.org/wiki/Hyperhomocysteinemia "Hyperhomocysteinemia") is associated with premature atherosclerosis;[\[69\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-69) whether elevated homocysteine in the normal range is causal is controversial.[\[70\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-70)
In people without evident [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease"), possible causes for the myocardial infarction are [coronary spasm](https://en.wikipedia.org/wiki/Coronary_spasm "Coronary spasm") or [coronary artery dissection](https://en.wikipedia.org/wiki/Spontaneous_coronary_artery_dissection "Spontaneous coronary artery dissection").[\[71\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-71)
## Mechanism
### Atherosclerosis
Further information: [Atherosclerosis](https://en.wikipedia.org/wiki/Atherosclerosis "Atherosclerosis")
The animation shows plaque buildup or a [coronary artery spasm](https://en.wikipedia.org/wiki/Vasospasm "Vasospasm") can lead to a heart attack and how blocked blood flow in a coronary artery can lead to a heart attack.
The most common cause of a myocardial infarction is the rupture of an atherosclerotic plaque on an [artery](https://en.wikipedia.org/wiki/Artery "Artery") supplying heart muscle.[\[41\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-ESC_STEMI-41)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Plaques can become unstable, rupture, and additionally promote the formation of a [blood clot](https://en.wikipedia.org/wiki/Thrombus "Thrombus") that blocks the artery; this can occur in minutes. Blockage of an artery can lead to tissue death in tissue being supplied by that artery.[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73) Atherosclerotic plaques are often present for decades before they result in symptoms.[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73)
The gradual buildup of [cholesterol](https://en.wikipedia.org/wiki/Cholesterol "Cholesterol") and fibrous tissue in plaques in the wall of the [coronary arteries](https://en.wikipedia.org/wiki/Coronary_artery "Coronary artery") or other arteries, typically over decades, is termed [atherosclerosis](https://en.wikipedia.org/wiki/Atherosclerosis "Atherosclerosis").[\[74\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid20065951-74) Atherosclerosis is characterized by progressive inflammation of the walls of the arteries.[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73) Inflammatory cells, particularly [macrophages](https://en.wikipedia.org/wiki/Macrophage "Macrophage"), move into affected arterial walls. Over time, they become laden with cholesterol products, particularly [LDL](https://en.wikipedia.org/wiki/LDL "LDL"), and become [foam cells](https://en.wikipedia.org/wiki/Foam_cell "Foam cell"). A [cholesterol core](https://en.wikipedia.org/wiki/Atheroma "Atheroma") forms as foam cells die. In response to [growth factors](https://en.wikipedia.org/wiki/Growth_factor "Growth factor") secreted by macrophages, [smooth muscle](https://en.wikipedia.org/wiki/Smooth_muscle "Smooth muscle") and other cells move into the plaque and act to stabilize it. A stable plaque may have a thick fibrous cap with [calcification](https://en.wikipedia.org/wiki/Calcification "Calcification"). If there is ongoing inflammation, the cap may be thin or ulcerate. Exposed to the pressure associated with blood flow, plaques, especially those with a thin lining, may rupture and trigger the formation of a blood clot (thrombus).[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73) The cholesterol crystals have been associated with plaque rupture through mechanical injury and inflammation.[\[75\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-75)
### Other causes
Atherosclerotic disease is not the only cause of myocardial infarction, but it may exacerbate or contribute to other causes. A myocardial infarction may result from a heart with a limited blood supply subject to increased oxygen demands, such as in fever, [a fast heart rate](https://en.wikipedia.org/wiki/Tachycardia "Tachycardia"), [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), [too few red blood cells in the bloodstream](https://en.wikipedia.org/wiki/Anemia "Anemia"), or [low blood pressure](https://en.wikipedia.org/wiki/Hypotension "Hypotension"). Damage or failure of procedures such as [percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention") (PCI) or [coronary artery bypass grafts](https://en.wikipedia.org/wiki/Coronary_artery_bypass_graft "Coronary artery bypass graft") (CABG) may cause a myocardial infarction. Spasm of coronary arteries, such as [Prinzmetal's angina](https://en.wikipedia.org/wiki/Prinzmetal%27s_angina "Prinzmetal's angina") may cause blockage.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)
### Tissue death
[](https://en.wikipedia.org/wiki/File:Heart_ant_wall_infarction.jpg)
Cross section showing anterior left ventricle wall infarction
If impaired blood flow to the heart lasts long enough, it triggers a process called the [ischemic cascade](https://en.wikipedia.org/wiki/Ischemic_cascade "Ischemic cascade"); the heart cells in the territory of the blocked coronary artery die ([infarction](https://en.wiktionary.org/wiki/infarction "wikt:infarction")), chiefly through [necrosis](https://en.wikipedia.org/wiki/Necrosis "Necrosis"), and do not grow back. A [collagen](https://en.wikipedia.org/wiki/Collagen "Collagen") [scar](https://en.wikipedia.org/wiki/Scar "Scar") forms in their place.[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73) When an artery is blocked, cells lack [oxygen](https://en.wikipedia.org/wiki/Oxygen "Oxygen"), needed to produce [ATP](https://en.wikipedia.org/wiki/Adenosine_triphosphate "Adenosine triphosphate") in [mitochondria](https://en.wikipedia.org/wiki/Mitochondria "Mitochondria"). ATP is required for the maintenance of electrolyte balance, particularly through the [Na/K ATPase](https://en.wikipedia.org/wiki/Na/K_ATPase "Na/K ATPase"). This leads to an ischemic cascade of intracellular changes, necrosis and [apoptosis](https://en.wikipedia.org/wiki/Apoptosis "Apoptosis") of affected cells.[\[76\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BUJA2005-76)
Cells in the area with the worst blood supply, just below the inner surface of the heart ([endocardium](https://en.wikipedia.org/wiki/Endocardium "Endocardium")), are most susceptible to damage.[\[77\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-77)[\[78\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BOLOOKI2010-78) Ischemia first affects this region, the *subendocardial* region, and tissue begins to die within 15–30 minutes of loss of blood supply.[\[79\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AARONSON2013-79) The dead tissue is surrounded by a zone of potentially reversible ischemia that progresses to become a full-thickness *transmural* infarct.[\[76\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BUJA2005-76)[\[79\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AARONSON2013-79) The initial "wave" of infarction can take place over 3–4 hours.[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73)[\[76\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BUJA2005-76) These changes are seen on [gross pathology](https://en.wikipedia.org/wiki/Gross_pathology "Gross pathology") and cannot be predicted by the presence or absence of Q waves on an ECG.[\[78\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BOLOOKI2010-78) The position, size and extent of an infarct depends on the affected artery, totality of the blockage, duration of the blockage, the presence of [collateral blood vessels](https://en.wikipedia.org/wiki/Collateralization "Collateralization"), oxygen demand, and success of interventional procedures.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)
Tissue death and [myocardial scarring](https://en.wikipedia.org/wiki/Myocardial_scarring "Myocardial scarring") alter the normal conduction pathways of the heart and weaken affected areas. The size and location put a person at risk of [abnormal heart rhythms (arrhythmias)](https://en.wikipedia.org/wiki/Heart_arrhythmia "Heart arrhythmia") or [heart block](https://en.wikipedia.org/wiki/Heart_block "Heart block"), [aneurysm of the heart ventricles](https://en.wikipedia.org/wiki/Ventricular_aneurysm "Ventricular aneurysm"), [inflammation of the heart wall](https://en.wikipedia.org/wiki/Dressler%27s_syndrome "Dressler's syndrome") following infarction, and rupture of the heart wall that can have catastrophic consequences.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[80\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Kutty2013-80)
Injury to the myocardium also occurs during re-perfusion. This might manifest as ventricular arrhythmia. The re-perfusion injury is a consequence of the calcium and sodium uptake from the cardiac cells and the release of oxygen radicals during reperfusion. No-reflow phenomenon—when blood is still unable to be distributed to the affected myocardium despite clearing the occlusion—also contributes to myocardial injury. Topical endothelial swelling is one of many factors contributing to this phenomenon.[\[81\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-KlonerHale-81)
## Diagnosis
Main article: [Diagnosis of myocardial infarction](https://en.wikipedia.org/wiki/Diagnosis_of_myocardial_infarction "Diagnosis of myocardial infarction")
### Criteria
[](https://en.wikipedia.org/wiki/File:Patterns_of_topographic_distribution_of_myocardial_infarction.jpg)
Topographic distribution of MI
A myocardial infarction, according to established consensus, is defined by elevated cardiac [biomarkers](https://en.wikipedia.org/wiki/Biomarkers "Biomarkers") with a rising or falling trend and at least one of the following:[\[82\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-82)
- Symptoms relating to ischemia
- Changes on an [electrocardiogram](https://en.wikipedia.org/wiki/Electrocardiogram "Electrocardiogram") (ECG), such as [ST segment](https://en.wikipedia.org/wiki/ST_segment "ST segment") changes, new [left bundle branch block](https://en.wikipedia.org/wiki/Left_bundle_branch_block "Left bundle branch block"), or pathologic [Q waves](https://en.wikipedia.org/wiki/QRS_complex#Q_wave "QRS complex")
- Changes in the motion of the heart wall on imaging
- Demonstration of a thrombus on [angiogram](https://en.wikipedia.org/wiki/Angiogram "Angiogram") or at [autopsy](https://en.wikipedia.org/wiki/Autopsy "Autopsy").
### Types
See also: [Electrocardiography in myocardial infarction](https://en.wikipedia.org/wiki/Electrocardiography_in_myocardial_infarction "Electrocardiography in myocardial infarction")
"STEMI" redirects here. For the Christian evangelist organization, see [Stephen Tong § Ministry](https://en.wikipedia.org/wiki/Stephen_Tong#Ministry "Stephen Tong").
A myocardial infarction is usually clinically classified as an ST-elevation MI (STEMI) or a non-ST elevation MI (NSTEMI). These are based on [ST elevation](https://en.wikipedia.org/wiki/ST_elevation "ST elevation"), a portion of a heartbeat graphically recorded on an [ECG](https://en.wikipedia.org/wiki/ECG "ECG").[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) STEMIs make up about 25–40% of myocardial infarctions.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) A more explicit classification system, based on international consensus in 2012, also exists. This classifies myocardial infarctions into five types:[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)
1. Spontaneous MI related to plaque erosion and/or rupture fissuring, or dissection
2. MI related to ischemia, such as from increased oxygen demand or decreased supply, e.g., coronary artery spasm, coronary embolism, anemia, arrhythmias, high blood pressure, or low blood pressure
3. Sudden unexpected cardiac death, including cardiac arrest, where symptoms may suggest MI, an ECG may be taken with suggestive changes, or a blood clot is found in a coronary artery by angiography and/or at autopsy, but where blood samples could not be obtained, or at a time before the appearance of cardiac biomarkers in the blood
4. Associated with [coronary angioplasty](https://en.wikipedia.org/wiki/Coronary_angioplasty "Coronary angioplasty") or [stents](https://en.wikipedia.org/wiki/Stent "Stent")
- Associated with [percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention") (PCI)
- Associated with stent thrombosis as documented by angiography or at autopsy
5. Associated with [CABG](https://en.wikipedia.org/wiki/Coronary_artery_bypass_graft "Coronary artery bypass graft")
6. Associated with [spontaneous coronary artery dissection](https://en.wikipedia.org/wiki/Spontaneous_coronary_artery_dissection "Spontaneous coronary artery dissection") in young, fit women
### Cardiac biomarkers
There are many different [biomarkers](https://en.wikipedia.org/wiki/Biomarker "Biomarker") used to determine the presence of cardiac muscle damage. [Troponins](https://en.wikipedia.org/wiki/Troponin "Troponin"), measured through a blood test, are considered to be the best,[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) and are preferred because they have greater [sensitivity and specificity](https://en.wikipedia.org/wiki/Sensitivity_and_specificity "Sensitivity and specificity") for measuring injury to the heart muscle than other tests.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) A rise in troponin occurs within 2–3 hours of injury to the heart muscle, and peaks within 1–2 days. The level of the troponin, as well as a change over time, are useful in measuring and diagnosing or excluding myocardial infarctions, and the diagnostic accuracy of troponin testing is improving over time.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) One high-sensitivity cardiac troponin can rule out a heart attack as long as the ECG is normal.[\[83\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-83)[\[84\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-84)
Other tests, such as [CK-MB](https://en.wikipedia.org/wiki/CK-MB "CK-MB") or [myoglobin](https://en.wikipedia.org/wiki/Myoglobin "Myoglobin"), are discouraged.[\[85\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHANSTEMI2014-85) CK-MB is not as specific as troponins for acute myocardial injury, and may be elevated with past cardiac surgery, inflammation or electrical cardioversion; it rises within 4–8 hours and returns to normal within 2–3 days.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) [Copeptin](https://en.wikipedia.org/wiki/Copeptin "Copeptin") may be useful to rule out MI rapidly when used along with troponin.[\[86\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-86)
### Electrocardiogram
[](https://en.wikipedia.org/wiki/File:Inferior_and_RtV_MI_12_lead.jpg)
A 12-lead ECG showing an inferior STEMI due to reduced perfusion through the [right coronary artery](https://en.wikipedia.org/wiki/Right_coronary_artery "Right coronary artery"). Elevation of the [ST segment](https://en.wikipedia.org/wiki/ST_segment "ST segment") can be seen in leads II, III and aVF.
An [electrocardiogram](https://en.wikipedia.org/wiki/Electrocardiogram "Electrocardiogram") (ECGs) is a series of electrodes placed on a person's chest that measure electrical activity associated with contraction of the heart muscle.[\[87\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010C-87) The taking of an ECG is an important part of the workup of an AMI,[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) and ECGs are often not just taken once but may be repeated over minutes to hours, or in response to changes in signs or symptoms.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)
ECG readouts produce a waveform with different labeled features.[\[87\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010C-87) In addition to a rise in biomarkers, a rise in the [ST segment](https://en.wikipedia.org/wiki/ST_segment "ST segment"), changes in the shape or flipping of [T waves](https://en.wikipedia.org/wiki/T_wave "T wave"), new [Q waves](https://en.wikipedia.org/wiki/QRS_complex#Q_wave "QRS complex"), or a new [left bundle branch block](https://en.wikipedia.org/wiki/Left_bundle_branch_block "Left bundle branch block") can be used to diagnose an AMI.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) In addition, [ST elevation](https://en.wikipedia.org/wiki/ST_elevation "ST elevation") can be used to diagnose an ST segment myocardial infarction (STEMI). A rise must be new in V2 and V3 ≥2 mm (0,2 mV) for males or ≥1.5 mm (0.15 mV) for females or ≥1 mm (0.1 mV) in two other [adjacent chest or limb leads](https://en.wikipedia.org/wiki/Contiguous_leads "Contiguous leads").[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19)[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) ST elevation is associated with infarction, and may be preceded by changes indicating ischemia, such as ST depression or inversion of the T waves.[\[87\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010C-87) Abnormalities can help differentiate the location of an infarct, based on the leads that are affected by changes.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Early STEMIs may be preceded by peaked T waves.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) Other ECG abnormalities relating to complications of acute myocardial infarctions may also be evident, such as [atrial](https://en.wikipedia.org/wiki/Atrial_fibrillation "Atrial fibrillation") or [ventricular fibrillation](https://en.wikipedia.org/wiki/Ventricular_fibrillation "Ventricular fibrillation").[\[88\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-88)
### Imaging
[](https://en.wikipedia.org/wiki/File:ECG_V2-4_ST_change.jpg)
ECG: AMI with ST elevation in V2-4
Noninvasive imaging plays an important role in the diagnosis and characterisation of myocardial infarction.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) Tests such as [chest X-rays](https://en.wikipedia.org/wiki/Chest_X-ray "Chest X-ray") can be used to explore and exclude alternate causes of a person's symptoms.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) [Echocardiography](https://en.wikipedia.org/wiki/Echocardiography "Echocardiography") may assist in modifying clinical suspicion of ongoing myocardial infarction in patients that can't be ruled out or ruled in following initial [ECG](https://en.wikipedia.org/wiki/Electrocardiography "Electrocardiography") and [Troponin](https://en.wikipedia.org/wiki/Troponin "Troponin") testing.[\[89\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-auto-89) [Myocardial perfusion imaging](https://en.wikipedia.org/wiki/Myocardial_perfusion_imaging "Myocardial perfusion imaging") has no role in the acute diagnostic algorithm; however, it can confirm a clinical suspicion of Chronic Coronary Syndrome when the patient's history, [physical examination](https://en.wikipedia.org/wiki/Physical_examination "Physical examination") (including [cardiac examination](https://en.wikipedia.org/wiki/Cardiac_examination "Cardiac examination")) ECG, and cardiac biomarkers suggest coronary artery disease.[\[90\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WISELY2017-90)
[Echocardiography](https://en.wikipedia.org/wiki/Echocardiography "Echocardiography"), an [ultrasound](https://en.wikipedia.org/wiki/Ultrasound "Ultrasound") scan of the heart, is able to visualize the heart, its size, shape, and any abnormal motion of the heart walls as they beat that may indicate a myocardial infarction. The flow of blood can be imaged, and [contrast dyes](https://en.wikipedia.org/wiki/Contrast_dye "Contrast dye") may be given to improve image.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) Other scans using [radioactive](https://en.wikipedia.org/wiki/Radioactive "Radioactive") contrast include [SPECT](https://en.wikipedia.org/wiki/SPECT "SPECT") [CT-scans](https://en.wikipedia.org/wiki/CT-scans "CT-scans") using [thallium](https://en.wikipedia.org/wiki/Thallium_chloride "Thallium chloride"), [sestamibi](https://en.wikipedia.org/wiki/Technetium_\(99mTc\)_sestamibi "Technetium (99mTc) sestamibi") ([MIBI scans](https://en.wikipedia.org/wiki/MIBI_scan "MIBI scan")) or [tetrofosmin](https://en.wikipedia.org/wiki/Tetrofosmin "Tetrofosmin"); or a [PET scan](https://en.wikipedia.org/wiki/PET_scan "PET scan") using [Fludeoxyglucose](https://en.wikipedia.org/wiki/Fludeoxyglucose_\(18F\) "Fludeoxyglucose (18F)") or [rubidium-82](https://en.wikipedia.org/wiki/Rubidium-82 "Rubidium-82").[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) These [nuclear medicine](https://en.wikipedia.org/wiki/Nuclear_medicine "Nuclear medicine") scans can visualize the perfusion of heart muscle.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) SPECT may also be used to determine viability of tissue, and whether areas of ischemia are inducible.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)[\[91\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-91)
Medical societies and professional guidelines recommend that the physician confirm a person is at high risk for Chronic Coronary Syndrome before conducting diagnostic non-invasive imaging tests to make a diagnosis,[\[90\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WISELY2017-90)[\[92\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG94-92)[\[89\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-auto-89) as such tests are unlikely to change management and result in increased costs.[\[90\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WISELY2017-90) Patients who have a normal ECG and who are able to exercise, for example, most likely do not merit routine imaging.[\[90\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WISELY2017-90)
- Poor movement of the heart due to an MI as seen on ultrasound[\[93\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-UOTW36-93)
- Pulmonary edema due to an MI as seen on ultrasound[\[93\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-UOTW36-93)
### Differential diagnosis
There are many causes of [chest pain](https://en.wikipedia.org/wiki/Chest_pain "Chest pain"), which can originate from the heart, [lungs](https://en.wikipedia.org/wiki/Lung "Lung"), [gastrointestinal tract](https://en.wikipedia.org/wiki/Gastrointestinal_tract "Gastrointestinal tract"), [aorta](https://en.wikipedia.org/wiki/Aorta "Aorta"), and other muscles, bones and nerves surrounding the chest.[\[94\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010D-94) In addition to myocardial infarction, other causes include [angina](https://en.wikipedia.org/wiki/Angina_pectoris "Angina pectoris"), insufficient blood supply ([ischemia](https://en.wikipedia.org/wiki/Ischemia "Ischemia")) to the heart muscles without evidence of cell death, [gastroesophageal reflux disease](https://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease "Gastroesophageal reflux disease"); [pulmonary embolism](https://en.wikipedia.org/wiki/Pulmonary_embolism "Pulmonary embolism"), tumors of the lungs, [pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia"), [rib fracture](https://en.wikipedia.org/wiki/Rib_fracture "Rib fracture"), [costochondritis](https://en.wikipedia.org/wiki/Costochondritis "Costochondritis"), [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure") and other musculoskeletal injuries.[\[94\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010D-94)[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) Rarer severe differential diagnoses include [aortic dissection](https://en.wikipedia.org/wiki/Aortic_dissection "Aortic dissection"), [esophageal rupture](https://en.wikipedia.org/wiki/Esophageal_rupture "Esophageal rupture"), [tension pneumothorax](https://en.wikipedia.org/wiki/Tension_pneumothorax "Tension pneumothorax"), and [pericardial effusion](https://en.wikipedia.org/wiki/Pericardial_effusion "Pericardial effusion") causing [cardiac tamponade](https://en.wikipedia.org/wiki/Cardiac_tamponade "Cardiac tamponade").[\[95\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid16199332-95) The chest pain in an MI may mimic [heartburn](https://en.wikipedia.org/wiki/Heartburn "Heartburn").[\[41\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-ESC_STEMI-41) Causes of sudden-onset [breathlessness](https://en.wikipedia.org/wiki/Breathlessness "Breathlessness") generally involve the lungs or heart – including [pulmonary edema](https://en.wikipedia.org/wiki/Pulmonary_edema "Pulmonary edema"), pneumonia, [allergic](https://en.wikipedia.org/wiki/Allergy "Allergy") reactions and [asthma](https://en.wikipedia.org/wiki/Asthma "Asthma"), and pulmonary embolus, [acute respiratory distress syndrome](https://en.wikipedia.org/wiki/ARDS "ARDS") and [metabolic acidosis](https://en.wikipedia.org/wiki/Metabolic_acidosis "Metabolic acidosis").[\[94\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010D-94) There are many different causes of fatigue, and myocardial infarction is not a common cause.[\[96\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-96)
## Prevention
There is a large crossover between the lifestyle and activity recommendations to prevent a myocardial infarction, and those that may be adopted as [secondary prevention](https://en.wikipedia.org/wiki/Secondary_prevention "Secondary prevention") after an initial myocardial infarction,[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) because of shared risk factors and an aim to reduce atherosclerosis affecting heart vessels.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) The [influenza vaccine](https://en.wikipedia.org/wiki/Influenza_vaccine "Influenza vaccine") also appears to protect against myocardial infarction with a benefit of 15 to 45%.[\[97\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-97)
### Primary prevention
#### Lifestyle
Physical activity can reduce the risk of cardiovascular disease, and people at risk are advised to engage in 150 minutes of moderate or 75 minutes of vigorous intensity [aerobic exercise](https://en.wikipedia.org/wiki/Aerobic_exercise "Aerobic exercise") a week.[\[98\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG181-98) Keeping a healthy weight, drinking alcohol within the recommended limits, and [quitting smoking](https://en.wikipedia.org/wiki/Smoking_cessation "Smoking cessation") reduce the risk of cardiovascular disease.[\[98\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG181-98)
Substituting [unsaturated fats](https://en.wikipedia.org/wiki/Unsaturated_fat "Unsaturated fat") such as [olive oil](https://en.wikipedia.org/wiki/Olive_oil "Olive oil") and [rapeseed oil](https://en.wikipedia.org/wiki/Rapeseed_oil "Rapeseed oil") instead of saturated fats may reduce the risk of myocardial infarction,[\[50\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-:1-50) although there is not universal agreement.[\[51\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Chow2014-51) Dietary modifications are recommended by some national authorities, with recommendations including increasing the intake of wholegrain starch, reducing sugar intake (particularly of refined sugar), consuming five portions of fruit and vegetables daily, consuming two or more portions of fish per week, and consuming 4–5 portions of unsalted [nuts](https://en.wikipedia.org/wiki/Nut_\(fruit\) "Nut (fruit)"), [seeds](https://en.wikipedia.org/wiki/Seed "Seed"), or [legumes](https://en.wikipedia.org/wiki/Legume "Legume") per week.[\[98\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG181-98) The dietary pattern with the greatest support is the [Mediterranean diet](https://en.wikipedia.org/wiki/Mediterranean_diet "Mediterranean diet").[\[99\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-99) [Vitamins](https://en.wikipedia.org/wiki/Vitamin "Vitamin") and mineral supplements are of no proven benefit,[\[100\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-100) and neither are plant [stanols](https://en.wikipedia.org/wiki/Stanol "Stanol") or [sterols](https://en.wikipedia.org/wiki/Phytosterol "Phytosterol").[\[98\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG181-98)
[Public health](https://en.wikipedia.org/wiki/Public_health "Public health") measures may also act at a population level to reduce the risk of myocardial infarction, for example by reducing unhealthy diets (excessive salt, saturated fat, and trans-fat) including food labeling and marketing requirements as well as requirements for catering and restaurants and stimulating physical activity. This may be part of regional cardiovascular disease prevention programs or through the [health impact assessment](https://en.wikipedia.org/wiki/Health_impact_assessment "Health impact assessment") of regional and local plans and policies.[\[101\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICEPH25-101)
Most guidelines recommend combining different preventive strategies. A 2015 Cochrane Review found some evidence that such an approach might help with [blood pressure](https://en.wikipedia.org/wiki/Blood_pressure "Blood pressure"), [body mass index](https://en.wikipedia.org/wiki/Body_mass_index "Body mass index") and [waist circumference](https://en.wikipedia.org/wiki/Waist_circumference "Waist circumference"). However, there was insufficient evidence to show an effect on mortality or actual cardio-vascular events.[\[102\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-102)
#### Medication
[Statins](https://en.wikipedia.org/wiki/Statin "Statin"), drugs that act to lower blood cholesterol, decrease the incidence and mortality rates of myocardial infarctions.[\[103\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-103) They are often recommended in those at an elevated risk of cardiovascular diseases.[\[98\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG181-98)
[Aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin") has been studied extensively in people considered at increased risk of myocardial infarction. Based on numerous studies in different groups (e.g. people with or without diabetes), there does not appear to be a benefit strong enough to outweigh the risk of excessive bleeding.[\[104\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-ATTaspirin2009-104)[\[105\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-105) Nevertheless, many [clinical practice guidelines](https://en.wikipedia.org/wiki/Clinical_practice_guideline "Clinical practice guideline") continue to recommend aspirin for primary prevention,[\[106\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-106) and some researchers feel that those with very high cardiovascular risk but low risk of bleeding should continue to receive aspirin.[\[107\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-107)
### Secondary prevention
There is a large crossover between the lifestyle and activity recommendations to prevent a myocardial infarction, and those that may be adopted as [secondary prevention](https://en.wikipedia.org/wiki/Secondary_prevention "Secondary prevention") after an initial myocardial infarct.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Recommendations include [stopping smoking](https://en.wikipedia.org/wiki/Smoking_cessation "Smoking cessation"), a gradual return to exercise, eating a healthy [diet](https://en.wikipedia.org/wiki/Diet_\(nutrition\) "Diet (nutrition)"), low in [saturated fat](https://en.wikipedia.org/wiki/Saturated_fat "Saturated fat") and low in [cholesterol](https://en.wikipedia.org/wiki/Cholesterol "Cholesterol"), [drinking alcohol within recommended limits](https://en.wikipedia.org/wiki/Alcohol_consumption_recommendations "Alcohol consumption recommendations"), exercising, and trying to achieve a healthy weight.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108) Exercise is both safe and effective even if people have had stents or heart failure,[\[109\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-109) and is recommended to start gradually after 1–2 weeks.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Counselling should be provided relating to medications used, and for warning signs of depression.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Previous studies suggested a benefit from [omega-3 fatty acid](https://en.wikipedia.org/wiki/Omega-3_fatty_acid "Omega-3 fatty acid") supplementation but this has not been confirmed.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108)
#### Medications
Following a heart attack, nitrates, when taken for two days, and [ACE-inhibitors](https://en.wikipedia.org/wiki/ACE_inhibitor "ACE inhibitor") decrease the risk of death.[\[110\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-110) Other medications include:
[Aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin") is continued indefinitely, as well as another antiplatelet agent such as clopidogrel or ticagrelor ("dual antiplatelet therapy" or DAPT) for up to twelve months.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108) If someone has another medical condition that requires anticoagulation (e.g. with [warfarin](https://en.wikipedia.org/wiki/Warfarin "Warfarin")) this may need to be adjusted based on risk of further cardiac events as well as bleeding risk.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108) In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death.[\[111\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-111)
[Beta blocker](https://en.wikipedia.org/wiki/Beta_blocker "Beta blocker") therapy such as [metoprolol](https://en.wikipedia.org/wiki/Metoprolol "Metoprolol") or [carvedilol](https://en.wikipedia.org/wiki/Carvedilol "Carvedilol") is recommended to be started within 24 hours, provided there is no acute heart failure or [heart block](https://en.wikipedia.org/wiki/Heart_block "Heart block").[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19)[\[85\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHANSTEMI2014-85) The dose should be increased to the highest tolerated.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108) Contrary to most guidelines, the use of beta blockers does not appear to affect the risk of death,[\[112\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-112)[\[113\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-113) possibly because other treatments for MI have improved. When beta blocker medication is given within the first 24–72 hours of a STEMI no lives are saved. However, 1 in 200 people were prevented from a repeat heart attack, and another 1 in 200 from having an abnormal heart rhythm. Additionally, for 1 in 91 the medication causes a [temporary decrease in the heart's ability to pump blood](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock").[\[114\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BetaNNT2015-114)
[ACE inhibitor](https://en.wikipedia.org/wiki/ACE_inhibitor "ACE inhibitor") therapy should be started within 24 hours and continued indefinitely at the highest tolerated dose. This is provided there is no evidence of worsening [kidney failure](https://en.wikipedia.org/wiki/Kidney_failure "Kidney failure"), [high potassium](https://en.wikipedia.org/wiki/Hyperkalaemia "Hyperkalaemia"), low blood pressure, or known narrowing of the [renal arteries](https://en.wikipedia.org/wiki/Renal_artery "Renal artery").[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Those who cannot tolerate ACE inhibitors may be treated with an [angiotensin II receptor antagonist](https://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonist "Angiotensin II receptor antagonist").[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108)
[Statin](https://en.wikipedia.org/wiki/Statin "Statin") therapy has been shown to reduce mortality and subsequent cardiac events and should be commenced to lower LDL cholesterol. Other medications, such as [ezetimibe](https://en.wikipedia.org/wiki/Ezetimibe "Ezetimibe"), may also be added with this goal in mind.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)
[Aldosterone antagonists](https://en.wikipedia.org/wiki/Aldosterone_antagonist "Aldosterone antagonist") ([spironolactone](https://en.wikipedia.org/wiki/Spironolactone "Spironolactone") or [eplerenone](https://en.wikipedia.org/wiki/Eplerenone "Eplerenone")) may be used if there is evidence of left ventricular dysfunction after an MI, ideally after beginning treatment with an ACE inhibitor.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108)[\[115\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid26891235-115)
#### Other
A [defibrillator](https://en.wikipedia.org/wiki/Defibrillator "Defibrillator"), an electric device connected to the heart and surgically inserted under the skin, may be recommended. This is particularly if there are any ongoing signs of heart failure, with a low [left ventricular ejection fraction](https://en.wikipedia.org/wiki/LVEF "LVEF") and a New York Heart Association grade II or III after 40 days of the infarction.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Defibrillators detect potentially fatal arrhythmia and deliver an electrical shock to the person to depolarize a critical mass of the heart muscle.[\[116\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Hazinski2015-116)
## Management
Main article: [Management of acute coronary syndrome](https://en.wikipedia.org/wiki/Management_of_acute_coronary_syndrome "Management of acute coronary syndrome")
A myocardial infarction requires immediate medical attention. Treatment aims to preserve as much heart muscle as possible, and to prevent further complications.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Treatment depends on whether the myocardial infarction is a STEMI or NSTEMI.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Treatment in general aims to unblock blood vessels, reduce blood clot enlargement, reduce ischemia, and modify risk factors with the aim of preventing future MIs.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) In addition, the main treatment for myocardial infarctions with ECG evidence of ST elevation (STEMI) include [thrombolysis](https://en.wikipedia.org/wiki/Thrombolysis "Thrombolysis") or [percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention"), although PCI is also ideally conducted within 1–3 days for NSTEMI.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) In addition to [clinical judgement](https://en.wikipedia.org/wiki/Clinical_judgement "Clinical judgement"), risk stratification may be used to guide treatment, such as with the [TIMI](https://en.wikipedia.org/wiki/TIMI_Risk_Score "TIMI Risk Score") and [GRACE](https://en.wikipedia.org/w/index.php?title=GRACE_Risk_Score&action=edit&redlink=1 "GRACE Risk Score (page does not exist)") scoring systems.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[117\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-117)
### Pain
The pain associated with myocardial infarction is often treated with [nitroglycerin](https://en.wikipedia.org/wiki/Nitroglycerin_\(medication\) "Nitroglycerin (medication)"), a [vasodilator](https://en.wikipedia.org/wiki/Vasodilator "Vasodilator"), or [opioid](https://en.wikipedia.org/wiki/Opioid "Opioid") medications such as [morphine](https://en.wikipedia.org/wiki/Morphine "Morphine").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Nitroglycerin (given [under the tongue](https://en.wikipedia.org/wiki/Sublingual_administration "Sublingual administration") or [injected into a vein](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy")) may improve blood supply to the heart.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) It is an important part of therapy for its pain relief effects, though there is no proven benefit to [mortality](https://en.wikipedia.org/wiki/Case_fatality_rate "Case fatality rate").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[118\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-118) Morphine or other opioid medications may also be used, and are effective for the pain associated with STEMI.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) There is poor evidence that morphine shows any benefit to [overall outcomes](https://en.wikipedia.org/wiki/Outcome_measure "Outcome measure"), and there is some evidence of potential harm.[\[119\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-119)[\[120\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-120)
### Antithrombotics
[Aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin"), an [antiplatelet drug](https://en.wikipedia.org/wiki/Antiplatelet_drug "Antiplatelet drug"), is given as a [loading dose](https://en.wikipedia.org/wiki/Loading_dose "Loading dose") to reduce the clot size and reduce further clotting in the affected artery.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) It is known to decrease mortality associated with acute myocardial infarction by at least 50%.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [P2Y12 inhibitors](https://en.wikipedia.org/wiki/P2Y12_inhibitors "P2Y12 inhibitors") such as [clopidogrel](https://en.wikipedia.org/wiki/Clopidogrel "Clopidogrel"), [prasugrel](https://en.wikipedia.org/wiki/Prasugrel "Prasugrel") and [ticagrelor](https://en.wikipedia.org/wiki/Ticagrelor "Ticagrelor") are given concurrently, also as a loading dose, with the dose depending on whether further surgical management or fibrinolysis is planned.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Prasugrel and ticagrelor are recommended in European and American guidelines, as they are active more quickly and consistently than clopidogrel.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) P2Y12 inhibitors are recommended in both NSTEMI and STEMI, including in PCI, with evidence also to suggest improved mortality.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Heparins](https://en.wikipedia.org/wiki/Heparin "Heparin"), particularly in the unfractionated form, act at several points in the [clotting cascade](https://en.wikipedia.org/wiki/Clotting_cascade "Clotting cascade"), help to prevent the enlargement of a clot, and are also given in myocardial infarction, owing to evidence suggesting improved mortality rates.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) In very high-risk scenarios, [inhibitors of the platelet glycoprotein αIIbβ3a receptor](https://en.wikipedia.org/wiki/Glycoprotein_IIb/IIIa_inhibitors "Glycoprotein IIb/IIIa inhibitors") such as [eptifibatide](https://en.wikipedia.org/wiki/Eptifibatide "Eptifibatide") or [tirofiban](https://en.wikipedia.org/wiki/Tirofiban "Tirofiban") may be used.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)
There is varying evidence on the mortality benefits in NSTEMI. A 2014 review of P2Y12 inhibitors such as [clopidogrel](https://en.wikipedia.org/wiki/Clopidogrel "Clopidogrel") found they do not change the risk of death when given to people with a suspected NSTEMI prior to PCI,[\[121\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BMJP2Y12-121) nor do heparins change the risk of death.[\[122\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-And2014-122) They do decrease the risk of having a further myocardial infarction.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[122\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-And2014-122)
### Angiogram
[](https://en.wikipedia.org/wiki/File:Myocardial_infarction.svg)
Inserting a stent to widen the artery
Primary [percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention") (PCI) is the treatment of choice for STEMI if it can be performed in a timely manner, ideally within 90–120 minutes of contact with a medical provider.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[123\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Bagai2014-123) Some recommend it is also done in NSTEMI within 1–3 days, particularly when considered high-risk.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) A 2017 review, however, did not find a difference between early versus later PCI in NSTEMI.[\[124\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-124)
PCI involves small probes, inserted through peripheral blood vessels such as the [femoral artery](https://en.wikipedia.org/wiki/Femoral_artery "Femoral artery") or [radial artery](https://en.wikipedia.org/wiki/Radial_artery "Radial artery") into the blood vessels of the heart. The probes are then used to identify and clear blockages [using small balloons](https://en.wikipedia.org/wiki/Balloon_angioplasty "Balloon angioplasty"), which are dragged through the blocked segment, [dragging away the clot](https://en.wikipedia.org/wiki/Aspiration_thrombectomy "Aspiration thrombectomy"), or [the insertion of stents](https://en.wikipedia.org/wiki/Coronary_stenting "Coronary stenting").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Coronary artery bypass grafting](https://en.wikipedia.org/wiki/Coronary_artery_bypass_grafting "Coronary artery bypass grafting") is only considered when the affected area of heart muscle is large, and PCI is unsuitable, for example with difficult cardiac anatomy.[\[125\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-125) After PCI, people are generally placed on [aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin") indefinitely and on dual antiplatelet therapy (generally aspirin and [clopidogrel](https://en.wikipedia.org/wiki/Clopidogrel "Clopidogrel")) for at least a year.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[126\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-126)
### Fibrinolysis
Main article: [Thrombolysis](https://en.wikipedia.org/wiki/Thrombolysis "Thrombolysis")
If PCI cannot be performed within 90 to 120 minutes in STEMI then fibrinolysis, preferably within 30 minutes of arrival to hospital, is recommended.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[127\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-127) If a person has had symptoms for 12 to 24 hours evidence for effectiveness of thrombolysis is less and if they have had symptoms for more than 24 hours it is not recommended.[\[128\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-128) Thrombolysis involves the administration of medication that activates the [enzymes that normally dissolve blood clots](https://en.wikipedia.org/wiki/Fibrinolysis "Fibrinolysis"). These medications include [tissue plasminogen activator](https://en.wikipedia.org/wiki/Tissue_plasminogen_activator "Tissue plasminogen activator"), [reteplase](https://en.wikipedia.org/wiki/Reteplase "Reteplase"), [streptokinase](https://en.wikipedia.org/wiki/Streptokinase "Streptokinase"), and [tenecteplase](https://en.wikipedia.org/wiki/Tenecteplase "Tenecteplase").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Thrombolysis is not recommended in a number of situations, particularly when associated with a high risk of bleeding or the potential for problematic bleeding, such as active bleeding, past [strokes](https://en.wikipedia.org/wiki/Stroke "Stroke") or bleeds into the brain, or severe [hypertension](https://en.wikipedia.org/wiki/Hypertension "Hypertension"). Situations in which thrombolysis may be considered, but with caution, include recent surgery, use of anticoagulants, pregnancy, and proclivity to bleeding.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Major risks of thrombolysis are major bleeding and [intracranial bleeding](https://en.wikipedia.org/wiki/Intracranial_bleed "Intracranial bleed").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Pre-hospital thrombolysis reduces time to thrombolytic treatment, based on studies conducted in higher income countries; however, it is unclear whether this has an impact on mortality rates.[\[129\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-mccaul-129)
### Other
In the past, high flow oxygen was recommended for everyone with a possible myocardial infarction.[\[85\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHANSTEMI2014-85) More recently, no evidence was found for routine use in those with normal oxygen levels and there is potential harm from the intervention.[\[130\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-130)[\[131\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-131)[\[132\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-132)[\[133\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-133)[\[134\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-134) Therefore, oxygen is currently only recommended if oxygen levels are found to be low or if someone is in respiratory distress.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[85\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHANSTEMI2014-85)
If despite thrombolysis there is significant [cardiogenic shock](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock"), continued severe chest pain, or less than a 50% improvement in [ST elevation](https://en.wikipedia.org/wiki/ST_elevation "ST elevation") on the ECG recording after 90 minutes, then rescue PCI is indicated emergently.[\[135\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Wang2011-135)[\[136\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-136)
Those who have had [cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest") may benefit from [targeted temperature management](https://en.wikipedia.org/wiki/Targeted_temperature_management "Targeted temperature management") with evaluation for implementation of hypothermia protocols. Furthermore, those with cardiac arrest, and ST elevation at any time, should usually have angiography.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) [Aldosterone antagonists](https://en.wikipedia.org/wiki/Aldosterone_antagonists "Aldosterone antagonists") appear to be useful in people who have had an STEMI and do not have heart failure.[\[137\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-137)
### Rehabilitation and exercise
[Cardiac rehabilitation](https://en.wikipedia.org/wiki/Cardiopulmonary_rehabilitation "Cardiopulmonary rehabilitation") benefits many who have experienced myocardial infarction,[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) even if there has been substantial heart damage and resultant [left ventricular failure](https://en.wikipedia.org/wiki/Left_ventricular_failure "Left ventricular failure"). It should start soon after discharge from the hospital. The program may include lifestyle advice, exercise, social support, as well as recommendations about driving, flying, sports participation, stress management, and sexual intercourse.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108) Returning to sexual activity after myocardial infarction is a major concern for most patients, and is an important area to be discussed in the provision of holistic care.[\[138\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-138)[\[139\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid20168196-139)
In the short-term, exercise-based cardiovascular rehabilitation programs may reduce the risk of a myocardial infarction, reduces a large number of hospitalizations from all causes, reduces hospital costs, improves [health-related quality of life](https://en.wikipedia.org/wiki/Health_related_quality_of_life "Health related quality of life"), and has a small effect on [all-cause mortality](https://en.wikipedia.org/wiki/All-cause_mortality "All-cause mortality").[\[140\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-140) Longer-term studies indicate that exercise-based cardiovascular rehabilitation programs may reduce cardiovascular mortality and myocardial infarction.
## Prognosis
The prognosis after myocardial infarction varies greatly depending on the extent and location of the affected heart muscle, and the development and management of complications.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Prognosis is worse with older age and social isolation.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Anterior infarcts, persistent ventricular tachycardia or fibrillation, development of [heart blocks](https://en.wikipedia.org/wiki/Heart_block "Heart block"), and left ventricular impairment are all associated with poorer prognosis.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Without treatment, about a quarter of those affected by MI die within minutes and about forty percent within the first month.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Morbidity and mortality from myocardial infarction has, however, improved over the years due to earlier and better treatment:[\[30\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015B-30) in those who have a STEMI in the United States, between 5 and 6 percent die before leaving the hospital and 7 to 18 percent die within a year.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19)
It is unusual for babies to experience a myocardial infarction, but when they do, about half die.[\[141\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-:0-141) In the short-term, neonatal survivors seem to have a normal quality of life.[\[141\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-:0-141)
### Complications
Main article: [Myocardial infarction complications](https://en.wikipedia.org/wiki/Myocardial_infarction_complications "Myocardial infarction complications")
Complications may occur immediately following the myocardial infarction or may take time to develop. [Disturbances of heart rhythms](https://en.wikipedia.org/wiki/Heart_arrhythmia "Heart arrhythmia"), including [atrial fibrillation](https://en.wikipedia.org/wiki/Atrial_fibrillation "Atrial fibrillation"), [ventricular tachycardia](https://en.wikipedia.org/wiki/Ventricular_tachycardia "Ventricular tachycardia") and [fibrillation](https://en.wikipedia.org/wiki/Ventricular_fibrillation "Ventricular fibrillation") and [heart block](https://en.wikipedia.org/wiki/Heart_block "Heart block") can arise as a result of ischemia, cardiac scarring, and infarct location.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Stroke](https://en.wikipedia.org/wiki/Stroke "Stroke") is also a risk, either as a result of [clots](https://en.wikipedia.org/wiki/Arterial_embolism "Arterial embolism") transmitted from the heart during PCI, as a result of bleeding following anticoagulation, or as a result of disturbances in the heart's ability to pump effectively as a result of the infarction.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Regurgitation of blood through the mitral valve](https://en.wikipedia.org/wiki/Mitral_regurgitation "Mitral regurgitation") is possible, particularly if the infarction causes dysfunction of the papillary muscle.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Cardiogenic shock](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock") as a result of the heart being unable to adequately pump blood may develop, dependent on infarct size, and is most likely to occur within the days following an acute myocardial infarction. Cardiogenic shock is the largest cause of in-hospital mortality.[\[30\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015B-30)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Rupture of the ventricular dividing wall or left ventricular wall may occur within the initial weeks.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Dressler's syndrome](https://en.wikipedia.org/wiki/Dressler%27s_syndrome "Dressler's syndrome"), a reaction following larger infarcts and a cause of [pericarditis](https://en.wikipedia.org/wiki/Pericarditis "Pericarditis") is also possible.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)
[Heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure") may develop as a long-term consequence, with an impaired ability of heart muscle to pump, scarring, and an increase in the size of the existing muscle. [Aneurysm of the left ventricle myocardium](https://en.wikipedia.org/wiki/Ventricular_aneurysm "Ventricular aneurysm") develops in about 10% of MI and is itself a risk factor for heart failure, ventricular arrhythmia, and the development of [clots](https://en.wikipedia.org/wiki/Embolism "Embolism").[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16)
Risk factors for complications and death include age, [hemodynamic](https://en.wikipedia.org/wiki/Hemodynamics "Hemodynamics") parameters (such as [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), [cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest") on admission, [systolic](https://en.wikipedia.org/wiki/Systole_\(medicine\) "Systole (medicine)") [blood pressure](https://en.wikipedia.org/wiki/Blood_pressure "Blood pressure"), or [Killip class](https://en.wikipedia.org/wiki/Killip_class "Killip class") of two or greater), ST-segment deviation, diabetes, serum [creatinine](https://en.wikipedia.org/wiki/Creatinine "Creatinine"), [peripheral vascular disease](https://en.wikipedia.org/wiki/Peripheral_artery_occlusive_disease "Peripheral artery occlusive disease"), and elevation of cardiac markers.[\[142\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-PEPA-142)[\[143\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-GRACE-143)[\[144\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Weir-2006-144)
## Epidemiology
Myocardial infarction is a common presentation of [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease"). The [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease;[\[145\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WHO-2004-145) with it being the leading cause of death in high- or middle-income countries and second only to [lower respiratory infections](https://en.wikipedia.org/wiki/Lower_respiratory_tract_infection "Lower respiratory tract infection") in [lower-income countries](https://en.wikipedia.org/wiki/Developing_country "Developing country").[\[145\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WHO-2004-145) Worldwide, more than 3 million people have STEMIs and 4 million have NSTEMIs a year.[\[18\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Lancet08-18) STEMIs occur about twice as often in men as women.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19)
Rates of death from ischemic heart disease (IHD) have slowed or declined in most high-income countries, although cardiovascular disease still accounted for one in three of all deaths in the US in 2008.[\[146\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-146) For example, rates of death from cardiovascular disease have decreased almost a third between 2001 and 2011 in the United States.[\[147\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-147)
In contrast, IHD is becoming a more common cause of death in the developing world. For example, in [India](https://en.wikipedia.org/wiki/India "India"), IHD had become the leading cause of death by 2004, accounting for 1.46 million deaths (14% of total deaths) and deaths due to IHD were expected to double during 1985–2015.[\[148\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-148) Globally, [disability adjusted life years](https://en.wikipedia.org/wiki/Disability_adjusted_life_year "Disability adjusted life year") (DALYs) lost to ischemic heart disease are predicted to account for 5.5% of total DALYs in 2030, making it the second-most-important cause of disability (after [unipolar depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder")), as well as the leading cause of death by this date.[\[145\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WHO-2004-145)
## Social determinants of health
| | |
|---|---|
|  | The examples and perspective in this section **may not represent a [worldwide view](https://en.wikipedia.org/wiki/Wikipedia:WikiProject_Countering_systemic_bias "Wikipedia:WikiProject Countering systemic bias") of the subject**. You may [improve this section](https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&action=edit), discuss the issue on the [talk page](https://en.wikipedia.org/wiki/Talk:Myocardial_infarction "Talk:Myocardial infarction"), or create a new section, as appropriate. *(October 2024)* *([Learn how and when to remove this message](https://en.wikipedia.org/wiki/Help:Maintenance_template_removal "Help:Maintenance template removal"))* |
Social determinants such as [neighborhood](https://en.wikipedia.org/wiki/Neighbourhood "Neighbourhood") disadvantage, [immigration](https://en.wikipedia.org/wiki/Immigration "Immigration") status, lack of [social support](https://en.wikipedia.org/wiki/Social_support "Social support"), [social isolation](https://en.wikipedia.org/wiki/Social_isolation "Social isolation"), and access to [health services](https://en.wikipedia.org/wiki/Health_care "Health care") play an important role in myocardial infarction risk and survival.[\[149\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-149)[\[150\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-150)[\[151\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-151)[\[152\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-152) Studies have shown that low [socioeconomic status](https://en.wikipedia.org/wiki/Socioeconomic_status "Socioeconomic status") is associated with an increased risk of poorer survival. There are well-documented disparities in myocardial infarction survival by socioeconomic status, [race](https://en.wikipedia.org/wiki/Race_and_ethnicity_in_the_United_States "Race and ethnicity in the United States"), [education](https://en.wikipedia.org/wiki/Education "Education"), and census-tract-level [poverty](https://en.wikipedia.org/wiki/Poverty "Poverty").[\[153\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-153)
Race: In the U.S. [African Americans](https://en.wikipedia.org/wiki/African_Americans "African Americans") have a greater burden of myocardial infarction and other cardiovascular events. On a population level, there is a higher overall [prevalence](https://en.wikipedia.org/wiki/Prevalence "Prevalence") of risk factors that are unrecognized and therefore not treated, which places these individuals at a greater likelihood of experiencing adverse outcomes and therefore potentially higher [morbidity](https://en.wikipedia.org/wiki/Morbidity "Morbidity") and [mortality](https://en.wikipedia.org/wiki/Mortality_rate "Mortality rate").[\[154\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-154) Similarly, South Asians (including South Asians that have migrated to other countries around the world) experience higher rates of acute myocardial infarctions at younger ages, which can be largely explained by a higher prevalence of risk factors at younger ages.[\[155\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-155)
Socioeconomic status: Among individuals who live in the low-socioeconomic (SES) areas, which is close to 25% of the US population, myocardial infarctions (MIs) occurred twice as often compared with people who lived in higher SES areas.[\[156\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-156)
Immigration status: In 2018 many lawfully present [immigrants](https://en.wikipedia.org/wiki/Immigrant "Immigrant") who were eligible for coverage remained uninsured because immigrant families faced a range of enrollment barriers, including fear, confusion about eligibility policies, difficulty navigating the enrollment process, and [language](https://en.wikipedia.org/wiki/Language "Language") and [literacy](https://en.wikipedia.org/wiki/Literacy "Literacy") challenges. Uninsured [undocumented immigrants](https://en.wikipedia.org/wiki/Undocumented_immigrants_\(U.S.\) "Undocumented immigrants (U.S.)") are ineligible for coverage options due to their immigration status.[\[157\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-157)
Health care access: Lack of [health insurance](https://en.wikipedia.org/wiki/Health_insurance "Health insurance") and financial concerns about accessing care were associated with delays in seeking emergency care for acute myocardial infarction which can have significant, adverse consequences on patient outcomes.[\[158\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-158)
Education: Researchers found that compared to people with [graduate degrees](https://en.wikipedia.org/wiki/Graduate_degrees "Graduate degrees"), those with lower educational attainment appeared to have a higher [risk](https://en.wikipedia.org/wiki/Risk "Risk") of heart attack, dying from a [cardiovascular](https://en.wikipedia.org/wiki/Cardiovascular "Cardiovascular") event, and overall death.[\[159\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-159)
## Society and culture
Depictions of heart attacks in popular media often include collapsing or loss of consciousness which are not common symptoms; these depictions contribute to widespread misunderstanding about the symptoms of myocardial infarctions, which in turn contributes to people not getting care when they should.[\[160\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-160)
## Legal implications
At [common law](https://en.wikipedia.org/wiki/Common_law "Common law"), in general, a myocardial infarction is a [disease](https://en.wikipedia.org/wiki/Disease "Disease") but may sometimes be an [injury](https://en.wikipedia.org/wiki/Injury "Injury"). This can create coverage issues in the administration of no-fault insurance schemes such as [workers' compensation](https://en.wikipedia.org/wiki/Workers%27_compensation "Workers' compensation"). In general, a heart attack is not covered;[\[161\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-prairieview-161) however, it may be a [work-related injury](https://en.wikipedia.org/wiki/Industrial_injury "Industrial injury") if it results, for example, from unusual emotional stress or unusual exertion.[\[162\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-biia-162) In addition, in some jurisdictions, heart attacks had by persons in particular occupations such as [police officers](https://en.wikipedia.org/wiki/Police_officer "Police officer") may be classified as line-of-duty injuries by statute or policy.[\[163\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-163) In some countries or states, a person having had an MI may be prevented from participating in activity that puts other people's lives at risk, for example driving a car or flying an airplane.[\[164\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NovaScotia-DrivingRegulations-164)
## References
1. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2014_1-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2014_1-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2014_1-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2014_1-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2014_1-4)
["What Are the Signs and Symptoms of Coronary Heart Disease?"](https://web.archive.org/web/20150224034615/http://www.nhlbi.nih.gov/health/health-topics/topics/cad/signs). *www.nhlbi.nih.gov*. September 29, 2014. Archived from [the original](http://www.nhlbi.nih.gov/health/health-topics/topics/cad/signs) on 24 February 2015. Retrieved 23 February 2015.
2. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-2)**
["Heart Attack Symptoms in Women"](https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women). *American Heart Association*.
3. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-5)
["What Is a Heart Attack?"](https://www.nhlbi.nih.gov/health/heart-attack). *www.nhlbi.nih.gov*. December 17, 2013. [Archived](https://web.archive.org/web/20150219152830/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/) from the original on 19 February 2015. Retrieved 24 February 2015.
4. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Heart2015_4-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Heart2015_4-1)
["Heart Attack or Sudden Cardiac Arrest: How Are They Different?"](http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Heart-Attack-or-Sudden-Cardiac-Arrest-How-Are-They-Different_UCM_440804_Article.jsp). *www.heart.org*. Jul 30, 2014. [Archived](https://web.archive.org/web/20150224045054/http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Heart-Attack-or-Sudden-Cardiac-Arrest-How-Are-They-Different_UCM_440804_Article.jsp) from the original on 24 February 2015. Retrieved 24 February 2015.
5. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Meh2014_5-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Meh2014_5-1)
Mehta PK, Wei J, Wenger NK (February 2015). ["Ischemic heart disease in women: a focus on risk factors"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336825). *Trends in Cardiovascular Medicine*. **25** (2): 140–51\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.tcm.2014.10.005](https://doi.org/10.1016%2Fj.tcm.2014.10.005). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4336825](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336825). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25453985](https://pubmed.ncbi.nlm.nih.gov/25453985).
6. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WHO2011_6-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WHO2011_6-1)
Mendis S, Puska P, Norrving B (2011). [*Global atlas on cardiovascular disease prevention and control*](http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1) (PDF) (1st ed.). Geneva: World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization. pp. 3–18\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-92-4-156437-3](https://en.wikipedia.org/wiki/Special:BookSources/978-92-4-156437-3 "Special:BookSources/978-92-4-156437-3")
. [Archived](https://web.archive.org/web/20140817123106/http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1) (PDF) from the original on 2014-08-17.
7. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013D_7-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013D_7-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013D_7-2)
["How Is a Heart Attack Diagnosed?"](https://www.nhlbi.nih.gov/health/heart-attack/diagnosis). *www.nhlbi.nih.gov*. December 17, 2013. [Archived](https://web.archive.org/web/20150224044949/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/diagnosis) from the original on 24 February 2015. Retrieved 24 February 2015.
8. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-8)
Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. (October 2012). ["ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation"](https://doi.org/10.1093%2Feurheartj%2Fehs215). *European Heart Journal*. **33** (20): 2569–619\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehs215](https://doi.org/10.1093%2Feurheartj%2Fehs215). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22922416](https://pubmed.ncbi.nlm.nih.gov/22922416).
9. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Oc2010_9-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Oc2010_9-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Oc2010_9-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Oc2010_9-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Oc2010_9-4)
O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, et al. (November 2010). ["Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care"](https://doi.org/10.1161%2FCIRCULATIONAHA.110.971028). *Circulation*. **122** (18 Suppl 3): S787–817. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIRCULATIONAHA.110.971028](https://doi.org/10.1161%2FCIRCULATIONAHA.110.971028). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20956226](https://pubmed.ncbi.nlm.nih.gov/20956226).
10. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-GBD2015Pre_10-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-GBD2015Pre_10-1)
Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease Injury Incidence Prevalence Collaborators) (October 2016). ["Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). *Lancet*. **388** (10053): 1545–1602\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(16)31678-6](https://doi.org/10.1016%2FS0140-6736%2816%2931678-6). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5055577](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27733282](https://pubmed.ncbi.nlm.nih.gov/27733282).
11. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-11)**
Coventry LL, Finn J, Bremner AP (2011). "Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis". *Heart & Lung*. **40** (6): 477–91\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.hrtlng.2011.05.001](https://doi.org/10.1016%2Fj.hrtlng.2011.05.001). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22000678](https://pubmed.ncbi.nlm.nih.gov/22000678).
12. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Val2011_12-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Val2011_12-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Val2011_12-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Val2011_12-3)
Valensi P, Lorgis L, Cottin Y (March 2011). ["Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: a review of the literature"](https://doi.org/10.1016%2Fj.acvd.2010.11.013). *Archives of Cardiovascular Diseases*. **104** (3): 178–88\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.acvd.2010.11.013](https://doi.org/10.1016%2Fj.acvd.2010.11.013). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21497307](https://pubmed.ncbi.nlm.nih.gov/21497307).
13. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-13)**
["What Causes a Heart Attack?"](https://web.archive.org/web/20150218075735/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/causes). *www.nhlbi.nih.gov*. December 17, 2013. Archived from [the original](http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/causes) on 18 February 2015. Retrieved 24 February 2015.
14. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-14)**
Devlin RJ, Henry JA (2008). ["Clinical review: Major consequences of illicit drug consumption"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374627). *Critical Care*. **12** (1): 202. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1186/cc6166](https://doi.org/10.1186%2Fcc6166). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2374627](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374627). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18279535](https://pubmed.ncbi.nlm.nih.gov/18279535).
15. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-15)**
["Electrocardiogram"](https://web.archive.org/web/20170411140634/https://www.nhlbi.nih.gov/health/health-topics/topics/ekg). *NHLBI, NIH*. 9 December 2016. Archived from [the original](https://www.nhlbi.nih.gov/health/health-topics/topics/ekg) on 11 April 2017. Retrieved 10 April 2017.
16. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-8) [***j***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-9) [***k***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-10) [***l***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-11) [***m***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-12) [***n***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-13)
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). *Davidson's principles and practice of medicine* (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 588–599\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7020-3085-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-3085-7 "Special:BookSources/978-0-7020-3085-7")
.
17. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Hamm2011_17-0)**
Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. (December 2011). ["ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)"](https://doi.org/10.1093%2Feurheartj%2Fehr236). *European Heart Journal*. **32** (23): 2999–3054\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehr236](https://doi.org/10.1093%2Feurheartj%2Fehr236). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21873419](https://pubmed.ncbi.nlm.nih.gov/21873419).
18. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Lancet08_18-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Lancet08_18-1)
White HD, Chew DP (August 2008). ["Acute myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931354). *Lancet*. **372** (9638): 570–84\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(08)61237-4](https://doi.org/10.1016%2FS0140-6736%2808%2961237-4). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1931354](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931354). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18707987](https://pubmed.ncbi.nlm.nih.gov/18707987).
19. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-8) [***j***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-9) [***k***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-10)
O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. (January 2013). ["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"](https://doi.org/10.1161%2FCIR.0b013e3182742cf6). *Circulation*. **127** (4): e362–425. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIR.0b013e3182742cf6](https://doi.org/10.1161%2FCIR.0b013e3182742cf6). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23247304](https://pubmed.ncbi.nlm.nih.gov/23247304).
20. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-20)**
Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Flaxman A, et al. (April 2014). ["The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181601). *Circulation*. **129** (14): 1493–501\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/circulationaha.113.004046](https://doi.org/10.1161%2Fcirculationaha.113.004046). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4181601](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181601). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24573351](https://pubmed.ncbi.nlm.nih.gov/24573351).
21. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-21)**
Torio C (August 2013). ["National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011"](https://hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp). *HCUP*. [Archived](https://web.archive.org/web/20170314171958/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp) from the original on 14 March 2017. Retrieved 1 May 2017.
22. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrowBraunwald20161%E2%80%933Dwight201641_22-0)** [Morrow & Braunwald 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrowBraunwald2016), pp. 1–3; [Dwight 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFDwight2016), p. 41.
23. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrowBraunwald20161%E2%80%933_23-0)** [Morrow & Braunwald 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrowBraunwald2016), pp. 1–3.
24. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-8) [***j***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-9) [***k***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-10) [***l***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-11) [***m***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-12) [***n***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-13) [***o***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-14) [***p***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-15) [***q***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-16) [***r***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-17)
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. (October 2012). ["Third universal definition of myocardial infarction"](https://doi.org/10.1161%2FCIR.0b013e31826e1058). *Circulation*. **126** (16): 2020–35\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIR.0b013e31826e1058](https://doi.org/10.1161%2FCIR.0b013e31826e1058). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22923432](https://pubmed.ncbi.nlm.nih.gov/22923432).
25. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEBlumenthalMargolis20074%E2%80%935_25-0)** [Blumenthal & Margolis 2007](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFBlumenthalMargolis2007), pp. 4–5.
26. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrowBohula2016295_26-0)** [Morrow & Bohula 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrowBohula2016), p. 295.
27. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrow201659%E2%80%9361_27-0)** [Morrow 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrow2016), pp. 59–61.
28. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-8) [***j***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-9) [***k***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-10) [***l***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-11) [***m***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-12) [***n***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-13) [***o***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-14) [***p***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-15) [***q***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-16) [***r***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-17) [***s***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-18)
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015). *Harrison's principles of internal medicine*. McGraw Hill Education. pp. 1593–1610\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-07-180215-4](https://en.wikipedia.org/wiki/Special:BookSources/978-0-07-180215-4 "Special:BookSources/978-0-07-180215-4")
. [OCLC](https://en.wikipedia.org/wiki/OCLC_\(identifier\) "OCLC (identifier)") [923181481](https://search.worldcat.org/oclc/923181481).
29. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrow201659%E2%80%9360_29-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrow201659%E2%80%9360_29-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrow201659%E2%80%9360_29-2) [Morrow 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrow2016), pp. 59–60.
30. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015B_30-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015B_30-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015B_30-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015B_30-3)
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015). *Harrison's Principles of Internal Medicine*. McGraw Hill Education. pp. 98–99\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-07-180215-4](https://en.wikipedia.org/wiki/Special:BookSources/978-0-07-180215-4 "Special:BookSources/978-0-07-180215-4")
. [OCLC](https://en.wikipedia.org/wiki/OCLC_\(identifier\) "OCLC (identifier)") [923181481](https://search.worldcat.org/oclc/923181481).
31. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Gupta2016_31-0)**
Gupta R, Munoz R (August 2016). "Evaluation and Management of Chest Pain in the Elderly". *Emergency Medicine Clinics of North America*. **34** (3): 523–42\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.emc.2016.04.006](https://doi.org/10.1016%2Fj.emc.2016.04.006). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27475013](https://pubmed.ncbi.nlm.nih.gov/27475013).
32. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid17208083_32-0)**
Marcus GM, Cohen J, Varosy PD, Vessey J, Rose E, Massie BM, et al. (January 2007). "The utility of gestures in patients with chest discomfort". *The American Journal of Medicine*. **120** (1): 83–9\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.amjmed.2006.05.045](https://doi.org/10.1016%2Fj.amjmed.2006.05.045). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17208083](https://pubmed.ncbi.nlm.nih.gov/17208083).
33. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEAllisonMurphy2012197Morrow201660_33-0)** [Allison & Murphy 2012](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFAllisonMurphy2012), p. 197; [Morrow 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrow2016), p. 60.
34. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-ACSwomen_34-0)**
Canto JG, Goldberg RJ, Hand MM, Bonow RO, Sopko G, Pepine CJ, Long T (December 2007). "Symptom presentation of females with acute coronary syndromes: myth vs reality". *Archives of Internal Medicine*. **167** (22): 2405–2413\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/archinte.167.22.2405](https://doi.org/10.1001%2Farchinte.167.22.2405). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18071161](https://pubmed.ncbi.nlm.nih.gov/18071161).
35. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-35)**
["Heart Attack Symptoms, Risk, and Recovery"](https://www.cdc.gov/heartdisease/heart_attack.htm). *CDC.gov*. U.S. Department of Health & Human Services. Retrieved July 20, 2021.
36. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-36)**
Coventry LL, Finn J, Bremner AP (November–December 2011). "Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis". *Heart & Lung*. **40** (6): 477–491\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.hrtlng.2011.05.001](https://doi.org/10.1016%2Fj.hrtlng.2011.05.001). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22000678](https://pubmed.ncbi.nlm.nih.gov/22000678).
37. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-37)**
Chen W, Woods SL, Puntillo KA (July–August 2005). "Sex differences in symptoms associated with acute myocardial infarction: a review of the research". *Heart & Lung*. **34** (4): 240–247\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.hrtlng.2004.12.004](https://doi.org/10.1016%2Fj.hrtlng.2004.12.004). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16027643](https://pubmed.ncbi.nlm.nih.gov/16027643).
38. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-38)**
DeVon HA, Zerwic JJ (July–August 2002). "Symptoms of acute coronary syndromes: are there gender differences? A review of the literature". *Heart & Lung*. **31** (4): 235–245\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1067/mhl.2002.126105](https://doi.org/10.1067%2Fmhl.2002.126105). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12122387](https://pubmed.ncbi.nlm.nih.gov/12122387).
39. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-39)**
Ashton R, Raman D. ["Dyspnea"](http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/dyspnea/). *www.clevelandclinicmeded.com*. Cleveland Clinic. [Archived](https://web.archive.org/web/20170711084207/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/dyspnea/) from the original on 11 July 2017. Retrieved 24 May 2017.
40. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-40)**
Lilly LS (2012). [*Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty*](https://books.google.com/books?id=0lxSGJYeXikC&pg=PA172). Lippincott Williams & Wilkins. p. 172. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-4698-1668-5](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4698-1668-5 "Special:BookSources/978-1-4698-1668-5")
. [Archived](https://web.archive.org/web/20170728135942/https://books.google.com.au/books?id=0lxSGJYeXikC&pg=PA172&lpg=PA172) from the original on 2017-07-28.
41. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-ESC_STEMI_41-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-ESC_STEMI_41-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-ESC_STEMI_41-2)
Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. (December 2008). ["Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology"](https://doi.org/10.1093%2Feurheartj%2Fehn416). *European Heart Journal*. **29** (23): 2909–2945\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehn416](https://doi.org/10.1093%2Feurheartj%2Fehn416). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19004841](https://pubmed.ncbi.nlm.nih.gov/19004841).
42. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Diabetologica2004-David_42-0)**
Davis TM, Fortun P, Mulder J, Davis WA, Bruce DG (March 2004). "Silent myocardial infarction and its prognosis in a community-based cohort of Type 2 diabetic patients: the Fremantle Diabetes Study". *Diabetologia*. **47** (3): 395–399\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00125-004-1344-4](https://doi.org/10.1007%2Fs00125-004-1344-4). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [14963648](https://pubmed.ncbi.nlm.nih.gov/14963648). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [12567614](https://api.semanticscholar.org/CorpusID:12567614).
43. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-rubin_43-0)**
Rubin E, Gorstein F, Rubin R, Schwarting R, Strayer D (2001). *Rubin's Pathology — Clinicopathological Foundations of Medicine*. Maryland: Lippincott Williams & Wilkins. p. 549. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7817-4733-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7817-4733-2 "Special:BookSources/978-0-7817-4733-2")
.
44. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEGazianoGaziano201611-22_44-0)** [Gaziano & Gaziano 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFGazianoGaziano2016), p. 11-22.
45. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-EUROPEAN2012_45-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-EUROPEAN2012_45-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-EUROPEAN2012_45-2)
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. (July 2012). ["European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts)"](https://doi.org/10.1093%2Feurheartj%2Fehs092). *European Heart Journal*. **33** (13): 1635–701\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehs092](https://doi.org/10.1093%2Feurheartj%2Fehs092). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22555213](https://pubmed.ncbi.nlm.nih.gov/22555213).
46. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid=16697342_46-0)**
Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. (May 2006). ["AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute"](https://doi.org/10.1016%2Fj.jacc.2006.04.026). *Journal of the American College of Cardiology*. **47** (10): 2130–9\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jacc.2006.04.026](https://doi.org/10.1016%2Fj.jacc.2006.04.026). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16697342](https://pubmed.ncbi.nlm.nih.gov/16697342).
47. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Kivi2012_47-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Kivi2012_47-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Kivi2012_47-2)
Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L, et al. (October 2012). ["Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486012). *Lancet*. **380** (9852): 1491–7\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(12)60994-5](https://doi.org/10.1016%2FS0140-6736%2812%2960994-5). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3486012](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486012). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22981903](https://pubmed.ncbi.nlm.nih.gov/22981903).
48. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-48)**
Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT (July 2012). ["Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500). *Lancet*. **380** (9838): 219–29\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(12)61031-9](https://doi.org/10.1016%2FS0140-6736%2812%2961031-9). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3645500](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22818936](https://pubmed.ncbi.nlm.nih.gov/22818936).
49. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid=22473079_49-0)**
Steptoe A, Kivimäki M (April 2012). "Stress and cardiovascular disease". *Nature Reviews. Cardiology*. **9** (6): 360–70\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/nrcardio.2012.45](https://doi.org/10.1038%2Fnrcardio.2012.45). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22473079](https://pubmed.ncbi.nlm.nih.gov/22473079). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [27925226](https://api.semanticscholar.org/CorpusID:27925226).
50. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-:1_50-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-:1_50-1)
Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS (August 2020). ["Reduction in saturated fat intake for cardiovascular disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092457). *The Cochrane Database of Systematic Reviews*. **2020** (8) CD011737. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD011737.pub3](https://doi.org/10.1002%2F14651858.CD011737.pub3). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [8092457](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092457). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32827219](https://pubmed.ncbi.nlm.nih.gov/32827219).
51. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Chow2014_51-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Chow2014_51-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Chow2014_51-2)
Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. (March 2014). "Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis". *Annals of Internal Medicine*. **160** (6): 398–406\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7326/M13-1788](https://doi.org/10.7326%2FM13-1788). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24723079](https://pubmed.ncbi.nlm.nih.gov/24723079).
52. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-52)**
de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, et al. (August 2015). ["Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532752). *BMJ*. **351** h3978. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.h3978](https://doi.org/10.1136%2Fbmj.h3978). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4532752](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532752). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26268692](https://pubmed.ncbi.nlm.nih.gov/26268692).
53. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-53)**
["Scientific Report of the 2015 Dietary Guidelines Advisory Committee"](https://web.archive.org/web/20160503071439/http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf) (PDF). *health.gov*. Feb 2015. p. 17. Archived from [the original](https://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf) (PDF) on 2016-05-03. Retrieved 2015-03-05.
54. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Krenz2012_54-0)**
Krenz M, Korthuis RJ (January 2012). ["Moderate ethanol ingestion and cardiovascular protection: from epidemiologic associations to cellular mechanisms"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246046). *Journal of Molecular and Cellular Cardiology*. **52** (1): 93–104\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.yjmcc.2011.10.011](https://doi.org/10.1016%2Fj.yjmcc.2011.10.011). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3246046](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246046). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22041278](https://pubmed.ncbi.nlm.nih.gov/22041278).
55. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Genomics_of_Cardiovascular_Disease_55-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Genomics_of_Cardiovascular_Disease_55-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Genomics_of_Cardiovascular_Disease_55-2)
O'Donnell CJ, Nabel EG (December 2011). ["Genomics of cardiovascular disease"](https://doi.org/10.1056%2FNEJMra1105239). *The New England Journal of Medicine*. **365** (22): 2098–109\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1056/NEJMra1105239](https://doi.org/10.1056%2FNEJMra1105239). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22129254](https://pubmed.ncbi.nlm.nih.gov/22129254).
56. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Culic2007_56-0)**
Culić V (April 2007). "Acute risk factors for myocardial infarction". *International Journal of Cardiology*. **117** (2): 260–9\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.ijcard.2006.05.011](https://doi.org/10.1016%2Fj.ijcard.2006.05.011). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16860887](https://pubmed.ncbi.nlm.nih.gov/16860887).
57. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Shaw2009_57-0)**
Shaw E, Tofler GH (July 2009). "Circadian rhythm and cardiovascular disease". *Current Atherosclerosis Reports*. **11** (4): 289–95\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s11883-009-0044-4](https://doi.org/10.1007%2Fs11883-009-0044-4). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19500492](https://pubmed.ncbi.nlm.nih.gov/19500492). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [43626425](https://api.semanticscholar.org/CorpusID:43626425).
58. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Vyas2012_58-0)**
Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, et al. (July 2012). ["Shift work and vascular events: systematic review and meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406223). *BMJ*. **345** e4800. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.e4800](https://doi.org/10.1136%2Fbmj.e4800). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3406223](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406223). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22835925](https://pubmed.ncbi.nlm.nih.gov/22835925).
59. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-59)**
Janszky I, Ljung R (October 2008). ["Shifts to and from daylight saving time and incidence of myocardial infarction"](https://doi.org/10.1056%2FNEJMc0807104). *The New England Journal of Medicine*. **359** (18): 1966–8\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1056/NEJMc0807104](https://doi.org/10.1056%2FNEJMc0807104). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18971502](https://pubmed.ncbi.nlm.nih.gov/18971502). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [205040478](https://api.semanticscholar.org/CorpusID:205040478).
60. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-60)**
Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM (August 2015). ["Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494192). *The Cochrane Database of Systematic Reviews*. **2015** (8) CD011054. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD011054.pub2](https://doi.org/10.1002%2F14651858.CD011054.pub2). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[1874/340787](https://hdl.handle.net/1874%2F340787). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6494192](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494192). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26310586](https://pubmed.ncbi.nlm.nih.gov/26310586).
61. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-61)**
Bally M, Dendukuri N, Rich B, Nadeau L, Helin-Salmivaara A, Garbe E, Brophy JM (May 2017). ["Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423546). *BMJ*. **357** j1909. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.j1909](https://doi.org/10.1136%2Fbmj.j1909). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5423546](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423546). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28487435](https://pubmed.ncbi.nlm.nih.gov/28487435).
62. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-62)**
Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA (May 2016). ["Endometriosis and Risk of Coronary Heart Disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940126). *Circulation: Cardiovascular Quality and Outcomes*. **9** (3): 257–64\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIRCOUTCOMES.115.002224](https://doi.org/10.1161%2FCIRCOUTCOMES.115.002224). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4940126](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940126). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27025928](https://pubmed.ncbi.nlm.nih.gov/27025928).
63. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-63)**
Mustafic H, Jabre P, Caussin C, Murad MH, Escolano S, Tafflet M, et al. (February 2012). "Main air pollutants and myocardial infarction: a systematic review and meta-analysis". *JAMA*. **307** (7): 713–21\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.2012.126](https://doi.org/10.1001%2Fjama.2012.126). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22337682](https://pubmed.ncbi.nlm.nih.gov/22337682).
64. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-64)**
Ho AF, Wah W, Earnest A, Ng YY, Xie Z, Shahidah N, et al. (November 2018). "Health impacts of the Southeast Asian haze problem – A time-stratified case crossover study of the relationship between ambient air pollution and sudden cardiac deaths in Singapore". *International Journal of Cardiology*. **271**: 352–358\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.ijcard.2018.04.070](https://doi.org/10.1016%2Fj.ijcard.2018.04.070). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30223374](https://pubmed.ncbi.nlm.nih.gov/30223374). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [52282745](https://api.semanticscholar.org/CorpusID:52282745).
65. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-65)**
Sun Z, Chen C, Xu D, Li T (October 2018). "Effects of ambient temperature on myocardial infarction: A systematic review and meta-analysis". *Environmental Pollution*. **241**: 1106–1114\. [Bibcode](https://en.wikipedia.org/wiki/Bibcode_\(identifier\) "Bibcode (identifier)"):[2018EPoll.241.1106S](https://ui.adsabs.harvard.edu/abs/2018EPoll.241.1106S). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.envpol.2018.06.045](https://doi.org/10.1016%2Fj.envpol.2018.06.045). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30029319](https://pubmed.ncbi.nlm.nih.gov/30029319). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [51705159](https://api.semanticscholar.org/CorpusID:51705159).
66. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Chat2012_66-0)**
Chatzidimitriou D, Kirmizis D, Gavriilaki E, Chatzidimitriou M, Malisiovas N (October 2012). "Atherosclerosis and infection: is the jury still not in?". *Future Microbiology*. **7** (10): 1217–30\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2217/fmb.12.87](https://doi.org/10.2217%2Ffmb.12.87). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23030426](https://pubmed.ncbi.nlm.nih.gov/23030426).
67. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Sanchez2014_67-0)**
Sánchez-Manubens J, Bou R, Anton J (February 2014). "Diagnosis and classification of Kawasaki disease". *Journal of Autoimmunity*. 48–49: 113–7\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jaut.2014.01.010](https://doi.org/10.1016%2Fj.jaut.2014.01.010). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24485156](https://pubmed.ncbi.nlm.nih.gov/24485156).
68. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-68)**
Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC (March 2011). ["Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis"](https://doi.org/10.1016%2Fj.jacc.2010.10.011). *Journal of the American College of Cardiology*. **57** (10): 1237–47\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jacc.2010.10.011](https://doi.org/10.1016%2Fj.jacc.2010.10.011). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21145688](https://pubmed.ncbi.nlm.nih.gov/21145688).
69. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-69)**
Clarke R, Halsey J, Bennett D, Lewington S (February 2011). "Homocysteine and vascular disease: review of published results of the homocysteine-lowering trials". *Journal of Inherited Metabolic Disease*. **34** (1): 83–91\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s10545-010-9235-y](https://doi.org/10.1007%2Fs10545-010-9235-y). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21069462](https://pubmed.ncbi.nlm.nih.gov/21069462). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [8714058](https://api.semanticscholar.org/CorpusID:8714058).
70. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-70)**
Lonn E (September 2007). "Homocysteine in the prevention of ischemic heart disease, stroke and venous thromboembolism: therapeutic target or just another distraction?". *Current Opinion in Hematology*. **14** (5): 481–7\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/MOH.0b013e3282c48bd8](https://doi.org/10.1097%2FMOH.0b013e3282c48bd8). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17934354](https://pubmed.ncbi.nlm.nih.gov/17934354). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [8734056](https://api.semanticscholar.org/CorpusID:8734056).
71. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-71)**
Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, et al. (January 2017). ["ESC working group position paper on myocardial infarction with non-obstructive coronary arteries"](https://doi.org/10.1093%2Feurheartj%2Fehw149). *European Heart Journal*. **38** (3): 143–153\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehw149](https://doi.org/10.1093%2Feurheartj%2Fehw149). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[11577/3304417](https://hdl.handle.net/11577%2F3304417). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28158518](https://pubmed.ncbi.nlm.nih.gov/28158518).
72. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-8) [***j***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-9) [***k***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-10) [***l***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-11) [***m***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-12) [***n***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-13) [***o***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-14) [***p***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-15) [***q***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-16) [***r***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-17) [***s***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-18) [***t***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-19) [***u***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-20) [***v***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-21) [***w***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-22) [***x***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-23) [***y***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-24) [***z***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-25) [***aa***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-26) [***ab***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-27) [***ac***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-28) [***ad***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-29) [***ae***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-30) [***af***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-31) [***ag***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-32) [***ah***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-33) [***ai***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-34) [***aj***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-35)
Reed GW, Rossi JE, Cannon CP (January 2017). "Acute myocardial infarction". *Lancet*. **389** (10065): 197–210\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(16)30677-8](https://doi.org/10.1016%2FS0140-6736%2816%2930677-8). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27502078](https://pubmed.ncbi.nlm.nih.gov/27502078). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [33523662](https://api.semanticscholar.org/CorpusID:33523662).
73. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-5)
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). *Davidson's principles and practice of medicine* (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 577–9\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7020-3085-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-3085-7 "Special:BookSources/978-0-7020-3085-7")
.
74. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid20065951_74-0)**
Woollard KJ, Geissmann F (February 2010). ["Monocytes in atherosclerosis: subsets and functions"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813241). *Nature Reviews. Cardiology*. **7** (2): 77–86\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/nrcardio.2009.228](https://doi.org/10.1038%2Fnrcardio.2009.228). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2813241](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813241). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20065951](https://pubmed.ncbi.nlm.nih.gov/20065951).
75. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-75)**
Janoudi A, Shamoun FE, Kalavakunta JK, Abela GS (July 2016). ["Cholesterol crystal induced arterial inflammation and destabilization of atherosclerotic plaque"](https://doi.org/10.1093%2Feurheartj%2Fehv653). *European Heart Journal*. **37** (25): 1959–67\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehv653](https://doi.org/10.1093%2Feurheartj%2Fehv653). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26705388](https://pubmed.ncbi.nlm.nih.gov/26705388).
76. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BUJA2005_76-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BUJA2005_76-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BUJA2005_76-2)
Buja LM (July 2005). "Myocardial ischemia and reperfusion injury". *Cardiovascular Pathology*. **14** (4): 170–5\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.carpath.2005.03.006](https://doi.org/10.1016%2Fj.carpath.2005.03.006). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16009313](https://pubmed.ncbi.nlm.nih.gov/16009313).
77. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-77)**
Algranati D, Kassab GS, Lanir Y (March 2011). ["Why is the subendocardium more vulnerable to ischemia? A new paradigm"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064294). *American Journal of Physiology. Heart and Circulatory Physiology*. **300** (3): H1090–100. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1152/ajpheart.00473.2010](https://doi.org/10.1152%2Fajpheart.00473.2010). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3064294](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064294). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21169398](https://pubmed.ncbi.nlm.nih.gov/21169398).
78. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BOLOOKI2010_78-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BOLOOKI2010_78-1)
Bolooki HM, Askari A (August 2010). ["Acute Myocardial Infarction"](http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/acute-myocardial-infarction/). *www.clevelandclinicmeded.com*. [Archived](https://web.archive.org/web/20170428050921/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/acute-myocardial-infarction/) from the original on 28 April 2017. Retrieved 24 May 2017.
79. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AARONSON2013_79-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AARONSON2013_79-1)
Aaronson PI, Ward JP, Connolly MJ (2013). *The cardiovascular system at a glance* (4th ed.). Chichester, West Sussex: Wiley-Blackwell. pp. 88–89\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-470-65594-8](https://en.wikipedia.org/wiki/Special:BookSources/978-0-470-65594-8 "Special:BookSources/978-0-470-65594-8")
.
80. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Kutty2013_80-0)**
Kutty RS, Jones N, Moorjani N (November 2013). "Mechanical complications of acute myocardial infarction". *Cardiology Clinics* (Review). **31** (4): 519–31, vii–viii. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.ccl.2013.07.004](https://doi.org/10.1016%2Fj.ccl.2013.07.004). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24188218](https://pubmed.ncbi.nlm.nih.gov/24188218).
81. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-KlonerHale_81-0)**
Kloner R, Hale SL (15 September 2016). "Reperfusion Injury: Prevention and Management". In Morrow DA (ed.). [*Myocardial Infarction: A Companion to Braunwald's Heart Disease*](https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 286–288\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-323-35943-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-35943-6 "Special:BookSources/978-0-323-35943-6")
.
82. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-82)**
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD (January 2019). ["Fourth universal definition of myocardial infarction (2018)"](https://doi.org/10.1093%2Feurheartj%2Fehy462). *European Heart Journal*. **40** (3): 237–269\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehy462](https://doi.org/10.1093%2Feurheartj%2Fehy462). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[10044/1/73052](https://hdl.handle.net/10044%2F1%2F73052). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30165617](https://pubmed.ncbi.nlm.nih.gov/30165617).
83. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-83)**
Pickering JW, Than MP, Cullen L, Aldous S, Ter Avest E, Body R, et al. (May 2017). ["Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis"](https://www.research.manchester.ac.uk/portal/en/publications/rapid-ruleout-of-acute-myocardial-infarction-with-a-single-highsensitivity-cardiac-troponin-t-measurement-below-the-limit-of-detection\(0e2cb8e0-229a-446b-9389-7fa319a649d4\).html). *Annals of Internal Medicine*. **166** (10): 715–724\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7326/M16-2562](https://doi.org/10.7326%2FM16-2562). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28418520](https://pubmed.ncbi.nlm.nih.gov/28418520).
84. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-84)**
Chapman AR, Lee KK, McAllister DA, Cullen L, Greenslade JH, Parsonage W, et al. (November 2017). ["Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710293). *JAMA*. **318** (19): 1913–1924\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.2017.17488](https://doi.org/10.1001%2Fjama.2017.17488). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5710293](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710293). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29127948](https://pubmed.ncbi.nlm.nih.gov/29127948).
85. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHANSTEMI2014_85-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHANSTEMI2014_85-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHANSTEMI2014_85-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHANSTEMI2014_85-3)
Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. (December 2014). ["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"](https://doi.org/10.1161%2FCIR.0000000000000134). *Circulation*. **130** (25): e344–426. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIR.0000000000000134](https://doi.org/10.1161%2FCIR.0000000000000134). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25249585](https://pubmed.ncbi.nlm.nih.gov/25249585).
86. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-86)**
Lipinski MJ, Escárcega RO, D'Ascenzo F, Magalhães MA, Baker NC, Torguson R, et al. (May 2014). "A systematic review and collaborative meta-analysis to determine the incremental value of copeptin for rapid rule-out of acute myocardial infarction". *The American Journal of Cardiology*. **113** (9): 1581–91\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.amjcard.2014.01.436](https://doi.org/10.1016%2Fj.amjcard.2014.01.436). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24731654](https://pubmed.ncbi.nlm.nih.gov/24731654).
87. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010C_87-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010C_87-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010C_87-2)
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). *Davidson's principles and practice of medicine* (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 529–30\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7020-3085-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-3085-7 "Special:BookSources/978-0-7020-3085-7")
.
88. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-88)**
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015). *Harrison's principles of internal medicine*. McGraw Hill Education. p. 1457. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-07-180215-4](https://en.wikipedia.org/wiki/Special:BookSources/978-0-07-180215-4 "Special:BookSources/978-0-07-180215-4")
. [OCLC](https://en.wikipedia.org/wiki/OCLC_\(identifier\) "OCLC (identifier)") [923181481](https://search.worldcat.org/oclc/923181481).
89. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-auto_89-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-auto_89-1)
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. (April 2021). ["2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation"](https://doi.org/10.1093%2Feurheartj%2Fehaa575). *European Heart Journal*. **42** (14): 1289–1367\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehaa575](https://doi.org/10.1093%2Feurheartj%2Fehaa575). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32860058](https://pubmed.ncbi.nlm.nih.gov/32860058).
90. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WISELY2017_90-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WISELY2017_90-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WISELY2017_90-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WISELY2017_90-3)
["American College of Cardiology"](http://www.choosingwisely.org/societies/american-college-of-cardiology/). *www.choosingwisely.org*. Choosing Wisely. 28 February 2017. [Archived](https://web.archive.org/web/20170728125746/http://www.choosingwisely.org/societies/american-college-of-cardiology/) from the original on 28 July 2017. Retrieved 24 May 2017.
91. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-91)**
Schinkel AF, Valkema R, Geleijnse ML, Sijbrands EJ, Poldermans D (May 2010). "Single-photon emission computed tomography for assessment of myocardial viability". *EuroIntervention*. **6** (Supplement G): G115–22. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20542817](https://pubmed.ncbi.nlm.nih.gov/20542817).
92. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG94_92-0)** [National Institute for Health and Clinical Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence "National Institute for Health and Clinical Excellence"). *[Clinical guideline cg94: Unstable angina and NSTEMI](https://www.nice.org.uk/guidance/CGcg94)*. London, 2010.
93. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-UOTW36_93-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-UOTW36_93-1)
["UOTW \#36 – Ultrasound of the Week"](https://www.ultrasoundoftheweek.com/uotw-36/). *Ultrasound of the Week*. 5 February 2015. [Archived](https://web.archive.org/web/20170509115806/https://www.ultrasoundoftheweek.com/uotw-36/) from the original on 9 May 2017. Retrieved 27 May 2017.
94. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010D_94-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010D_94-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010D_94-2)
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). *Davidson's principles and practice of medicine* (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 535, 539. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7020-3085-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-3085-7 "Special:BookSources/978-0-7020-3085-7")
.
95. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid16199332_95-0)**
Boie ET (November 2005). "Initial evaluation of chest pain". *Emergency Medicine Clinics of North America*. **23** (4): 937–57\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.emc.2005.07.007](https://doi.org/10.1016%2Fj.emc.2005.07.007). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16199332](https://pubmed.ncbi.nlm.nih.gov/16199332).
96. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-96)**
["Assessment of fatigue"](https://web.archive.org/web/20210828180811/https://bestpractice.bmj.com/topics/en-gb/571/differentials). *BMJ Best Practice*. 17 August 2016. Archived from [the original](http://bestpractice.bmj.com/best-practice/monograph/571/diagnosis/differential-diagnosis.html) on 28 August 2021. Retrieved 6 June 2017.
97. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-97)**
MacIntyre CR, Mahimbo A, Moa AM, Barnes M (December 2016). ["Influenza vaccine as a coronary intervention for prevention of myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256393). *Heart*. **102** (24): 1953–1956\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/heartjnl-2016-309983](https://doi.org/10.1136%2Fheartjnl-2016-309983). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5256393](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256393). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27686519](https://pubmed.ncbi.nlm.nih.gov/27686519).
98. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG181_98-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG181_98-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG181_98-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG181_98-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG181_98-4) [National Institute for Health and Clinical Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence "National Institute for Health and Clinical Excellence"). *[Clinical guideline 181: Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease](https://www.nice.org.uk/guidance/CG181)*. London, 2014.
99. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-99)**
Stradling C, Hamid M, Taheri S, Thomas GN (2014). "A review of dietary influences on cardiovascular health: part 2: dietary patterns". *Cardiovascular & Hematological Disorders Drug Targets*. **14** (1): 50–63\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2174/1871529x14666140701095426](https://doi.org/10.2174%2F1871529x14666140701095426). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24993125](https://pubmed.ncbi.nlm.nih.gov/24993125).
100. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-100)**
Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP (December 2013). "Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force". *Annals of Internal Medicine*. **159** (12): 824–34\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7326/0003-4819-159-12-201312170-00729](https://doi.org/10.7326%2F0003-4819-159-12-201312170-00729). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24217421](https://pubmed.ncbi.nlm.nih.gov/24217421). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [17366251](https://api.semanticscholar.org/CorpusID:17366251).
101. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICEPH25_101-0)**
McPherson K, et al. (June 2010). ["Prevention of cardiovascular disease – NICE public health guidance 25"](http://guidance.nice.org.uk/ph25). London: [National Institute for Health and Care Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence "National Institute for Health and Care Excellence"). [Archived](https://web.archive.org/web/20140329171156/http://guidance.nice.org.uk/PH25) from the original on 2014-03-29.
102. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-102)**
Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G (January 2011). ["Multiple risk factor interventions for primary prevention of coronary heart disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160097). *The Cochrane Database of Systematic Reviews*. **2013** (1) CD001561. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.cd001561.pub3](https://doi.org/10.1002%2F14651858.cd001561.pub3). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4160097](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160097). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21249647](https://pubmed.ncbi.nlm.nih.gov/21249647).
103. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-103)**
Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. (January 2013). ["Statins for the primary prevention of cardiovascular disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481400). *The Cochrane Database of Systematic Reviews*. **1** (1) CD004816. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD004816.pub5](https://doi.org/10.1002%2F14651858.CD004816.pub5). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6481400](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481400). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23440795](https://pubmed.ncbi.nlm.nih.gov/23440795).
104. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-ATTaspirin2009_104-0)**
Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. (May 2009). ["Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715005). *Lancet*. **373** (9678): 1849–60\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(09)60503-1](https://doi.org/10.1016%2FS0140-6736%2809%2960503-1). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2715005](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715005). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19482214](https://pubmed.ncbi.nlm.nih.gov/19482214).
105. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-105)**
Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Kandala NB, et al. (September 2013). ["Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781046). *[Health Technology Assessment](https://en.wikipedia.org/wiki/Health_Technology_Assessment_\(journal\) "Health Technology Assessment (journal)")*. **17** (43): 1–253\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3310/hta17430](https://doi.org/10.3310%2Fhta17430). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4781046](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781046). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24074752](https://pubmed.ncbi.nlm.nih.gov/24074752).
106. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-106)**
Matthys F, De Backer T, De Backer G, Stichele RV (March 2014). ["Review of guidelines on primary prevention of cardiovascular disease with aspirin: how much evidence is needed to turn a tanker?"](https://doi.org/10.1177%2F2047487312472077). *European Journal of Preventive Cardiology*. **21** (3): 354–65\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1177/2047487312472077](https://doi.org/10.1177%2F2047487312472077). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23610452](https://pubmed.ncbi.nlm.nih.gov/23610452). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [28350632](https://api.semanticscholar.org/CorpusID:28350632).
107. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-107)**
Hodis HN, Mack WJ (July 2014). "Hormone replacement therapy and the association with coronary heart disease and overall mortality: clinical application of the timing hypothesis". *The Journal of Steroid Biochemistry and Molecular Biology*. **142**: 68–75\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jsbmb.2013.06.011](https://doi.org/10.1016%2Fj.jsbmb.2013.06.011). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23851166](https://pubmed.ncbi.nlm.nih.gov/23851166). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [30838065](https://api.semanticscholar.org/CorpusID:30838065).
108. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-7) [National Institute for Health and Clinical Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence "National Institute for Health and Clinical Excellence"). *[Clinical guideline 172: Secondary prevention in primary and secondary care for patients following a myocardial infarction](https://www.nice.org.uk/guidance/CG172)*. London, 2013.
109. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-109)**
Anderson L, Taylor RS (December 2014). ["Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7087435). *The Cochrane Database of Systematic Reviews*. **2021** (12) CD011273. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD011273.pub2](https://doi.org/10.1002%2F14651858.CD011273.pub2). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[10871/19152](https://hdl.handle.net/10871%2F19152). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7087435](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7087435). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25503364](https://pubmed.ncbi.nlm.nih.gov/25503364).
110. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-110)**
Perez MI, Musini VM, Wright JM (October 2009). "Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event". *The Cochrane Database of Systematic Reviews* (4) CD006743. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD006743.pub2](https://doi.org/10.1002%2F14651858.CD006743.pub2). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19821384](https://pubmed.ncbi.nlm.nih.gov/19821384).
111. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-111)**
Elmariah S, Mauri L, Doros G, Galper BZ, O'Neill KE, Steg PG, et al. (February 2015). ["Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386690). *Lancet*. **385** (9970): 792–8\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(14)62052-3](https://doi.org/10.1016%2FS0140-6736%2814%2962052-3). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4386690](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386690). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25467565](https://pubmed.ncbi.nlm.nih.gov/25467565).
112. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-112)**
Bangalore S, Makani H, Radford M, Thakur K, Toklu B, Katz SD, et al. (October 2014). ["Clinical outcomes with β-blockers for myocardial infarction: a meta-analysis of randomized trials"](https://doi.org/10.1016%2Fj.amjmed.2014.05.032). *The American Journal of Medicine*. **127** (10): 939–953\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.amjmed.2014.05.032](https://doi.org/10.1016%2Fj.amjmed.2014.05.032). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24927909](https://pubmed.ncbi.nlm.nih.gov/24927909).
113. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-113)**
Safi S, Sethi NJ, Nielsen EE, Feinberg J, Jakobsen JC, Gluud C, et al. (Cochrane Heart Group) (December 2019). ["Beta-blockers for suspected or diagnosed acute myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915833). *The Cochrane Database of Systematic Reviews*. **12** (12) CD012484. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD012484.pub2](https://doi.org/10.1002%2F14651858.CD012484.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6915833](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915833). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31845756](https://pubmed.ncbi.nlm.nih.gov/31845756).
114. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BetaNNT2015_114-0)**
Newman D (19 August 2010). ["Beta Blockers for Acute Heart Attack (Myocardial Infarction)"](http://www.thennt.com/nnt/beta-blockers-for-heart-attack/). *TheNNT.com*. [Archived](https://web.archive.org/web/20151222092449/http://www.thennt.com/nnt/beta-blockers-for-heart-attack/) from the original on 22 December 2015. Retrieved 11 December 2015.
115. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid26891235_115-0)**
Le HH, El-Khatib C, Mombled M, Guitarian F, Al-Gobari M, Fall M, et al. (2016). ["Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758660). *PLOS ONE*. **11** (2) e0145958. [Bibcode](https://en.wikipedia.org/wiki/Bibcode_\(identifier\) "Bibcode (identifier)"):[2016PLoSO..1145958L](https://ui.adsabs.harvard.edu/abs/2016PLoSO..1145958L). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1371/journal.pone.0145958](https://doi.org/10.1371%2Fjournal.pone.0145958). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4758660](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758660). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26891235](https://pubmed.ncbi.nlm.nih.gov/26891235).
116. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Hazinski2015_116-0)**
Hazinski MF, Nolan JP, Aickin R, Bhanji F, Billi JE, Callaway CW, et al. (October 2015). ["Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations"](https://doi.org/10.1161%2FCIR.0000000000000270). *Circulation* (Review). **132** (16 Suppl 1): S2–39. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIR.0000000000000270](https://doi.org/10.1161%2FCIR.0000000000000270). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26472854](https://pubmed.ncbi.nlm.nih.gov/26472854).
117. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-117)**
Hess EP, Agarwal D, Chandra S, Murad MH, Erwin PJ, Hollander JE, et al. (July 2010). ["Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900327). *CMAJ*. **182** (10): 1039–44\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1503/cmaj.092119](https://doi.org/10.1503%2Fcmaj.092119). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2900327](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900327). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20530163](https://pubmed.ncbi.nlm.nih.gov/20530163).
118. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-118)**
Reeder G (27 December 2016). ["Nitrates in the management of acute coronary syndrome"](https://www.uptodate.com/contents/nitrates-in-the-management-of-acute-coronary-syndrome). *www.uptodate.com*. [Archived](https://web.archive.org/web/20170728135423/https://www.uptodate.com/contents/nitrates-in-the-management-of-acute-coronary-syndrome) from the original on 28 July 2017. Retrieved 24 May 2017.
119. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-119)**
Yadlapati A, Gajjar M, Schimmel DR, Ricciardi MJ, Flaherty JD (December 2016). "Contemporary management of ST-segment elevation myocardial infarction". *Internal and Emergency Medicine*. **11** (8): 1107–1113\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s11739-016-1550-3](https://doi.org/10.1007%2Fs11739-016-1550-3). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27714584](https://pubmed.ncbi.nlm.nih.gov/27714584). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [23759756](https://api.semanticscholar.org/CorpusID:23759756).
120. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-120)**
McCarthy CP, Mullins KV, Sidhu SS, Schulman SP, McEvoy JW (June 2016). "The on- and off-target effects of morphine in acute coronary syndrome: A narrative review". *American Heart Journal*. **176**: 114–21\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.ahj.2016.04.004](https://doi.org/10.1016%2Fj.ahj.2016.04.004). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27264228](https://pubmed.ncbi.nlm.nih.gov/27264228).
121. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BMJP2Y12_121-0)**
Bellemain-Appaix A, Kerneis M, O'Connor SA, Silvain J, Cucherat M, Beygui F, et al. (October 2014). ["Reappraisal of thienopyridine pretreatment in patients with non-ST elevation acute coronary syndrome: a systematic review and meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208629). *BMJ*. **349** g6269. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.g6269](https://doi.org/10.1136%2Fbmj.g6269). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4208629](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208629). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25954988](https://pubmed.ncbi.nlm.nih.gov/25954988).
122. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-And2014_122-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-And2014_122-1)
Andrade-Castellanos CA, Colunga-Lozano LE, Delgado-Figueroa N, Magee K (June 2014). ["Heparin versus placebo for non-ST elevation acute coronary syndromes"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769062). *The Cochrane Database of Systematic Reviews*. **6** (6) CD003462. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD003462.pub3](https://doi.org/10.1002%2F14651858.CD003462.pub3). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6769062](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769062). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24972265](https://pubmed.ncbi.nlm.nih.gov/24972265).
123. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Bagai2014_123-0)**
Bagai A, Dangas GD, Stone GW, Granger CB (June 2014). ["Reperfusion strategies in acute coronary syndromes"](https://doi.org/10.1161%2FCIRCRESAHA.114.302744). *Circulation Research*. **114** (12): 1918–28\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIRCRESAHA.114.302744](https://doi.org/10.1161%2FCIRCRESAHA.114.302744). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24902975](https://pubmed.ncbi.nlm.nih.gov/24902975).
124. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-124)**
Jobs A, Mehta SR, Montalescot G, Vicaut E, Van't Hof AW, Badings EA, et al. (August 2017). "Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials". *Lancet*. **390** (10096): 737–746\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(17)31490-3](https://doi.org/10.1016%2FS0140-6736%2817%2931490-3). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28778541](https://pubmed.ncbi.nlm.nih.gov/28778541). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [4489347](https://api.semanticscholar.org/CorpusID:4489347).
125. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-125)**
Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. (October 2010). ["Guidelines on myocardial revascularization"](https://doi.org/10.1093%2Feurheartj%2Fehq277). *European Heart Journal*. **31** (20): 2501–55\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehq277](https://doi.org/10.1093%2Feurheartj%2Fehq277). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20802248](https://pubmed.ncbi.nlm.nih.gov/20802248).
126. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-126)**
Dalal F, Dalal HM, Voukalis C, Gandhi MM (July 2017). "Management of patients after primary percutaneous coronary intervention for myocardial infarction". *BMJ*. **358** j3237. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.j3237](https://doi.org/10.1136%2Fbmj.j3237). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28729460](https://pubmed.ncbi.nlm.nih.gov/28729460). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [46847680](https://api.semanticscholar.org/CorpusID:46847680).
127. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-127)**
Lassen JF, Bøtker HE, Terkelsen CJ (January 2013). "Timely and optimal treatment of patients with STEMI". *Nature Reviews. Cardiology*. 1. **10** (1): 41–8\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/nrcardio.2012.156](https://doi.org/10.1038%2Fnrcardio.2012.156). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23165072](https://pubmed.ncbi.nlm.nih.gov/23165072). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [21955018](https://api.semanticscholar.org/CorpusID:21955018).
128. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-128)**
Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. (November 2015). ["Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care"](https://doi.org/10.1161%2Fcir.0000000000000252). *Circulation*. **132** (18 Suppl 2): S315–67. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/cir.0000000000000252](https://doi.org/10.1161%2Fcir.0000000000000252). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26472989](https://pubmed.ncbi.nlm.nih.gov/26472989).
129. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-mccaul_129-0)**
McCaul M, Lourens A, Kredo T (September 2014). ["Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823254). *The Cochrane Database of Systematic Reviews*. **2014** (9) CD010191. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD010191.pub2](https://doi.org/10.1002%2F14651858.CD010191.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6823254](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823254). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25208209](https://pubmed.ncbi.nlm.nih.gov/25208209).
130. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-130)**
Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T (December 2016). ["Oxygen therapy for acute myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463792). *The Cochrane Database of Systematic Reviews*. **2016** (12) CD007160. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD007160.pub4](https://doi.org/10.1002%2F14651858.CD007160.pub4). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6463792](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463792). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27991651](https://pubmed.ncbi.nlm.nih.gov/27991651).
131. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-131)**
Hofmann R, James SK, Jernberg T, Lindahl B, Erlinge D, Witt N, et al. (September 2017). ["Oxygen Therapy in Suspected Acute Myocardial Infarction"](https://doi.org/10.1056%2Fnejmoa1706222). *The New England Journal of Medicine*. **377** (13): 1240–1249\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1056/nejmoa1706222](https://doi.org/10.1056%2Fnejmoa1706222). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28844200](https://pubmed.ncbi.nlm.nih.gov/28844200).
132. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-132)**
Abuzaid A, Fabrizio C, Felpel K, Al Ashry HS, Ranjan P, Elbadawi A, et al. (June 2018). ["Oxygen Therapy in Patients with Acute Myocardial Infarction: A Systemic Review and Meta-Analysis"](https://doi.org/10.1016%2Fj.amjmed.2017.12.027). *The American Journal of Medicine*. **131** (6): 693–701\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.amjmed.2017.12.027](https://doi.org/10.1016%2Fj.amjmed.2017.12.027). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29355510](https://pubmed.ncbi.nlm.nih.gov/29355510).
133. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-133)**
Sepehrvand N, James SK, Stub D, Khoshnood A, Ezekowitz JA, Hofmann R (October 2018). "Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials". *Heart*. **104** (20): 1691–1698\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/heartjnl-2018-313089](https://doi.org/10.1136%2Fheartjnl-2018-313089). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29599378](https://pubmed.ncbi.nlm.nih.gov/29599378). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [4472549](https://api.semanticscholar.org/CorpusID:4472549).
134. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-134)**
Singh A, Hussain S, Antony B (2020). ["How Much Evidence Is Needed to Conclude against the Use of Oxygen Therapy in Acute Myocardial Infarction?"](https://abstracts.isth.org/abstract/how-much-evidence-is-needed-to-conclude-against-the-use-of-oxygen-therapy-in-acute-myocardial-infarction/). *Res Pract Thromb Haemost*. **4** (Suppl 1). Retrieved 28 July 2020.
\[*[permanent dead link](https://en.wikipedia.org/wiki/Wikipedia:Link_rot "Wikipedia:Link rot")*\]
135. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Wang2011_135-0)**
Ardehali R, Perez M, Wang P (2011). [*A practical approach to cardiovascular medicine*](https://books.google.com/books?id=LZsoHMN8lM4C&pg=PA57). Chichester, West Sussex, UK: Wiley-Blackwell. p. 57. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-4443-9387-3](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4443-9387-3 "Special:BookSources/978-1-4443-9387-3")
.
136. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-136)**
Jindal SK, ed. (2011). [*Textbook of pulmonary and critical care medicine*](https://books.google.com/books?id=rAT1bdnDakAC&pg=PA1758). New Delhi: Jaypee Brothers Medical Publishers. p. 1758. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-93-5025-073-0](https://en.wikipedia.org/wiki/Special:BookSources/978-93-5025-073-0 "Special:BookSources/978-93-5025-073-0")
.
137. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-137)**
Dahal K, Hendrani A, Sharma SP, Singireddy S, Mina G, Reddy P, et al. (July 2018). ["Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145720). *JAMA Internal Medicine*. **178** (7): 913–920\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jamainternmed.2018.0850](https://doi.org/10.1001%2Fjamainternmed.2018.0850). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6145720](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145720). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29799995](https://pubmed.ncbi.nlm.nih.gov/29799995).
138. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-138)**
Rahim L, Allana S, Steinke EE, Ali F, Khan AH (November 2017). "Level of knowledge among cardiac nurses regarding sexual counseling of post-MI patients in three tertiary care hospitals in Pakistan". *Heart & Lung*. **46** (6): 412–416\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.hrtlng.2017.09.002](https://doi.org/10.1016%2Fj.hrtlng.2017.09.002). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28988654](https://pubmed.ncbi.nlm.nih.gov/28988654). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [4277993](https://api.semanticscholar.org/CorpusID:4277993).
139. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid20168196_139-0)**
Jaarsma T, Steinke EE, Gianotten WL (2010). "Sexual problems in cardiac patients: how to assess, when to refer". *The Journal of Cardiovascular Nursing*. **25** (2): 159–64\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/JCN.0b013e3181c60e7c](https://doi.org/10.1097%2FJCN.0b013e3181c60e7c). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20168196](https://pubmed.ncbi.nlm.nih.gov/20168196). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [25806176](https://api.semanticscholar.org/CorpusID:25806176).
140. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-140)**
Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS (November 2021). ["Exercise-based cardiac rehabilitation for coronary heart disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8571912). *The Cochrane Database of Systematic Reviews*. **2021** (11) CD001800. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD001800.pub4](https://doi.org/10.1002%2F14651858.CD001800.pub4). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [8571912](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8571912). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [34741536](https://pubmed.ncbi.nlm.nih.gov/34741536).
141. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-:0_141-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-:0_141-1)
Papneja K, Chan AK, Mondal TK, Paes B (March 2017). "Myocardial Infarction in Neonates: A Review of an Entity with Significant Morbidity and Mortality". *Pediatric Cardiology*. **38** (3): 427–441\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00246-016-1556-7](https://doi.org/10.1007%2Fs00246-016-1556-7). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28238152](https://pubmed.ncbi.nlm.nih.gov/28238152). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [20779415](https://api.semanticscholar.org/CorpusID:20779415).
142. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-PEPA_142-0)**
López de Sá E, López-Sendón J, Anguera I, Bethencourt A, Bosch X (November 2002). ["Prognostic value of clinical variables at presentation in patients with non-ST-segment elevation acute coronary syndromes: results of the Proyecto de Estudio del Pronóstico de la Angina (PEPA)"](https://doi.org/10.1097%2F00005792-200211000-00004). *Medicine*. **81** (6): 434–42\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/00005792-200211000-00004](https://doi.org/10.1097%2F00005792-200211000-00004). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[20\.500.13003/14561](https://hdl.handle.net/20.500.13003%2F14561). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12441900](https://pubmed.ncbi.nlm.nih.gov/12441900). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [10268606](https://api.semanticscholar.org/CorpusID:10268606).
143. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-GRACE_143-0)**
Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. (November 2006). ["Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE)"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661748). *BMJ*. **333** (7578): 1091. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.38985.646481.55](https://doi.org/10.1136%2Fbmj.38985.646481.55). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1661748](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661748). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17032691](https://pubmed.ncbi.nlm.nih.gov/17032691).
144. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Weir-2006_144-0)**
Weir RA, McMurray JJ, Velazquez EJ (May 2006). "Epidemiology of heart failure and left ventricular systolic dysfunction after acute myocardial infarction: prevalence, clinical characteristics, and prognostic importance". *The American Journal of Cardiology*. **97** (10A): 13F–25F. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.amjcard.2006.03.005](https://doi.org/10.1016%2Fj.amjcard.2006.03.005). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16698331](https://pubmed.ncbi.nlm.nih.gov/16698331).
145. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WHO-2004_145-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WHO-2004_145-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WHO-2004_145-2)
World Health Organization (2008). *The Global Burden of Disease: 2004 Update*. Geneva: World Health Organization. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-92-4-156371-0](https://en.wikipedia.org/wiki/Special:BookSources/978-92-4-156371-0 "Special:BookSources/978-92-4-156371-0")
.
146. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-146)**
Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. (American Heart Association Statistics Committee and Stroke Statistics Subcommittee) (January 2012). ["Executive summary: heart disease and stroke statistics--2012 update: a report from the American Heart Association"](https://doi.org/10.1161%2FCIR.0b013e3182456d46). *Circulation*. **125** (1): 188–97\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIR.0b013e3182456d46](https://doi.org/10.1161%2FCIR.0b013e3182456d46). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22215894](https://pubmed.ncbi.nlm.nih.gov/22215894).
147. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-147)**
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. (January 2015). ["Heart disease and stroke statistics--2015 update: a report from the American Heart Association"](https://doi.org/10.1161%2Fcir.0000000000000152). *Circulation*. **131** (4): e29–322. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/cir.0000000000000152](https://doi.org/10.1161%2Fcir.0000000000000152). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25520374](https://pubmed.ncbi.nlm.nih.gov/25520374). "From 2001 to 2011, death rates attributable to CVD declined 30.8%."
148. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-148)**
Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S (January 2008). "Epidemiology and causation of coronary heart disease and stroke in India". *Heart*. **94** (1): 16–26\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/hrt.2007.132951](https://doi.org/10.1136%2Fhrt.2007.132951). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18083949](https://pubmed.ncbi.nlm.nih.gov/18083949). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [27117207](https://api.semanticscholar.org/CorpusID:27117207).
149. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-149)**
Coady SA, Johnson NJ, Hakes JK, Sorlie PD (July 2014). ["Individual education, area income, and mortality and recurrence of myocardial infarction in a Medicare cohort: the National Longitudinal Mortality Study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227052). *BMC Public Health*. **14** (1) 705. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1186/1471-2458-14-705](https://doi.org/10.1186%2F1471-2458-14-705). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4227052](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227052). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25011538](https://pubmed.ncbi.nlm.nih.gov/25011538).
150. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-150)**
Salomaa V, Miettinen H, Niemelä M, Ketonen M, Mähönen M, Immonen-Räihä P, et al. (July 2001). ["Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events; the FINMONICA MI Register Study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731938). *Journal of Epidemiology and Community Health*. **55** (7): 475–82\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/jech.55.7.475](https://doi.org/10.1136%2Fjech.55.7.475). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1731938](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731938). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [11413176](https://pubmed.ncbi.nlm.nih.gov/11413176).
151. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-151)**
Bucholz EM, Ma S, Normand SL, Krumholz HM (October 2015). ["Race, Socioeconomic Status, and Life Expectancy After Acute Myocardial Infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097251). *Circulation*. **132** (14): 1338–46\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/circulationaha.115.017009](https://doi.org/10.1161%2Fcirculationaha.115.017009). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5097251](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097251). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26369354](https://pubmed.ncbi.nlm.nih.gov/26369354).
152. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-152)**
Kilpi F, Silventoinen K, Konttinen H, Martikainen P (April 2016). ["Disentangling the relative importance of different socioeconomic resources for myocardial infarction incidence and survival: a longitudinal study of over 300,000 Finnish adults"](https://doi.org/10.1093%2Feurpub%2Fckv202). *European Journal of Public Health*. **26** (2): 260–6\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurpub/ckv202](https://doi.org/10.1093%2Feurpub%2Fckv202). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26585783](https://pubmed.ncbi.nlm.nih.gov/26585783).
153. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-153)**
Rosvall M, Gerward S, Engström G, Hedblad B (October 2008). ["Income and short-term case fatality after myocardial infarction in the whole middle-aged population of Malmö, Sweden"](https://doi.org/10.1093%2Feurpub%2Fckn059). *European Journal of Public Health*. **18** (5): 533–8\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurpub/ckn059](https://doi.org/10.1093%2Feurpub%2Fckn059). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18621776](https://pubmed.ncbi.nlm.nih.gov/18621776).
154. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-154)**
Graham G (2015-05-14). ["Disparities in cardiovascular disease risk in the United States"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558355). *Current Cardiology Reviews*. **11** (3): 238–45\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2174/1573403X11666141122220003](https://doi.org/10.2174%2F1573403X11666141122220003). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4558355](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558355). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25418513](https://pubmed.ncbi.nlm.nih.gov/25418513).
155. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-155)**
Joshi P (2007-01-17). ["Risk Factors for Early Myocardial Infarction in South Asians Compared With Individuals in Other Countries"](https://jamanetwork.com/journals/jama/article-abstract/205159). *JAMA*. **297** (3): 286–294\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.297.3.286](https://doi.org/10.1001%2Fjama.297.3.286). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17227980](https://pubmed.ncbi.nlm.nih.gov/17227980). Retrieved 2023-11-16.
156. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-156)**
Hamad R, Penko J, Kazi DS, Coxson P, Guzman D, Wei PC, et al. (May 2020). ["Association of Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254448). *JAMA Cardiology*. **5** (8): 899–908\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jamacardio.2020.1458](https://doi.org/10.1001%2Fjamacardio.2020.1458). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7254448](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254448). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32459344](https://pubmed.ncbi.nlm.nih.gov/32459344).
157. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-157)**
["Health Coverage of Immigrants"](https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-of-immigrants/). *KFF*. 2020-03-18. Retrieved 2021-04-09.
158. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-158)**
Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, et al. (April 2010). ["Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020978). *JAMA*. **303** (14): 1392–400\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.2010.409](https://doi.org/10.1001%2Fjama.2010.409). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3020978](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020978). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20388895](https://pubmed.ncbi.nlm.nih.gov/20388895).
159. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-159)**
Kelli HM, Mehta A, Tahhan AS, Liu C, Kim JH, Dong TA, et al. (September 2019). ["Low Educational Attainment is a Predictor of Adverse Outcomes in Patients With Coronary Artery Disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755831). *Journal of the American Heart Association*. **8** (17) e013165. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/JAHA.119.013165](https://doi.org/10.1161%2FJAHA.119.013165). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6755831](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755831). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31476920](https://pubmed.ncbi.nlm.nih.gov/31476920).
160. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-160)**
Perry K, Petrie KJ, Ellis CJ, Horne R, Moss-Morris R (July 2001). ["Symptom expectations and delay in acute myocardial infarction patients"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1729795). *Heart*. **86** (1): 91–3\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/heart.86.1.91](https://doi.org/10.1136%2Fheart.86.1.91). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1729795](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1729795). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [11410572](https://pubmed.ncbi.nlm.nih.gov/11410572).
161. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-prairieview_161-0)** [Workers' Compensation FAQ](http://www.pvamu.edu/pages/2026.asp) [Archived](https://web.archive.org/web/20070711235600/http://www.pvamu.edu/pages/2026.asp) 2007-07-11 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine"). [Prairie View A\&M University](https://en.wikipedia.org/wiki/Prairie_View_A%26M_University "Prairie View A&M University"). Retrieved November 22, 2006.
162. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-biia_162-0)** [SIGNIFICANT DECISIONS Subject Index](http://www.biia.wa.gov/significantdecisions/contents.htm) [Archived](https://web.archive.org/web/20061206115257/http://www.biia.wa.gov/SignificantDecisions/contents.htm) 2006-12-06 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine"). Board of Industrial Insurance Appeals. Retrieved November 22, 2006.
163. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-163)**
["34 U.S. Code § 10281 - Payment of death benefits"](https://www.law.cornell.edu/uscode/text/34/10281). *Legal Information Institute (Cornell Law School)*. Retrieved 2025-07-27.
164. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NovaScotia-DrivingRegulations_164-0)**
["Classification of Drivers' Licenses Regulations"](http://www.gov.ns.ca/just/regulations/regs/mvclasdl.htm). Nova Scotia Registry of Regulations. May 24, 2000. [Archived](https://web.archive.org/web/20070420191108/http://www.gov.ns.ca/just/regulations/regs/mvclasdl.htm) from the original on April 20, 2007. Retrieved April 22, 2007.
### Sources
- Allison TG, Murphy JG (6 December 2012). "Stress Test Selection". In Murphy JG, Lloyd MA, Brady PA, Olsen LJ, Shields RC (eds.). [*Mayo Clinic Cardiology: Concise Textbook*](https://books.google.com/books?id=WSCRAAAAQBAJ). OUP US. pp. 196–202\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-19-991571-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-19-991571-2 "Special:BookSources/978-0-19-991571-2")
.
- Blumenthal RS, Margolis S (2007). [*Heart Attack Prevention 2007*](https://books.google.com/books?id=mM3l59uTj04C&pg=PA10). Johns Hopkins Health. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-933087-47-4](https://en.wikipedia.org/wiki/Special:BookSources/978-1-933087-47-4 "Special:BookSources/978-1-933087-47-4")
.
- Dwight J (16 June 2016). "Chest pain, breathlessness, fatigue". In Warrell D, Cox T, Firth J, Dwight J (eds.). [*Oxford Textbook of Medicine: Cardiovascular Disorders*](https://books.google.com/books?id=YqJHDAAAQBAJ). Oxford University Press. pp. 39–47\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-19-871702-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-19-871702-7 "Special:BookSources/978-0-19-871702-7")
.
- Gaziano TA, Gaziano JM (15 September 2016). "Global Evolving Epidemiology, Natural History, and Treatment Trends of Myocardial Infarction". In Morrow DA (ed.). [*Myocardial Infarction: A Companion to Braunwald's Heart Disease*](https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 11–21\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-323-35943-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-35943-6 "Special:BookSources/978-0-323-35943-6")
.
- Morrow DA, Bohula EA (15 September 2016). "Heart Failure and Cardiogenic Shock After Myocardial Infarction". In Morrow DA (ed.). [*Myocardial Infarction: A Companion to Braunwald's Heart Disease*](https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 295–313\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-323-35943-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-35943-6 "Special:BookSources/978-0-323-35943-6")
.
- Morrow DA, Braunwald E (15 September 2016). "Classification and Diagnosis of Acute Coronary Syndromes". In Morrow DA (ed.). [*Myocardial Infarction: A Companion to Braunwald's Heart Disease*](https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 1–10\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-323-35943-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-35943-6 "Special:BookSources/978-0-323-35943-6")
.
- Morrow DA (15 September 2016). "Clinical Approach to Suspected Acute Myocardial Infarction". In Morrow DA (ed.). [*Myocardial Infarction: A Companion to Braunwald's Heart Disease*](https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 55–65\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-323-35943-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-35943-6 "Special:BookSources/978-0-323-35943-6")
.
## Further reading
- Min Cho S, et al. (2021). "Machine learning compared with conventional statistical models for predicting myocardial infarction readmission and mortality: a systematic review". *Canadian Journal of Cardiology*. **37** (8). Elsevier: 1207–1214\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.cjca.2021.02.020](https://doi.org/10.1016%2Fj.cjca.2021.02.020). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33677098](https://pubmed.ncbi.nlm.nih.gov/33677098). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [232141652](https://api.semanticscholar.org/CorpusID:232141652).
## External links
**Myocardial infarction** at Wikipedia's [sister projects](https://en.wikipedia.org/wiki/Wikipedia:Wikimedia_sister_projects "Wikipedia:Wikimedia sister projects")
- [](https://en.wikipedia.org/wiki/File:Wiktionary-logo-en-v2.svg)[Definitions](https://en.wiktionary.org/wiki/Special:Search/Myocardial_infarction "wikt:Special:Search/Myocardial infarction") from Wiktionary
- [](https://en.wikipedia.org/wiki/File:Commons-logo.svg)[Media](https://commons.wikimedia.org/wiki/Category:Myocardial_infarction "c:Category:Myocardial infarction") from Commons
- [](https://en.wikipedia.org/wiki/File:Wikinews-logo.svg)[News](https://en.wikinews.org/wiki/Special:Search/Myocardial_infarction "n:Special:Search/Myocardial infarction") from Wikinews
- [Quotations](https://en.wikiquote.org/wiki/Special:Search/Myocardial_infarction "q:Special:Search/Myocardial infarction") from Wikiquote
- [](https://en.wikipedia.org/wiki/File:Wikisource-logo.svg)[Texts](https://en.wikisource.org/wiki/Special:Search/Myocardial_infarction "s:Special:Search/Myocardial infarction") from Wikisource
- [](https://en.wikipedia.org/wiki/File:Wikibooks-logo.svg)[Textbooks](https://en.wikibooks.org/wiki/Special:Search/Myocardial_infarction "b:Special:Search/Myocardial infarction") from Wikibooks
- [](https://en.wikipedia.org/wiki/File:Wikiversity_logo_2017.svg)[Resources](https://en.wikiversity.org/wiki/Special:Search/Myocardial_infarction "v:Special:Search/Myocardial infarction") from Wikiversity
- [American Heart Association's Heart Attack web site](http://www.americanheart.org/heartattack) — Information and resources for preventing, recognizing, and treating a heart attack.
- TIMI Score for [UA/NSTEMI](http://www.mdcalc.com/timi-risk-score-for-uanstemi/) [Archived](https://web.archive.org/web/20161105220551/http://www.mdcalc.com/timi-risk-score-for-uanstemi/) 2016-11-05 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") and [STEMI](http://www.mdcalc.com/timi-risk-score-for-stemi/) [Archived](https://web.archive.org/web/20090319073410/http://www.mdcalc.com/timi-risk-score-for-stemi) 2009-03-19 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine")
- [HEART Score for Major Cardiac Events](http://www.mdcalc.com/heart-score-for-major-cardiac-events/) [Archived](https://web.archive.org/web/20161028004807/http://www.mdcalc.com/heart-score-for-major-cardiac-events/) 2016-10-28 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine")
- ["Heart Attack"](https://medlineplus.gov/heartattack.html). *MedlinePlus*. U.S. National Library of Medicine.
| | |
|---|---|
| Classification | [D](https://www.wikidata.org/wiki/Q12152 "d:Q12152") **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10")**: [I21](https://icd.who.int/browse10/2019/en#/I21)\-[I22](https://icd.who.int/browse10/2019/en#/I22) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[9-CM](https://en.wikipedia.org/wiki/List_of_ICD-9_codes "List of ICD-9 codes")**: [410](http://www.icd9data.com/getICD9Code.ashx?icd9=410) **[MeSH](https://en.wikipedia.org/wiki/Medical_Subject_Headings "Medical Subject Headings")**: [D009203](https://meshb.nlm.nih.gov/record/ui?ui=D009203) **[DiseasesDB](https://en.wikipedia.org/wiki/Diseases_Database "Diseases Database")**: [8664](http://www.diseasesdatabase.com/ddb8664.htm) |
| External resources | **[MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus")**: [000195](https://www.nlm.nih.gov/medlineplus/ency/article/000195.htm) **[eMedicine](https://en.wikipedia.org/wiki/EMedicine "EMedicine")**: [med/1567](https://emedicine.medscape.com/med/1567-overview) [emerg/327](https://www.emedicine.com/emerg/topic327.htm) [ped/2520](https://www.emedicine.com/ped/topic2520.htm) **[Patient UK](https://en.wikipedia.org/wiki/Patient_UK "Patient UK")**: [Myocardial infarction](https://patient.info/doctor/acute-myocardial-infarction) |
| [v](https://en.wikipedia.org/wiki/Template:Heart_diseases "Template:Heart diseases") [t](https://en.wikipedia.org/wiki/Template_talk:Heart_diseases "Template talk:Heart diseases") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Heart_diseases "Special:EditPage/Template:Heart diseases")[Cardiovascular disease](https://en.wikipedia.org/wiki/Cardiovascular_disease "Cardiovascular disease") (heart) | |
|---|---|
| [Ischemia](https://en.wikipedia.org/wiki/Ischemia "Ischemia") | |
| | |
| Coronary disease | [Coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease") (CAD) [Coronary artery aneurysm](https://en.wikipedia.org/wiki/Coronary_artery_aneurysm "Coronary artery aneurysm") [Spontaneous coronary artery dissection](https://en.wikipedia.org/wiki/Spontaneous_coronary_artery_dissection "Spontaneous coronary artery dissection") (SCAD) [Coronary thrombosis](https://en.wikipedia.org/wiki/Coronary_thrombosis "Coronary thrombosis") [Coronary vasospasm](https://en.wikipedia.org/wiki/Coronary_vasospasm "Coronary vasospasm") [Myocardial bridge](https://en.wikipedia.org/wiki/Myocardial_bridge "Myocardial bridge") |
| Active ischemia | [Angina pectoris](https://en.wikipedia.org/wiki/Angina "Angina") [Prinzmetal's angina](https://en.wikipedia.org/wiki/Prinzmetal%27s_angina "Prinzmetal's angina") [Stable angina](https://en.wikipedia.org/wiki/Stable_angina "Stable angina") [Acute coronary syndrome](https://en.wikipedia.org/wiki/Acute_coronary_syndrome "Acute coronary syndrome") [Myocardial infarction]() [Unstable angina](https://en.wikipedia.org/wiki/Unstable_angina "Unstable angina") |
| [Sequelae](https://en.wikipedia.org/wiki/Myocardial_infarction_complications "Myocardial infarction complications") | *hours* [Hibernating myocardium](https://en.wikipedia.org/wiki/Hibernating_myocardium "Hibernating myocardium") [Myocardial stunning](https://en.wikipedia.org/wiki/Myocardial_stunning "Myocardial stunning") *days* [Myocardial rupture](https://en.wikipedia.org/wiki/Myocardial_rupture "Myocardial rupture") *weeks* [Ventricular aneurysm](https://en.wikipedia.org/wiki/Ventricular_aneurysm "Ventricular aneurysm") [Dressler syndrome](https://en.wikipedia.org/wiki/Dressler_syndrome "Dressler syndrome") |
| Layers | |
| | |
| [Pericardium](https://en.wikipedia.org/wiki/Pericardium "Pericardium") | [Pericarditis](https://en.wikipedia.org/wiki/Pericarditis "Pericarditis") [Acute](https://en.wikipedia.org/wiki/Acute_pericarditis "Acute pericarditis") [Chronic](https://en.wikipedia.org/wiki/Pericarditis#Acute_vs._chronic "Pericarditis") / [Constrictive](https://en.wikipedia.org/wiki/Constrictive_pericarditis "Constrictive pericarditis") [Pericardial effusion](https://en.wikipedia.org/wiki/Pericardial_effusion "Pericardial effusion") [Cardiac tamponade](https://en.wikipedia.org/wiki/Cardiac_tamponade "Cardiac tamponade") [Hemopericardium](https://en.wikipedia.org/wiki/Hemopericardium "Hemopericardium") |
| [Myocardium](https://en.wikipedia.org/wiki/Cardiac_muscle "Cardiac muscle") | [Myocarditis](https://en.wikipedia.org/wiki/Myocarditis "Myocarditis") [Chagas disease](https://en.wikipedia.org/wiki/Chagas_disease "Chagas disease") [Cardiomyopathy](https://en.wikipedia.org/wiki/Cardiomyopathy "Cardiomyopathy") [Dilated](https://en.wikipedia.org/wiki/Dilated_cardiomyopathy "Dilated cardiomyopathy") [Alcoholic](https://en.wikipedia.org/wiki/Alcoholic_cardiomyopathy "Alcoholic cardiomyopathy") [Hypertrophic](https://en.wikipedia.org/wiki/Hypertrophic_cardiomyopathy "Hypertrophic cardiomyopathy") [Tachycardia-induced](https://en.wikipedia.org/wiki/Tachycardia-induced_cardiomyopathy "Tachycardia-induced cardiomyopathy") [Restrictive](https://en.wikipedia.org/wiki/Restrictive_cardiomyopathy "Restrictive cardiomyopathy") [Loeffler endocarditis](https://en.wikipedia.org/wiki/Loeffler_endocarditis "Loeffler endocarditis") [Cardiac amyloidosis](https://en.wikipedia.org/wiki/Amyloidosis "Amyloidosis") [Endocardial fibroelastosis](https://en.wikipedia.org/wiki/Endocardial_fibroelastosis "Endocardial fibroelastosis") [Viral](https://en.wikipedia.org/wiki/Viral_cardiomyopathy "Viral cardiomyopathy") [Arrhythmogenic right ventricular dysplasia](https://en.wikipedia.org/wiki/Arrhythmogenic_right_ventricular_dysplasia "Arrhythmogenic right ventricular dysplasia") |
| [Endocardium](https://en.wikipedia.org/wiki/Endocardium "Endocardium") / [valves](https://en.wikipedia.org/wiki/Valvular_heart_disease "Valvular heart disease") | |
| | |
| [Endocarditis](https://en.wikipedia.org/wiki/Endocarditis "Endocarditis") | *[infective endocarditis](https://en.wikipedia.org/wiki/Infective_endocarditis "Infective endocarditis")* [Subacute bacterial endocarditis](https://en.wikipedia.org/wiki/Subacute_bacterial_endocarditis "Subacute bacterial endocarditis") *[non-infective endocarditis](https://en.wikipedia.org/wiki/Endocarditis#Non-infective_endocarditis "Endocarditis")* [Libman–Sacks endocarditis](https://en.wikipedia.org/wiki/Libman%E2%80%93Sacks_endocarditis "Libman–Sacks endocarditis") [Nonbacterial thrombotic endocarditis](https://en.wikipedia.org/wiki/Nonbacterial_thrombotic_endocarditis "Nonbacterial thrombotic endocarditis") |
| Valves | *[mitral](https://en.wikipedia.org/wiki/Mitral_valve "Mitral valve")* [prolapse](https://en.wikipedia.org/wiki/Mitral_valve_prolapse "Mitral valve prolapse") [stenosis](https://en.wikipedia.org/wiki/Mitral_valve_stenosis "Mitral valve stenosis") [regurgitation](https://en.wikipedia.org/wiki/Mitral_regurgitation "Mitral regurgitation") *[aortic](https://en.wikipedia.org/wiki/Aortic_valve "Aortic valve")* [stenosis](https://en.wikipedia.org/wiki/Aortic_stenosis "Aortic stenosis") [regurgitation](https://en.wikipedia.org/wiki/Aortic_regurgitation "Aortic regurgitation") *[tricuspid](https://en.wikipedia.org/wiki/Tricuspid_valve "Tricuspid valve")* [stenosis](https://en.wikipedia.org/wiki/Tricuspid_valve_stenosis "Tricuspid valve stenosis") [regurgitation](https://en.wikipedia.org/wiki/Tricuspid_regurgitation "Tricuspid regurgitation") *[pulmonary](https://en.wikipedia.org/wiki/Pulmonary_valve "Pulmonary valve")* [stenosis](https://en.wikipedia.org/wiki/Pulmonary_valve_stenosis "Pulmonary valve stenosis") [regurgitation](https://en.wikipedia.org/wiki/Pulmonary_regurgitation "Pulmonary regurgitation") |
| [Conduction](https://en.wikipedia.org/wiki/Cardiac_conduction_system "Cardiac conduction system") / [arrhythmia](https://en.wikipedia.org/wiki/Arrhythmia "Arrhythmia") | |
| | |
| [Bradycardia](https://en.wikipedia.org/wiki/Bradycardia "Bradycardia") | [Sinus bradycardia](https://en.wikipedia.org/wiki/Sinus_bradycardia "Sinus bradycardia") [Sick sinus syndrome](https://en.wikipedia.org/wiki/Sick_sinus_syndrome "Sick sinus syndrome") [Heart block](https://en.wikipedia.org/wiki/Heart_block "Heart block"): [Sinoatrial](https://en.wikipedia.org/wiki/Sinoatrial_block "Sinoatrial block") [AV](https://en.wikipedia.org/wiki/Atrioventricular_block "Atrioventricular block") [1°](https://en.wikipedia.org/wiki/First-degree_atrioventricular_block "First-degree atrioventricular block") [2°](https://en.wikipedia.org/wiki/Second-degree_atrioventricular_block "Second-degree atrioventricular block") [3°](https://en.wikipedia.org/wiki/Third-degree_atrioventricular_block "Third-degree atrioventricular block") [Intraventricular](https://en.wikipedia.org/wiki/Intraventricular_block "Intraventricular block") [Bundle branch block](https://en.wikipedia.org/wiki/Bundle_branch_block "Bundle branch block") [Right](https://en.wikipedia.org/wiki/Right_bundle_branch_block "Right bundle branch block") [Left](https://en.wikipedia.org/wiki/Left_bundle_branch_block "Left bundle branch block") [Left anterior fascicle](https://en.wikipedia.org/wiki/Left_anterior_fascicular_block "Left anterior fascicular block") [Left posterior fascicle](https://en.wikipedia.org/wiki/Left_posterior_fascicular_block "Left posterior fascicular block") [Bifascicular](https://en.wikipedia.org/wiki/Bifascicular_block "Bifascicular block") [Trifascicular](https://en.wikipedia.org/wiki/Trifascicular_block "Trifascicular block") [Adams–Stokes syndrome](https://en.wikipedia.org/wiki/Adams%E2%80%93Stokes_syndrome "Adams–Stokes syndrome") |
| [Tachycardia](https://en.wikipedia.org/wiki/Tachycardia "Tachycardia") ([paroxysmal](https://en.wikipedia.org/wiki/Paroxysmal_tachycardia "Paroxysmal tachycardia") and [sinus](https://en.wikipedia.org/wiki/Sinus_tachycardia "Sinus tachycardia")) | |
| | |
| [Supraventricular](https://en.wikipedia.org/wiki/Supraventricular_tachycardia "Supraventricular tachycardia") | [Atrial](https://en.wikipedia.org/wiki/Atrial_tachycardia "Atrial tachycardia") [Multifocal](https://en.wikipedia.org/wiki/Multifocal_atrial_tachycardia "Multifocal atrial tachycardia") [Junctional](https://en.wikipedia.org/wiki/Junctional_tachycardia "Junctional tachycardia") [AV nodal reentrant](https://en.wikipedia.org/wiki/AV_nodal_reentrant_tachycardia "AV nodal reentrant tachycardia") [Junctional ectopic](https://en.wikipedia.org/wiki/Junctional_ectopic_tachycardia "Junctional ectopic tachycardia") |
| [Ventricular](https://en.wikipedia.org/wiki/Ventricular_tachycardia "Ventricular tachycardia") | [Accelerated idioventricular rhythm](https://en.wikipedia.org/wiki/Accelerated_idioventricular_rhythm "Accelerated idioventricular rhythm") [Catecholaminergic polymorphic](https://en.wikipedia.org/wiki/Catecholaminergic_polymorphic_ventricular_tachycardia "Catecholaminergic polymorphic ventricular tachycardia") [Torsades de pointes](https://en.wikipedia.org/wiki/Torsades_de_pointes "Torsades de pointes") |
| Premature contraction | [Atrial](https://en.wikipedia.org/wiki/Premature_atrial_contraction "Premature atrial contraction") [Junctional](https://en.wikipedia.org/wiki/Premature_junctional_contraction "Premature junctional contraction") [Ventricular](https://en.wikipedia.org/wiki/Premature_ventricular_contraction "Premature ventricular contraction") |
| [Pre-excitation syndrome](https://en.wikipedia.org/wiki/Pre-excitation_syndrome "Pre-excitation syndrome") | [Lown–Ganong–Levine](https://en.wikipedia.org/wiki/Lown%E2%80%93Ganong%E2%80%93Levine_syndrome "Lown–Ganong–Levine syndrome") [Wolff–Parkinson–White](https://en.wikipedia.org/wiki/Wolff%E2%80%93Parkinson%E2%80%93White_syndrome "Wolff–Parkinson–White syndrome") |
| Flutter / [fibrillation](https://en.wikipedia.org/wiki/Fibrillation "Fibrillation") | [Atrial flutter](https://en.wikipedia.org/wiki/Atrial_flutter "Atrial flutter") [Ventricular flutter](https://en.wikipedia.org/wiki/Ventricular_flutter "Ventricular flutter") [Atrial fibrillation](https://en.wikipedia.org/wiki/Atrial_fibrillation "Atrial fibrillation") [Familial](https://en.wikipedia.org/wiki/Familial_atrial_fibrillation "Familial atrial fibrillation") [Ventricular fibrillation](https://en.wikipedia.org/wiki/Ventricular_fibrillation "Ventricular fibrillation") |
| [Pacemaker](https://en.wikipedia.org/wiki/Artificial_cardiac_pacemaker "Artificial cardiac pacemaker") | [Ectopic pacemaker](https://en.wikipedia.org/wiki/Ectopic_pacemaker "Ectopic pacemaker") / [Ectopic beat](https://en.wikipedia.org/wiki/Ectopic_beat "Ectopic beat") [Multifocal atrial tachycardia](https://en.wikipedia.org/wiki/Multifocal_atrial_tachycardia "Multifocal atrial tachycardia") [Pacemaker syndrome](https://en.wikipedia.org/wiki/Pacemaker_syndrome "Pacemaker syndrome") [Parasystole](https://en.wikipedia.org/wiki/Parasystole "Parasystole") [Wandering atrial pacemaker](https://en.wikipedia.org/wiki/Wandering_atrial_pacemaker "Wandering atrial pacemaker") |
| [Long QT syndrome](https://en.wikipedia.org/wiki/Long_QT_syndrome "Long QT syndrome") | [Andersen–Tawil](https://en.wikipedia.org/wiki/Andersen%E2%80%93Tawil_syndrome "Andersen–Tawil syndrome") [Jervell and Lange-Nielsen](https://en.wikipedia.org/wiki/Jervell_and_Lange-Nielsen_syndrome "Jervell and Lange-Nielsen syndrome") [Romano–Ward](https://en.wikipedia.org/wiki/Romano%E2%80%93Ward_syndrome "Romano–Ward syndrome") |
| [Cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest") | [Sudden cardiac death](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest") [Asystole](https://en.wikipedia.org/wiki/Asystole "Asystole") [Pulseless electrical activity](https://en.wikipedia.org/wiki/Pulseless_electrical_activity "Pulseless electrical activity") [Sinoatrial arrest](https://en.wikipedia.org/wiki/Sinoatrial_arrest "Sinoatrial arrest") |
| Other / ungrouped | *[hexaxial reference system](https://en.wikipedia.org/wiki/Hexaxial_reference_system "Hexaxial reference system")* [Right axis deviation](https://en.wikipedia.org/wiki/Right_axis_deviation "Right axis deviation") [Left axis deviation](https://en.wikipedia.org/wiki/Left_axis_deviation "Left axis deviation") *[QT](https://en.wikipedia.org/wiki/QT_interval "QT interval")* [Short QT syndrome](https://en.wikipedia.org/wiki/Short_QT_syndrome "Short QT syndrome") *[T](https://en.wikipedia.org/wiki/T_wave "T wave")* [T wave alternans](https://en.wikipedia.org/wiki/T_wave_alternans "T wave alternans") *[ST](https://en.wikipedia.org/wiki/ST_segment "ST segment")* [J wave](https://en.wikipedia.org/wiki/J_wave "J wave") [ST elevation](https://en.wikipedia.org/wiki/ST_elevation "ST elevation") [ST depression](https://en.wikipedia.org/wiki/ST_depression "ST depression") [Strain pattern](https://en.wikipedia.org/wiki/Strain_pattern "Strain pattern") |
| [Cardiomegaly](https://en.wikipedia.org/wiki/Cardiomegaly "Cardiomegaly") | [Ventricular hypertrophy](https://en.wikipedia.org/wiki/Ventricular_hypertrophy "Ventricular hypertrophy") [Left](https://en.wikipedia.org/wiki/Left_ventricular_hypertrophy "Left ventricular hypertrophy") [Right](https://en.wikipedia.org/wiki/Right_ventricular_hypertrophy "Right ventricular hypertrophy") [Pulmonary](https://en.wikipedia.org/wiki/Pulmonary_heart_disease "Pulmonary heart disease") [Atrial enlargement](https://en.wikipedia.org/wiki/Atrial_enlargement "Atrial enlargement") [Left](https://en.wikipedia.org/wiki/Left_atrial_enlargement "Left atrial enlargement") [Right](https://en.wikipedia.org/wiki/Right_atrial_enlargement "Right atrial enlargement") [Athletic heart syndrome](https://en.wikipedia.org/wiki/Athletic_heart_syndrome "Athletic heart syndrome") |
| Other | [Cardiac fibrosis](https://en.wikipedia.org/wiki/Cardiac_fibrosis "Cardiac fibrosis") [Heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure") [Diastolic heart failure](https://en.wikipedia.org/wiki/Diastolic_heart_failure "Diastolic heart failure") [Cardiac asthma](https://en.wikipedia.org/wiki/Cardiac_asthma "Cardiac asthma") [Rheumatic fever](https://en.wikipedia.org/wiki/Rheumatic_fever "Rheumatic fever") [Obstructive shock](https://en.wikipedia.org/wiki/Obstructive_shock "Obstructive shock") |
| [v](https://en.wikipedia.org/wiki/Template:Ischaemia_and_infarction "Template:Ischaemia and infarction") [t](https://en.wikipedia.org/wiki/Template_talk:Ischaemia_and_infarction "Template talk:Ischaemia and infarction") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Ischaemia_and_infarction "Special:EditPage/Template:Ischaemia and infarction")[Ischaemia](https://en.wikipedia.org/wiki/Ischaemia "Ischaemia") and [infarction](https://en.wikipedia.org/wiki/Infarction "Infarction") | |
|---|---|
| [Ischemia](https://en.wikipedia.org/wiki/Ischemia "Ischemia") | Location [Brain](https://en.wikipedia.org/wiki/Brain_ischemia "Brain ischemia") [Heart](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease") [Large intestine](https://en.wikipedia.org/wiki/Ischemic_colitis "Ischemic colitis") [Small intestine](https://en.wikipedia.org/wiki/Mesenteric_ischemia "Mesenteric ischemia") |
| [Infarction](https://en.wikipedia.org/wiki/Infarction "Infarction") | Types [Anemic](https://en.wikipedia.org/wiki/Anemic_infarct "Anemic infarct") [Hemorrhagic](https://en.wikipedia.org/wiki/Hemorrhagic_infarct "Hemorrhagic infarct") Location [Heart]() [Brain](https://en.wikipedia.org/wiki/Cerebral_infarction "Cerebral infarction") [Spleen](https://en.wikipedia.org/wiki/Splenic_infarction "Splenic infarction") [Limb](https://en.wikipedia.org/wiki/Limb_infarction "Limb infarction") [Gangrene](https://en.wikipedia.org/wiki/Gangrene "Gangrene") |
| [Authority control databases](https://en.wikipedia.org/wiki/Help:Authority_control "Help:Authority control") [](https://www.wikidata.org/wiki/Q12152#identifiers "Edit this at Wikidata") | |
|---|---|
| International | [GND](https://d-nb.info/gnd/4024654-1) |
| National | [United States](https://id.loc.gov/authorities/sh85059683) [France](https://catalogue.bnf.fr/ark:/12148/cb11932573j) [BnF data](https://data.bnf.fr/ark:/12148/cb11932573j) [Japan](https://id.ndl.go.jp/auth/ndlna/00571052) [Czech Republic](https://aleph.nkp.cz/F/?func=find-c&local_base=aut&ccl_term=ica=ph114764&CON_LNG=ENG) [Israel](https://www.nli.org.il/en/authorities/987007553140905171) |
| Other | [Encyclopedia of Modern Ukraine](http://esu.com.ua/search_articles.php?id=12438) [Yale LUX](https://lux.collections.yale.edu/view/concept/1784680f-7a34-421c-89b6-3f414281908e) |
Retrieved from "<https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&oldid=1345938649>"
[Categories](https://en.wikipedia.org/wiki/Help:Category "Help:Category"):
- [Aging-associated diseases](https://en.wikipedia.org/wiki/Category:Aging-associated_diseases "Category:Aging-associated diseases")
- [Cardiovascular diseases](https://en.wikipedia.org/wiki/Category:Cardiovascular_diseases "Category:Cardiovascular diseases")
- [Causes of death](https://en.wikipedia.org/wiki/Category:Causes_of_death "Category:Causes of death")
- [Ischemic heart diseases](https://en.wikipedia.org/wiki/Category:Ischemic_heart_diseases "Category:Ischemic heart diseases")
- [Medical emergencies](https://en.wikipedia.org/wiki/Category:Medical_emergencies "Category:Medical emergencies")
- [Acute pain](https://en.wikipedia.org/wiki/Category:Acute_pain "Category:Acute pain")
Hidden categories:
- [CS1: long volume value](https://en.wikipedia.org/wiki/Category:CS1:_long_volume_value "Category:CS1: long volume value")
- [All articles with dead external links](https://en.wikipedia.org/wiki/Category:All_articles_with_dead_external_links "Category:All articles with dead external links")
- [Articles with dead external links from April 2025](https://en.wikipedia.org/wiki/Category:Articles_with_dead_external_links_from_April_2025 "Category:Articles with dead external links from April 2025")
- [Articles with permanently dead external links](https://en.wikipedia.org/wiki/Category:Articles_with_permanently_dead_external_links "Category:Articles with permanently dead external links")
- [Webarchive template wayback links](https://en.wikipedia.org/wiki/Category:Webarchive_template_wayback_links "Category:Webarchive template wayback links")
- [Wikipedia semi-protected pages](https://en.wikipedia.org/wiki/Category:Wikipedia_semi-protected_pages "Category:Wikipedia semi-protected pages")
- [Articles with short description](https://en.wikipedia.org/wiki/Category:Articles_with_short_description "Category:Articles with short description")
- [Short description is different from Wikidata](https://en.wikipedia.org/wiki/Category:Short_description_is_different_from_Wikidata "Category:Short description is different from Wikidata")
- [Good articles](https://en.wikipedia.org/wiki/Category:Good_articles "Category:Good articles")
- [Articles with limited geographic scope from October 2024](https://en.wikipedia.org/wiki/Category:Articles_with_limited_geographic_scope_from_October_2024 "Category:Articles with limited geographic scope from October 2024")
- [Pages using Sister project links with default search](https://en.wikipedia.org/wiki/Category:Pages_using_Sister_project_links_with_default_search "Category:Pages using Sister project links with default search")
- [Articles containing video clips](https://en.wikipedia.org/wiki/Category:Articles_containing_video_clips "Category:Articles containing video clips")
- [Wikipedia medicine articles ready to translate](https://en.wikipedia.org/wiki/Category:Wikipedia_medicine_articles_ready_to_translate "Category:Wikipedia medicine articles ready to translate")
- [Wikipedia emergency medicine articles ready to translate](https://en.wikipedia.org/wiki/Category:Wikipedia_emergency_medicine_articles_ready_to_translate "Category:Wikipedia emergency medicine articles ready to translate")
- This page was last edited on 29 March 2026, at 02:13 (UTC).
- Text is available under the [Creative Commons Attribution-ShareAlike 4.0 License](https://en.wikipedia.org/wiki/Wikipedia:Text_of_the_Creative_Commons_Attribution-ShareAlike_4.0_International_License "Wikipedia:Text of the Creative Commons Attribution-ShareAlike 4.0 International License"); additional terms may apply. By using this site, you agree to the [Terms of Use](https://foundation.wikimedia.org/wiki/Special:MyLanguage/Policy:Terms_of_Use "foundation:Special:MyLanguage/Policy:Terms of Use") and [Privacy Policy](https://foundation.wikimedia.org/wiki/Special:MyLanguage/Policy:Privacy_policy "foundation:Special:MyLanguage/Policy:Privacy policy"). Wikipedia® is a registered trademark of the [Wikimedia Foundation, Inc.](https://wikimediafoundation.org/), a non-profit organization.
- [Privacy policy](https://foundation.wikimedia.org/wiki/Special:MyLanguage/Policy:Privacy_policy)
- [About Wikipedia](https://en.wikipedia.org/wiki/Wikipedia:About)
- [Disclaimers](https://en.wikipedia.org/wiki/Wikipedia:General_disclaimer)
- [Contact Wikipedia](https://en.wikipedia.org/wiki/Wikipedia:Contact_us)
- [Legal & safety contacts](https://foundation.wikimedia.org/wiki/Special:MyLanguage/Legal:Wikimedia_Foundation_Legal_and_Safety_Contact_Information)
- [Code of Conduct](https://foundation.wikimedia.org/wiki/Special:MyLanguage/Policy:Universal_Code_of_Conduct)
- [Developers](https://developer.wikimedia.org/)
- [Statistics](https://stats.wikimedia.org/#/en.wikipedia.org)
- [Cookie statement](https://foundation.wikimedia.org/wiki/Special:MyLanguage/Policy:Cookie_statement)
- [Mobile view](https://en.wikipedia.org/w/index.php?title=Myocardial_infarction&mobileaction=toggle_view_mobile)
- [](https://www.wikimedia.org/)
- [](https://www.mediawiki.org/)
Search
Toggle the table of contents
Myocardial infarction
127 languages
[Add topic](https://en.wikipedia.org/wiki/Myocardial_infarction) |
| Readable Markdown | | Myocardial infarction | |
|---|---|
| Other names | Acute myocardial infarction (AMI), heart attack |
| [](https://en.wikipedia.org/wiki/File:Blausen_0463_HeartAttack.png) | |
| A myocardial infarction occurs when an [atherosclerotic](https://en.wikipedia.org/wiki/Atherosclerosis "Atherosclerosis") [plaque](https://en.wikipedia.org/wiki/Atheroma "Atheroma") slowly builds up in the inner lining of a [coronary artery](https://en.wikipedia.org/wiki/Coronary_artery "Coronary artery") and then suddenly ruptures, causing catastrophic [thrombus](https://en.wikipedia.org/wiki/Thrombus "Thrombus") formation, totally occluding the artery and preventing blood flow downstream to the heart muscle. | |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Cardiology](https://en.wikipedia.org/wiki/Cardiology "Cardiology"), [emergency medicine](https://en.wikipedia.org/wiki/Emergency_medicine "Emergency medicine") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | [Chest pain](https://en.wikipedia.org/wiki/Chest_pain "Chest pain"), [shortness of breath](https://en.wikipedia.org/wiki/Shortness_of_breath "Shortness of breath"), [nausea](https://en.wikipedia.org/wiki/Nausea "Nausea")/[vomiting](https://en.wikipedia.org/wiki/Vomiting "Vomiting"), [dizziness](https://en.wikipedia.org/wiki/Dizziness "Dizziness") or [lightheadedness](https://en.wikipedia.org/wiki/Presyncope "Presyncope"), [cold sweat](https://en.wikipedia.org/wiki/Diaphoresis "Diaphoresis"), [feeling tired](https://en.wikipedia.org/wiki/Fatigue_\(medical\) "Fatigue (medical)"); arm, neck, back, jaw, or stomach pain,[\[1\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2014-1)[\[2\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-2) [decreased level](https://en.wikipedia.org/wiki/Altered_level_of_consciousness "Altered level of consciousness") or [total loss of consciousness](https://en.wikipedia.org/wiki/Unconsciousness "Unconsciousness") |
| [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") | [Heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), [irregular heartbeat](https://en.wikipedia.org/wiki/Cardiac_arrhythmia "Cardiac arrhythmia"), [cardiogenic shock](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock"), [coma](https://en.wikipedia.org/wiki/Coma "Coma"), [cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest")[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3)[\[4\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Heart2015-4) |
| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") | [Angina](https://en.wikipedia.org/wiki/Angina "Angina") or [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease") usually[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3) |
| [Risk factors](https://en.wikipedia.org/wiki/Risk_factor "Risk factor") | [High blood pressure](https://en.wikipedia.org/wiki/Hypertension "Hypertension"), [smoking](https://en.wikipedia.org/wiki/Tobacco_smoking "Tobacco smoking"), [diabetes](https://en.wikipedia.org/wiki/Diabetes_mellitus "Diabetes mellitus"), [lack of exercise](https://en.wikipedia.org/wiki/Sedentary_lifestyle "Sedentary lifestyle"), [obesity](https://en.wikipedia.org/wiki/Obesity "Obesity"), [high blood cholesterol](https://en.wikipedia.org/wiki/Hypercholesterolaemia "Hypercholesterolaemia")[\[5\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Meh2014-5)[\[6\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WHO2011-6) |
| [Diagnostic method](https://en.wikipedia.org/wiki/Medical_diagnosis "Medical diagnosis") | [Electrocardiograms](https://en.wikipedia.org/wiki/Electrocardiogram "Electrocardiogram") (ECGs), blood tests, [coronary angiography](https://en.wikipedia.org/wiki/Coronary_angiography "Coronary angiography")[\[7\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013D-7) |
| Treatment | [Percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention"), [thrombolysis](https://en.wikipedia.org/wiki/Thrombolysis "Thrombolysis")[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8) |
| [Medication](https://en.wikipedia.org/wiki/Medication "Medication") | [Aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin"), [nitroglycerin](https://en.wikipedia.org/wiki/Nitroglycerin_\(drug\) "Nitroglycerin (drug)"), [heparin](https://en.wikipedia.org/wiki/Heparin "Heparin")[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8)[\[9\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Oc2010-9) |
| [Prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis") | STEMI 10% risk of death (developed world)[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8) |
| Frequency | 15\.9 million (2015)[\[10\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-GBD2015Pre-10) |
A **myocardial infarction** (**MI**), commonly known as a **heart attack**, occurs when [blood flow decreases](https://en.wikipedia.org/wiki/Ischemia "Ischemia") or stops in one of the [arteries of the heart](https://en.wikipedia.org/wiki/Coronary_arteries "Coronary arteries"), causing [infarction](https://en.wikipedia.org/wiki/Infarction "Infarction") (tissue death) to the [heart muscle](https://en.wikipedia.org/wiki/Heart_muscle "Heart muscle").[\[1\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2014-1) The most common symptom is retrosternal [chest pain or discomfort](https://en.wikipedia.org/wiki/Angina "Angina") that classically radiates to the left shoulder, arm, or jaw.[\[1\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2014-1) The pain may occasionally feel like [heartburn](https://en.wikipedia.org/wiki/Heartburn "Heartburn").[\[1\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2014-1) This is the dangerous type of [acute coronary syndrome](https://en.wikipedia.org/wiki/Acute_coronary_syndrome "Acute coronary syndrome").
Other symptoms may include [shortness of breath](https://en.wikipedia.org/wiki/Shortness_of_breath "Shortness of breath"), [nausea](https://en.wikipedia.org/wiki/Nausea "Nausea"), [feeling faint](https://en.wikipedia.org/wiki/Presyncope "Presyncope"), a [cold sweat](https://en.wikipedia.org/wiki/Diaphoresis "Diaphoresis"), [feeling tired](https://en.wikipedia.org/wiki/Fatigue "Fatigue"), and [decreased level of consciousness](https://en.wikipedia.org/wiki/Decreased_level_of_consciousness "Decreased level of consciousness").[\[1\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2014-1) About 30% of people have atypical symptoms.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8) Women more often present without chest pain and instead have neck pain, arm pain or feel tired.[\[11\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-11) Among those over 75 years old, about 5% have had an MI with little or no history of symptoms.[\[12\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Val2011-12) An MI may cause [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), an [irregular heartbeat](https://en.wikipedia.org/wiki/Cardiac_arrhythmia "Cardiac arrhythmia"), [cardiogenic shock](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock") or [cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest").[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3)[\[4\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Heart2015-4)
Most MIs occur due to [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease").[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3) Risk factors include [high blood pressure](https://en.wikipedia.org/wiki/Hypertension "Hypertension"), [smoking](https://en.wikipedia.org/wiki/Tobacco_smoking "Tobacco smoking"), [diabetes](https://en.wikipedia.org/wiki/Diabetes_mellitus "Diabetes mellitus"), [lack of exercise](https://en.wikipedia.org/wiki/Lack_of_exercise "Lack of exercise"), [obesity](https://en.wikipedia.org/wiki/Obesity "Obesity"), [high blood cholesterol](https://en.wikipedia.org/wiki/Hypercholesterolaemia "Hypercholesterolaemia"), poor diet, and [excessive alcohol intake](https://en.wikipedia.org/wiki/Excessive_alcohol_intake "Excessive alcohol intake").[\[5\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Meh2014-5)[\[6\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WHO2011-6) The complete blockage of a [coronary artery](https://en.wikipedia.org/wiki/Coronary_artery "Coronary artery") caused by a rupture of an [atherosclerotic plaque](https://en.wikipedia.org/wiki/Atherosclerosis "Atherosclerosis") is usually the underlying mechanism of an MI.[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3) MIs are less commonly caused by [coronary artery spasms](https://en.wikipedia.org/wiki/Coronary_artery_spasm "Coronary artery spasm"), which may be due to [cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine"), significant emotional stress (often known as [Takotsubo syndrome](https://en.wikipedia.org/wiki/Takotsubo_syndrome "Takotsubo syndrome") or *broken heart syndrome*) and extreme cold, among others.[\[13\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-13)[\[14\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-14) Many tests are helpful with diagnosis, including [electrocardiograms](https://en.wikipedia.org/wiki/Electrocardiogram "Electrocardiogram") (ECGs), blood tests and [coronary angiography](https://en.wikipedia.org/wiki/Coronary_angiography "Coronary angiography").[\[7\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013D-7) An ECG, which is a recording of the heart's electrical activity, may confirm an **ST elevation MI** ([STEMI](https://en.wikipedia.org/wiki/Myocardial_infarction#STEMI)), if [ST elevation](https://en.wikipedia.org/wiki/ST_elevation "ST elevation") is present.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8)[\[15\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-15) Commonly used blood tests include [troponin](https://en.wikipedia.org/wiki/Troponin "Troponin") and less often [creatine kinase MB](https://en.wikipedia.org/wiki/CPK-MB_test "CPK-MB test").[\[7\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013D-7)
Treatment of an MI is time-critical.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) [Aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin") is an appropriate immediate treatment for a suspected MI.[\[9\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Oc2010-9) [Nitroglycerin](https://en.wikipedia.org/wiki/Nitroglycerin_\(drug\) "Nitroglycerin (drug)") or [opioids](https://en.wikipedia.org/wiki/Opioid "Opioid") may be used to help with chest pain; however, they do not improve overall outcomes.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8)[\[9\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Oc2010-9) [Supplemental oxygen](https://en.wikipedia.org/wiki/Oxygen_therapy "Oxygen therapy") is recommended in those with [low oxygen levels](https://en.wikipedia.org/wiki/Hypoxia_\(medical\) "Hypoxia (medical)") or shortness of breath.[\[9\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Oc2010-9) In a STEMI, treatments attempt to restore blood flow to the [heart](https://en.wikipedia.org/wiki/Heart "Heart") and include [percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention") (PCI), where the arteries are pushed open and may be [stented](https://en.wikipedia.org/wiki/Stent "Stent"), or [thrombolysis](https://en.wikipedia.org/wiki/Thrombolysis "Thrombolysis"), where the blockage is removed using medications.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8) People who have a **non-ST elevation myocardial infarction** ([NSTEMI](https://en.wikipedia.org/wiki/Myocardial_infarction#NSTEMI)) are often managed with the blood thinner [heparin](https://en.wikipedia.org/wiki/Heparin "Heparin"), with the additional use of PCI in those at high risk.[\[9\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Oc2010-9) In people with blockages of multiple coronary arteries and diabetes, [coronary artery bypass surgery](https://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery "Coronary artery bypass surgery") (CABG) may be recommended rather than [angioplasty](https://en.wikipedia.org/wiki/Angioplasty "Angioplasty").[\[17\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Hamm2011-17) After an MI, lifestyle modifications, along with long-term treatment with aspirin, [beta blockers](https://en.wikipedia.org/wiki/Beta_blockers "Beta blockers") and [statins](https://en.wikipedia.org/wiki/Statin "Statin"), are typically recommended.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8)
Worldwide, about 15.9 million myocardial infarctions occurred in 2015.[\[10\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-GBD2015Pre-10) More than 3 million people had an ST elevation MI, and more than 4 million had an NSTEMI.[\[18\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Lancet08-18) STEMIs occur about twice as often in men as women.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) About one million people have an MI each year in the United States.[\[3\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-HLB2013MI-3) In the developed world, the risk of death in those who have had a STEMI is about 10%.[\[8\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Europe2012-8) Rates of MI for a given age have decreased globally between 1990 and 2010.[\[20\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-20) In 2011, an MI was one of the top five most expensive conditions during inpatient hospitalizations in the US, with a cost of about \$11.5 billion for 612,000 hospital stays.[\[21\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-21)
Terminology
Myocardial infarction (MI) refers to tissue death ([infarction](https://en.wikipedia.org/wiki/Infarction "Infarction")) of a part of the heart muscle ([myocardium](https://en.wikipedia.org/wiki/Myocardium "Myocardium")), caused by [ischemia](https://en.wikipedia.org/wiki/Myocardial_ischemia "Myocardial ischemia"), the lack of oxygen delivery to myocardial tissue. It is a type of [acute coronary syndrome](https://en.wikipedia.org/wiki/Acute_coronary_syndrome "Acute coronary syndrome"), which describes a sudden or short-term change in symptoms related to blood flow to the heart.[\[22\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrowBraunwald20161%E2%80%933Dwight201641-22) Unlike the other type of acute coronary syndrome, [unstable angina](https://en.wikipedia.org/wiki/Unstable_angina "Unstable angina"), a myocardial [infarction](https://en.wikipedia.org/wiki/Infarction "Infarction") occurs when there is [cell death](https://en.wikipedia.org/wiki/Cell_death "Cell death"), which can be estimated by measuring a [blood test](https://en.wikipedia.org/wiki/Blood_test "Blood test") for [biomarkers](https://en.wikipedia.org/wiki/Biomarker_\(medicine\) "Biomarker (medicine)") (the cardiac protein [troponin](https://en.wikipedia.org/wiki/Troponin "Troponin")).[\[23\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrowBraunwald20161%E2%80%933-23) When there is evidence of an MI, it may be classified as an ST elevation myocardial infarction (STEMI) or Non-ST elevation myocardial infarction (NSTEMI) based on the results of an [ECG](https://en.wikipedia.org/wiki/ECG "ECG").[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)
The phrase "heart attack" is often used non-specifically to refer to myocardial infarction. An MI is different from — but can cause — [cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest"), where the heart is not contracting at all or so poorly that all vital organs cease to function, thus leading to death.[\[25\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEBlumenthalMargolis20074%E2%80%935-25) It is also distinct from [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), in which the pumping action of the heart is impaired. However, an MI may lead to heart failure.[\[26\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrowBohula2016295-26)
Signs and symptoms
[](https://en.wikipedia.org/wiki/File:Acute_myocardial_infarction_pain_svg_hariadhi.svg)
[](https://en.wikipedia.org/wiki/File:Acute_myocardial_infarction_pain_back_svg_hariadhi.svg)
Areas where pain is experienced in myocardial infarction, showing common (dark red) and less common (light red) areas on the chest (top) and back (bottom).
Chest pain that may or may not radiate to other parts of the body is the most typical and significant symptom of myocardial infarction. It might be accompanied by other symptoms such as sweating.[\[27\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrow201659%E2%80%9361-27)
Pain
[Chest pain](https://en.wikipedia.org/wiki/Chest_pain "Chest pain") is one of the most common symptoms of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper [abdomen](https://en.wikipedia.org/wiki/Abdomen "Abdomen").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[29\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrow201659%E2%80%9360-29) The pain most suggestive of an acute MI, with the highest [likelihood ratio](https://en.wikipedia.org/wiki/Likelihood_function "Likelihood function"), is pain radiating to the right arm and shoulder.[\[30\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015B-30)[\[29\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrow201659%E2%80%9360-29) Similarly, chest pain similar to a previous heart attack is also suggestive.[\[31\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Gupta2016-31) The pain associated with MI is usually diffuse, does not change with position, and lasts for more than 20 minutes.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) It might be described as pressure, tightness, knifelike, tearing, burning sensation (all these are also manifested during other diseases). It could be felt as an unexplained anxiety, and pain might be absent altogether.[\[29\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEMorrow201659%E2%80%9360-29) [Levine's sign](https://en.wikipedia.org/wiki/Levine%27s_sign "Levine's sign"), in which a person localizes the chest pain by clenching one or both fists over their [sternum](https://en.wikipedia.org/wiki/Human_sternum "Human sternum"), has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed it had a poor [positive predictive value](https://en.wikipedia.org/wiki/Positive_predictive_value "Positive predictive value").[\[32\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid17208083-32)
Typically, chest pain because of ischemia, be it unstable angina or myocardial infarction, lessens with the use of [nitroglycerin](https://en.wikipedia.org/wiki/Nitroglycerin_\(drug\) "Nitroglycerin (drug)"), but nitroglycerin may also relieve chest pain arising from non-cardiac causes.[\[33\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEAllisonMurphy2012197Morrow201660-33)
Other
Chest pain may be accompanied by [sweating](https://en.wikipedia.org/wiki/Diaphoresis "Diaphoresis"), nausea or vomiting, and [fainting](https://en.wikipedia.org/wiki/Syncope_\(medicine\) "Syncope (medicine)"),[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)[\[30\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015B-30) and these symptoms may also occur without any pain at all.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Dizziness or lightheadedness is common and occurs due to reduction in oxygen and blood to the brain. In females, the most common symptoms of myocardial infarction include shortness of breath, weakness, and [fatigue](https://en.wikipedia.org/wiki/Fatigue_\(physical\) "Fatigue (physical)").[\[34\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-ACSwomen-34) Females are more likely to have unusual or unexplained tiredness and nausea or vomiting as symptoms.[\[35\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-35) Females having heart attacks are more likely to have palpitations, back pain, labored breath, vomiting, and left arm pain than males, although the studies showing these differences had high variability.[\[36\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-36) Females are less likely to report chest pain during a heart attack and more likely to report nausea, jaw pain, neck pain, cough, and fatigue, although these findings are inconsistent across studies.[\[37\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-37) Females with heart attacks also had more indigestion, [dizziness](https://en.wikipedia.org/wiki/Dizziness "Dizziness"), [loss of appetite](https://en.wikipedia.org/wiki/Anorexia_\(symptom\) "Anorexia (symptom)"), and loss of consciousness.[\[38\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-38) [Shortness of breath](https://en.wikipedia.org/wiki/Shortness_of_breath "Shortness of breath") is a common, and sometimes the only symptom, occurring when damage to the heart limits the [output](https://en.wikipedia.org/wiki/Cardiac_output "Cardiac output") of the [left ventricle](https://en.wikipedia.org/wiki/Left_ventricle "Left ventricle"), with breathlessness arising either from [low oxygen in the blood](https://en.wikipedia.org/wiki/Hypoxemia "Hypoxemia") or [pulmonary edema](https://en.wikipedia.org/wiki/Pulmonary_edema "Pulmonary edema").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[39\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-39)
Other less common symptoms include weakness, [light-headedness](https://en.wikipedia.org/wiki/Light-headedness "Light-headedness"), [palpitations](https://en.wikipedia.org/wiki/Palpitation "Palpitation"), and abnormalities in [heart rate](https://en.wikipedia.org/wiki/Heart_rate "Heart rate") or [blood pressure](https://en.wikipedia.org/wiki/Blood_pressure "Blood pressure").[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) These symptoms are likely induced by a massive surge of [catecholamines](https://en.wikipedia.org/wiki/Catecholamines "Catecholamines") from the [sympathetic nervous system](https://en.wikipedia.org/wiki/Sympathetic_nervous_system "Sympathetic nervous system"), which occurs in response to pain and, where present, low [blood pressure](https://en.wikipedia.org/wiki/Blood_pressure "Blood pressure").[\[40\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-40) [Loss of consciousness](https://en.wikipedia.org/wiki/Unconsciousness "Unconsciousness") can occur in myocardial infarctions due to inadequate blood flow to the [brain](https://en.wikipedia.org/wiki/Brain "Brain") and [cardiogenic shock](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock"), and [sudden death](https://en.wikipedia.org/wiki/Sudden_cardiac_death "Sudden cardiac death"), frequently due to the development of [ventricular fibrillation](https://en.wikipedia.org/wiki/Ventricular_fibrillation "Ventricular fibrillation").[\[41\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-ESC_STEMI-41) When the brain was without oxygen for too long due to a myocardial infarction, [coma](https://en.wikipedia.org/wiki/Coma "Coma") and [persistent vegetative state](https://en.wikipedia.org/wiki/Vegetative_state "Vegetative state") can occur. Cardiac arrest, and atypical symptoms such as [palpitations](https://en.wikipedia.org/wiki/Palpitations "Palpitations"), occur more frequently in females, the elderly, those with diabetes, in people who have just had surgery, and in critically ill patients.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)
Absence
"Silent" myocardial infarctions can happen without any symptoms at all.[\[12\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Val2011-12) These cases can be discovered later on [electrocardiograms](https://en.wikipedia.org/wiki/Electrocardiograms "Electrocardiograms"), using blood enzyme tests, or at [autopsy](https://en.wikipedia.org/wiki/Autopsy "Autopsy") after a person has died. Such silent myocardial infarctions represent between 22 and 64% of all infarctions,[\[12\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Val2011-12) and are more common in the [elderly](https://en.wikipedia.org/wiki/Elderly "Elderly"),[\[12\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Val2011-12) in those with [diabetes mellitus](https://en.wikipedia.org/wiki/Diabetes_mellitus "Diabetes mellitus")[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) and after [heart transplantation](https://en.wikipedia.org/wiki/Heart_transplantation "Heart transplantation"). In people with diabetes, differences in [pain threshold](https://en.wikipedia.org/wiki/Threshold_of_pain "Threshold of pain"), [autonomic neuropathy](https://en.wikipedia.org/wiki/Autonomic_neuropathy "Autonomic neuropathy"), and [psychological](https://en.wikipedia.org/wiki/Psychology "Psychology") factors have been cited as possible explanations for the lack of symptoms.[\[42\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Diabetologica2004-David-42) In heart transplantation, the [donor](https://en.wikipedia.org/wiki/Organ_donation "Organ donation") heart is not fully innervated by the nervous system of the recipient.[\[43\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-rubin-43)
Risk factors
The most prominent risk factors for myocardial infarction are older age, actively [smoking](https://en.wikipedia.org/wiki/Smoking "Smoking"), [high blood pressure](https://en.wikipedia.org/wiki/Hypertension "Hypertension"), [diabetes mellitus](https://en.wikipedia.org/wiki/Diabetes_mellitus "Diabetes mellitus"), and total [cholesterol](https://en.wikipedia.org/wiki/Cholesterol "Cholesterol") and [high-density lipoprotein](https://en.wikipedia.org/wiki/High-density_lipoprotein "High-density lipoprotein") levels.[\[44\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-FOOTNOTEGazianoGaziano201611-22-44) Many risk factors of myocardial infarction are shared with [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease"), the primary cause of myocardial infarction,[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) with other risk factors including male sex, low levels of physical activity, a past [family history](https://en.wikipedia.org/wiki/Family_history_\(medicine\) "Family history (medicine)"), [obesity](https://en.wikipedia.org/wiki/Obesity "Obesity"), and [alcohol use](https://en.wikipedia.org/wiki/Alcohol_use "Alcohol use").[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Risk factors for myocardial disease are often included in risk factor stratification scores, such as the [Framingham Risk Score](https://en.wikipedia.org/wiki/Framingham_Risk_Score "Framingham Risk Score").[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) At any given age, men are more at risk than women for the development of cardiovascular disease.[\[45\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-EUROPEAN2012-45) [High levels of blood cholesterol](https://en.wikipedia.org/wiki/Hypercholesterolemia "Hypercholesterolemia") is a known risk factor, particularly high [low-density lipoprotein](https://en.wikipedia.org/wiki/Low-density_lipoprotein "Low-density lipoprotein"), low [high-density lipoprotein](https://en.wikipedia.org/wiki/High-density_lipoprotein "High-density lipoprotein"), and high [triglycerides](https://en.wikipedia.org/wiki/Triglycerides "Triglycerides").[\[46\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid=16697342-46)
Many risk factors for myocardial infarction are potentially modifiable, with the most important being [tobacco smoking](https://en.wikipedia.org/wiki/Tobacco_smoking "Tobacco smoking") (including [secondhand smoke](https://en.wikipedia.org/wiki/Secondhand_smoke "Secondhand smoke")).[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Smoking appears to be the cause of about 36% and obesity the cause of 20% of [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease").[\[47\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Kivi2012-47) Lack of physical activity has been linked to 7–12% of cases.[\[47\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Kivi2012-47)[\[48\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-48) Less common causes include stress-related causes such as [job stress](https://en.wikipedia.org/wiki/Workplace_stress "Workplace stress"), which accounts for about 3% of cases,[\[47\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Kivi2012-47) and chronic high stress levels.[\[49\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid=22473079-49)
Diet
There is varying evidence about the importance of [saturated fat](https://en.wikipedia.org/wiki/Saturated_fat "Saturated fat") in the development of myocardial infarctions. Eating polyunsaturated fat instead of [saturated fats](https://en.wikipedia.org/wiki/Saturated_fat "Saturated fat") has been shown in studies to be associated with a decreased risk of myocardial infarction,[\[50\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-:1-50) while other studies find little evidence that reducing dietary saturated fat or increasing [polyunsaturated fat](https://en.wikipedia.org/wiki/Polyunsaturated_fat "Polyunsaturated fat") intake affects heart attack risk.[\[51\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Chow2014-51)[\[52\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-52) Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed.[\[53\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-53) [Trans fats](https://en.wikipedia.org/wiki/Trans_fats "Trans fats") do appear to increase risk.[\[51\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Chow2014-51) Acute and prolonged intake of high quantities of alcoholic drinks (3–4 or more daily) increases the risk of a heart attack.[\[54\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Krenz2012-54)
Genetics
Family history of [ischemic heart disease](https://en.wikipedia.org/wiki/Ischemic_heart_disease "Ischemic heart disease") or MI, particularly if one has a male first-degree relative (father, brother) who had a myocardial infarction before age 55 years, or a female first-degree relative (mother, sister) less than age 65 increases a person's risk of MI.[\[45\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-EUROPEAN2012-45)
[Genome-wide association studies](https://en.wikipedia.org/wiki/Genome-wide_association_studies "Genome-wide association studies") have found 27 genetic variants that are associated with an increased risk of myocardial infarction.[\[55\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Genomics_of_Cardiovascular_Disease-55) The strongest association of MI has been found with [chromosome 9](https://en.wikipedia.org/wiki/Chromosome_9 "Chromosome 9") on the short arm *p* at [locus](https://en.wikipedia.org/wiki/Locus_\(genetics\) "Locus (genetics)") 21, which contains genes CDKN2A and 2B, although the [single nucleotide polymorphisms](https://en.wikipedia.org/wiki/Single_nucleotide_polymorphisms "Single nucleotide polymorphisms") that are implicated are within a non-coding region.[\[55\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Genomics_of_Cardiovascular_Disease-55) The majority of these variants are in regions that have not been previously implicated in coronary artery disease. The following genes have an association with MI: [PCSK9](https://en.wikipedia.org/wiki/PCSK9 "PCSK9"), [SORT1](https://en.wikipedia.org/wiki/SORT1 "SORT1"), [MIA3](https://en.wikipedia.org/wiki/MIA3 "MIA3"), [WDR12](https://en.wikipedia.org/wiki/WDR12 "WDR12"), [MRAS](https://en.wikipedia.org/wiki/MRAS "MRAS"), [PHACTR1](https://en.wikipedia.org/wiki/PHACTR1 "PHACTR1"), [LPA](https://en.wikipedia.org/wiki/Lipoprotein\(a\) "Lipoprotein(a)"), [TCF21](https://en.wikipedia.org/wiki/TCF21 "TCF21"), [MTHFDSL](https://en.wikipedia.org/w/index.php?title=MTHFDSL&action=edit&redlink=1 "MTHFDSL (page does not exist)"), [ZC3HC1](https://en.wikipedia.org/wiki/ZC3HC1 "ZC3HC1"), [CDKN2A](https://en.wikipedia.org/wiki/CDKN2A "CDKN2A"), [2B](https://en.wikipedia.org/wiki/CDKN2B "CDKN2B"), [ABO](https://en.wikipedia.org/wiki/ABO "ABO"), [PDGF0](https://en.wikipedia.org/w/index.php?title=PDGF0&action=edit&redlink=1 "PDGF0 (page does not exist)"), [APOA5](https://en.wikipedia.org/wiki/APOA5 "APOA5"), [MNF1ASM283](https://en.wikipedia.org/w/index.php?title=MNF1ASM283&action=edit&redlink=1 "MNF1ASM283 (page does not exist)"), [COL4A1](https://en.wikipedia.org/wiki/Collagen,_type_IV,_alpha_1 "Collagen, type IV, alpha 1"), [HHIPC1](https://en.wikipedia.org/w/index.php?title=HHIPC1&action=edit&redlink=1 "HHIPC1 (page does not exist)"), [SMAD3](https://en.wikipedia.org/wiki/SMAD3 "SMAD3"), [ADAMTS7](https://en.wikipedia.org/wiki/ADAMTS7 "ADAMTS7"), [RAS1](https://en.wikipedia.org/w/index.php?title=RAS1&action=edit&redlink=1 "RAS1 (page does not exist)"), [SMG6](https://en.wikipedia.org/wiki/SMG6 "SMG6"), [SNF8](https://en.wikipedia.org/wiki/SNF8 "SNF8"), [LDLR](https://en.wikipedia.org/wiki/LDLR "LDLR"), [SLC5A3](https://en.wikipedia.org/wiki/SLC5A3 "SLC5A3"), [MRPS6](https://en.wikipedia.org/wiki/MRPS6 "MRPS6"), [KCNE2](https://en.wikipedia.org/wiki/KCNE2 "KCNE2").[\[55\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Genomics_of_Cardiovascular_Disease-55)
Other
The risk of having a myocardial infarction increases with older age, low physical activity, and low [socioeconomic status](https://en.wikipedia.org/wiki/Socioeconomic_status "Socioeconomic status").[\[45\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-EUROPEAN2012-45) Heart attacks appear to occur more commonly in the morning hours, especially between 6AM and noon.[\[56\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Culic2007-56) Evidence suggests that heart attacks are at least three times more likely to occur in the morning than in the late evening.[\[57\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Shaw2009-57) [Shift work](https://en.wikipedia.org/wiki/Shift_work "Shift work") is also associated with a higher risk of MI.[\[58\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Vyas2012-58) One analysis has found an increase in heart attacks immediately following the start of [daylight saving time](https://en.wikipedia.org/wiki/Daylight_saving_time "Daylight saving time").[\[59\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-59)
Women who use [combined oral contraceptive pills](https://en.wikipedia.org/wiki/Combined_oral_contraceptive_pill "Combined oral contraceptive pill") have a modestly increased risk of myocardial infarction, especially in the presence of other risk factors.[\[60\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-60) The use of [non-steroidal anti inflammatory drugs](https://en.wikipedia.org/wiki/Non-steroidal_anti_inflammatory_drugs "Non-steroidal anti inflammatory drugs") (NSAIDs), even for as short as a week, increases risk.[\[61\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-61)
[Endometriosis](https://en.wikipedia.org/wiki/Endometriosis "Endometriosis") in women under the age of 40 is an identified risk factor.[\[62\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-62)
[Air pollution](https://en.wikipedia.org/wiki/Air_pollution "Air pollution") is also an important modifiable risk. Short-term exposure to air pollution such as [carbon monoxide](https://en.wikipedia.org/wiki/Carbon_monoxide "Carbon monoxide"), [nitrogen dioxide](https://en.wikipedia.org/wiki/Nitrogen_dioxide "Nitrogen dioxide"), and [sulfur dioxide](https://en.wikipedia.org/wiki/Sulfur_dioxide "Sulfur dioxide") (but not [ozone](https://en.wikipedia.org/wiki/Ozone "Ozone")) has been associated with MI and other acute cardiovascular events.[\[63\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-63) For sudden cardiac deaths, every increment of 30 units in Pollutant Standards Index correlated with an 8% increased risk of out-of-hospital cardiac arrest on the day of exposure.[\[64\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-64) Extremes of temperature are also associated.[\[65\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-65)
A number of acute and chronic [infections](https://en.wikipedia.org/wiki/Infections "Infections") including *[Chlamydophila pneumoniae](https://en.wikipedia.org/wiki/Chlamydophila_pneumoniae "Chlamydophila pneumoniae")*, [influenza](https://en.wikipedia.org/wiki/Influenza "Influenza"), *[Helicobacter pylori](https://en.wikipedia.org/wiki/Helicobacter_pylori "Helicobacter pylori")*, and *[Porphyromonas gingivalis](https://en.wikipedia.org/wiki/Porphyromonas_gingivalis "Porphyromonas gingivalis")* among others have been linked to atherosclerosis and myocardial infarction.[\[66\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Chat2012-66) Myocardial infarction can also occur as a late consequence of [Kawasaki disease](https://en.wikipedia.org/wiki/Kawasaki_disease "Kawasaki disease").[\[67\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Sanchez2014-67)
Calcium deposits in the coronary arteries can be detected with [CT scans](https://en.wikipedia.org/wiki/CT_scan "CT scan"). Calcium seen in coronary arteries can provide predictive information beyond that of classical risk factors.[\[68\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-68) [High blood levels of the amino acid homocysteine](https://en.wikipedia.org/wiki/Hyperhomocysteinemia "Hyperhomocysteinemia") is associated with premature atherosclerosis;[\[69\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-69) whether elevated homocysteine in the normal range is causal is controversial.[\[70\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-70)
In people without evident [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease"), possible causes for the myocardial infarction are [coronary spasm](https://en.wikipedia.org/wiki/Coronary_spasm "Coronary spasm") or [coronary artery dissection](https://en.wikipedia.org/wiki/Spontaneous_coronary_artery_dissection "Spontaneous coronary artery dissection").[\[71\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-71)
Mechanism
Atherosclerosis
The animation shows plaque buildup or a [coronary artery spasm](https://en.wikipedia.org/wiki/Vasospasm "Vasospasm") can lead to a heart attack and how blocked blood flow in a coronary artery can lead to a heart attack.
The most common cause of a myocardial infarction is the rupture of an atherosclerotic plaque on an [artery](https://en.wikipedia.org/wiki/Artery "Artery") supplying heart muscle.[\[41\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-ESC_STEMI-41)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Plaques can become unstable, rupture, and additionally promote the formation of a [blood clot](https://en.wikipedia.org/wiki/Thrombus "Thrombus") that blocks the artery; this can occur in minutes. Blockage of an artery can lead to tissue death in tissue being supplied by that artery.[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73) Atherosclerotic plaques are often present for decades before they result in symptoms.[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73)
The gradual buildup of [cholesterol](https://en.wikipedia.org/wiki/Cholesterol "Cholesterol") and fibrous tissue in plaques in the wall of the [coronary arteries](https://en.wikipedia.org/wiki/Coronary_artery "Coronary artery") or other arteries, typically over decades, is termed [atherosclerosis](https://en.wikipedia.org/wiki/Atherosclerosis "Atherosclerosis").[\[74\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid20065951-74) Atherosclerosis is characterized by progressive inflammation of the walls of the arteries.[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73) Inflammatory cells, particularly [macrophages](https://en.wikipedia.org/wiki/Macrophage "Macrophage"), move into affected arterial walls. Over time, they become laden with cholesterol products, particularly [LDL](https://en.wikipedia.org/wiki/LDL "LDL"), and become [foam cells](https://en.wikipedia.org/wiki/Foam_cell "Foam cell"). A [cholesterol core](https://en.wikipedia.org/wiki/Atheroma "Atheroma") forms as foam cells die. In response to [growth factors](https://en.wikipedia.org/wiki/Growth_factor "Growth factor") secreted by macrophages, [smooth muscle](https://en.wikipedia.org/wiki/Smooth_muscle "Smooth muscle") and other cells move into the plaque and act to stabilize it. A stable plaque may have a thick fibrous cap with [calcification](https://en.wikipedia.org/wiki/Calcification "Calcification"). If there is ongoing inflammation, the cap may be thin or ulcerate. Exposed to the pressure associated with blood flow, plaques, especially those with a thin lining, may rupture and trigger the formation of a blood clot (thrombus).[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73) The cholesterol crystals have been associated with plaque rupture through mechanical injury and inflammation.[\[75\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-75)
Other causes
Atherosclerotic disease is not the only cause of myocardial infarction, but it may exacerbate or contribute to other causes. A myocardial infarction may result from a heart with a limited blood supply subject to increased oxygen demands, such as in fever, [a fast heart rate](https://en.wikipedia.org/wiki/Tachycardia "Tachycardia"), [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), [too few red blood cells in the bloodstream](https://en.wikipedia.org/wiki/Anemia "Anemia"), or [low blood pressure](https://en.wikipedia.org/wiki/Hypotension "Hypotension"). Damage or failure of procedures such as [percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention") (PCI) or [coronary artery bypass grafts](https://en.wikipedia.org/wiki/Coronary_artery_bypass_graft "Coronary artery bypass graft") (CABG) may cause a myocardial infarction. Spasm of coronary arteries, such as [Prinzmetal's angina](https://en.wikipedia.org/wiki/Prinzmetal%27s_angina "Prinzmetal's angina") may cause blockage.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)
Tissue death
[](https://en.wikipedia.org/wiki/File:Heart_ant_wall_infarction.jpg)
Cross section showing anterior left ventricle wall infarction
If impaired blood flow to the heart lasts long enough, it triggers a process called the [ischemic cascade](https://en.wikipedia.org/wiki/Ischemic_cascade "Ischemic cascade"); the heart cells in the territory of the blocked coronary artery die ([infarction](https://en.wiktionary.org/wiki/infarction "wikt:infarction")), chiefly through [necrosis](https://en.wikipedia.org/wiki/Necrosis "Necrosis"), and do not grow back. A [collagen](https://en.wikipedia.org/wiki/Collagen "Collagen") [scar](https://en.wikipedia.org/wiki/Scar "Scar") forms in their place.[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73) When an artery is blocked, cells lack [oxygen](https://en.wikipedia.org/wiki/Oxygen "Oxygen"), needed to produce [ATP](https://en.wikipedia.org/wiki/Adenosine_triphosphate "Adenosine triphosphate") in [mitochondria](https://en.wikipedia.org/wiki/Mitochondria "Mitochondria"). ATP is required for the maintenance of electrolyte balance, particularly through the [Na/K ATPase](https://en.wikipedia.org/wiki/Na/K_ATPase "Na/K ATPase"). This leads to an ischemic cascade of intracellular changes, necrosis and [apoptosis](https://en.wikipedia.org/wiki/Apoptosis "Apoptosis") of affected cells.[\[76\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BUJA2005-76)
Cells in the area with the worst blood supply, just below the inner surface of the heart ([endocardium](https://en.wikipedia.org/wiki/Endocardium "Endocardium")), are most susceptible to damage.[\[77\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-77)[\[78\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BOLOOKI2010-78) Ischemia first affects this region, the *subendocardial* region, and tissue begins to die within 15–30 minutes of loss of blood supply.[\[79\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AARONSON2013-79) The dead tissue is surrounded by a zone of potentially reversible ischemia that progresses to become a full-thickness *transmural* infarct.[\[76\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BUJA2005-76)[\[79\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AARONSON2013-79) The initial "wave" of infarction can take place over 3–4 hours.[\[73\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010B-73)[\[76\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BUJA2005-76) These changes are seen on [gross pathology](https://en.wikipedia.org/wiki/Gross_pathology "Gross pathology") and cannot be predicted by the presence or absence of Q waves on an ECG.[\[78\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BOLOOKI2010-78) The position, size and extent of an infarct depends on the affected artery, totality of the blockage, duration of the blockage, the presence of [collateral blood vessels](https://en.wikipedia.org/wiki/Collateralization "Collateralization"), oxygen demand, and success of interventional procedures.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)
Tissue death and [myocardial scarring](https://en.wikipedia.org/wiki/Myocardial_scarring "Myocardial scarring") alter the normal conduction pathways of the heart and weaken affected areas. The size and location put a person at risk of [abnormal heart rhythms (arrhythmias)](https://en.wikipedia.org/wiki/Heart_arrhythmia "Heart arrhythmia") or [heart block](https://en.wikipedia.org/wiki/Heart_block "Heart block"), [aneurysm of the heart ventricles](https://en.wikipedia.org/wiki/Ventricular_aneurysm "Ventricular aneurysm"), [inflammation of the heart wall](https://en.wikipedia.org/wiki/Dressler%27s_syndrome "Dressler's syndrome") following infarction, and rupture of the heart wall that can have catastrophic consequences.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[80\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Kutty2013-80)
Injury to the myocardium also occurs during re-perfusion. This might manifest as ventricular arrhythmia. The re-perfusion injury is a consequence of the calcium and sodium uptake from the cardiac cells and the release of oxygen radicals during reperfusion. No-reflow phenomenon—when blood is still unable to be distributed to the affected myocardium despite clearing the occlusion—also contributes to myocardial injury. Topical endothelial swelling is one of many factors contributing to this phenomenon.[\[81\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-KlonerHale-81)
Diagnosis
Criteria
[](https://en.wikipedia.org/wiki/File:Patterns_of_topographic_distribution_of_myocardial_infarction.jpg)
Topographic distribution of MI
A myocardial infarction, according to established consensus, is defined by elevated cardiac [biomarkers](https://en.wikipedia.org/wiki/Biomarkers "Biomarkers") with a rising or falling trend and at least one of the following:[\[82\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-82)
- Symptoms relating to ischemia
- Changes on an [electrocardiogram](https://en.wikipedia.org/wiki/Electrocardiogram "Electrocardiogram") (ECG), such as [ST segment](https://en.wikipedia.org/wiki/ST_segment "ST segment") changes, new [left bundle branch block](https://en.wikipedia.org/wiki/Left_bundle_branch_block "Left bundle branch block"), or pathologic [Q waves](https://en.wikipedia.org/wiki/QRS_complex#Q_wave "QRS complex")
- Changes in the motion of the heart wall on imaging
- Demonstration of a thrombus on [angiogram](https://en.wikipedia.org/wiki/Angiogram "Angiogram") or at [autopsy](https://en.wikipedia.org/wiki/Autopsy "Autopsy").
Types
"STEMI" redirects here. For the Christian evangelist organization, see [Stephen Tong § Ministry](https://en.wikipedia.org/wiki/Stephen_Tong#Ministry "Stephen Tong").
A myocardial infarction is usually clinically classified as an ST-elevation MI (STEMI) or a non-ST elevation MI (NSTEMI). These are based on [ST elevation](https://en.wikipedia.org/wiki/ST_elevation "ST elevation"), a portion of a heartbeat graphically recorded on an [ECG](https://en.wikipedia.org/wiki/ECG "ECG").[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) STEMIs make up about 25–40% of myocardial infarctions.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) A more explicit classification system, based on international consensus in 2012, also exists. This classifies myocardial infarctions into five types:[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)
1. Spontaneous MI related to plaque erosion and/or rupture fissuring, or dissection
2. MI related to ischemia, such as from increased oxygen demand or decreased supply, e.g., coronary artery spasm, coronary embolism, anemia, arrhythmias, high blood pressure, or low blood pressure
3. Sudden unexpected cardiac death, including cardiac arrest, where symptoms may suggest MI, an ECG may be taken with suggestive changes, or a blood clot is found in a coronary artery by angiography and/or at autopsy, but where blood samples could not be obtained, or at a time before the appearance of cardiac biomarkers in the blood
4. Associated with [coronary angioplasty](https://en.wikipedia.org/wiki/Coronary_angioplasty "Coronary angioplasty") or [stents](https://en.wikipedia.org/wiki/Stent "Stent")
- Associated with [percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention") (PCI)
- Associated with stent thrombosis as documented by angiography or at autopsy
5. Associated with [CABG](https://en.wikipedia.org/wiki/Coronary_artery_bypass_graft "Coronary artery bypass graft")
6. Associated with [spontaneous coronary artery dissection](https://en.wikipedia.org/wiki/Spontaneous_coronary_artery_dissection "Spontaneous coronary artery dissection") in young, fit women
Cardiac biomarkers
There are many different [biomarkers](https://en.wikipedia.org/wiki/Biomarker "Biomarker") used to determine the presence of cardiac muscle damage. [Troponins](https://en.wikipedia.org/wiki/Troponin "Troponin"), measured through a blood test, are considered to be the best,[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) and are preferred because they have greater [sensitivity and specificity](https://en.wikipedia.org/wiki/Sensitivity_and_specificity "Sensitivity and specificity") for measuring injury to the heart muscle than other tests.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) A rise in troponin occurs within 2–3 hours of injury to the heart muscle, and peaks within 1–2 days. The level of the troponin, as well as a change over time, are useful in measuring and diagnosing or excluding myocardial infarctions, and the diagnostic accuracy of troponin testing is improving over time.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) One high-sensitivity cardiac troponin can rule out a heart attack as long as the ECG is normal.[\[83\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-83)[\[84\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-84)
Other tests, such as [CK-MB](https://en.wikipedia.org/wiki/CK-MB "CK-MB") or [myoglobin](https://en.wikipedia.org/wiki/Myoglobin "Myoglobin"), are discouraged.[\[85\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHANSTEMI2014-85) CK-MB is not as specific as troponins for acute myocardial injury, and may be elevated with past cardiac surgery, inflammation or electrical cardioversion; it rises within 4–8 hours and returns to normal within 2–3 days.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) [Copeptin](https://en.wikipedia.org/wiki/Copeptin "Copeptin") may be useful to rule out MI rapidly when used along with troponin.[\[86\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-86)
Electrocardiogram
[](https://en.wikipedia.org/wiki/File:Inferior_and_RtV_MI_12_lead.jpg)
A 12-lead ECG showing an inferior STEMI due to reduced perfusion through the [right coronary artery](https://en.wikipedia.org/wiki/Right_coronary_artery "Right coronary artery"). Elevation of the [ST segment](https://en.wikipedia.org/wiki/ST_segment "ST segment") can be seen in leads II, III and aVF.
An [electrocardiogram](https://en.wikipedia.org/wiki/Electrocardiogram "Electrocardiogram") (ECGs) is a series of electrodes placed on a person's chest that measure electrical activity associated with contraction of the heart muscle.[\[87\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010C-87) The taking of an ECG is an important part of the workup of an AMI,[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) and ECGs are often not just taken once but may be repeated over minutes to hours, or in response to changes in signs or symptoms.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)
ECG readouts produce a waveform with different labeled features.[\[87\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010C-87) In addition to a rise in biomarkers, a rise in the [ST segment](https://en.wikipedia.org/wiki/ST_segment "ST segment"), changes in the shape or flipping of [T waves](https://en.wikipedia.org/wiki/T_wave "T wave"), new [Q waves](https://en.wikipedia.org/wiki/QRS_complex#Q_wave "QRS complex"), or a new [left bundle branch block](https://en.wikipedia.org/wiki/Left_bundle_branch_block "Left bundle branch block") can be used to diagnose an AMI.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) In addition, [ST elevation](https://en.wikipedia.org/wiki/ST_elevation "ST elevation") can be used to diagnose an ST segment myocardial infarction (STEMI). A rise must be new in V2 and V3 ≥2 mm (0,2 mV) for males or ≥1.5 mm (0.15 mV) for females or ≥1 mm (0.1 mV) in two other [adjacent chest or limb leads](https://en.wikipedia.org/wiki/Contiguous_leads "Contiguous leads").[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19)[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) ST elevation is associated with infarction, and may be preceded by changes indicating ischemia, such as ST depression or inversion of the T waves.[\[87\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010C-87) Abnormalities can help differentiate the location of an infarct, based on the leads that are affected by changes.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Early STEMIs may be preceded by peaked T waves.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) Other ECG abnormalities relating to complications of acute myocardial infarctions may also be evident, such as [atrial](https://en.wikipedia.org/wiki/Atrial_fibrillation "Atrial fibrillation") or [ventricular fibrillation](https://en.wikipedia.org/wiki/Ventricular_fibrillation "Ventricular fibrillation").[\[88\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-88)
Imaging
[](https://en.wikipedia.org/wiki/File:ECG_V2-4_ST_change.jpg)
ECG: AMI with ST elevation in V2-4
Noninvasive imaging plays an important role in the diagnosis and characterisation of myocardial infarction.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) Tests such as [chest X-rays](https://en.wikipedia.org/wiki/Chest_X-ray "Chest X-ray") can be used to explore and exclude alternate causes of a person's symptoms.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) [Echocardiography](https://en.wikipedia.org/wiki/Echocardiography "Echocardiography") may assist in modifying clinical suspicion of ongoing myocardial infarction in patients that can't be ruled out or ruled in following initial [ECG](https://en.wikipedia.org/wiki/Electrocardiography "Electrocardiography") and [Troponin](https://en.wikipedia.org/wiki/Troponin "Troponin") testing.[\[89\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-auto-89) [Myocardial perfusion imaging](https://en.wikipedia.org/wiki/Myocardial_perfusion_imaging "Myocardial perfusion imaging") has no role in the acute diagnostic algorithm; however, it can confirm a clinical suspicion of Chronic Coronary Syndrome when the patient's history, [physical examination](https://en.wikipedia.org/wiki/Physical_examination "Physical examination") (including [cardiac examination](https://en.wikipedia.org/wiki/Cardiac_examination "Cardiac examination")) ECG, and cardiac biomarkers suggest coronary artery disease.[\[90\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WISELY2017-90)
[Echocardiography](https://en.wikipedia.org/wiki/Echocardiography "Echocardiography"), an [ultrasound](https://en.wikipedia.org/wiki/Ultrasound "Ultrasound") scan of the heart, is able to visualize the heart, its size, shape, and any abnormal motion of the heart walls as they beat that may indicate a myocardial infarction. The flow of blood can be imaged, and [contrast dyes](https://en.wikipedia.org/wiki/Contrast_dye "Contrast dye") may be given to improve image.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) Other scans using [radioactive](https://en.wikipedia.org/wiki/Radioactive "Radioactive") contrast include [SPECT](https://en.wikipedia.org/wiki/SPECT "SPECT") [CT-scans](https://en.wikipedia.org/wiki/CT-scans "CT-scans") using [thallium](https://en.wikipedia.org/wiki/Thallium_chloride "Thallium chloride"), [sestamibi](https://en.wikipedia.org/wiki/Technetium_\(99mTc\)_sestamibi "Technetium (99mTc) sestamibi") ([MIBI scans](https://en.wikipedia.org/wiki/MIBI_scan "MIBI scan")) or [tetrofosmin](https://en.wikipedia.org/wiki/Tetrofosmin "Tetrofosmin"); or a [PET scan](https://en.wikipedia.org/wiki/PET_scan "PET scan") using [Fludeoxyglucose](https://en.wikipedia.org/wiki/Fludeoxyglucose_\(18F\) "Fludeoxyglucose (18F)") or [rubidium-82](https://en.wikipedia.org/wiki/Rubidium-82 "Rubidium-82").[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) These [nuclear medicine](https://en.wikipedia.org/wiki/Nuclear_medicine "Nuclear medicine") scans can visualize the perfusion of heart muscle.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) SPECT may also be used to determine viability of tissue, and whether areas of ischemia are inducible.[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24)[\[91\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-91)
Medical societies and professional guidelines recommend that the physician confirm a person is at high risk for Chronic Coronary Syndrome before conducting diagnostic non-invasive imaging tests to make a diagnosis,[\[90\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WISELY2017-90)[\[92\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG94-92)[\[89\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-auto-89) as such tests are unlikely to change management and result in increased costs.[\[90\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WISELY2017-90) Patients who have a normal ECG and who are able to exercise, for example, most likely do not merit routine imaging.[\[90\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WISELY2017-90)
- Poor movement of the heart due to an MI as seen on ultrasound[\[93\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-UOTW36-93)
- Pulmonary edema due to an MI as seen on ultrasound[\[93\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-UOTW36-93)
Differential diagnosis
There are many causes of [chest pain](https://en.wikipedia.org/wiki/Chest_pain "Chest pain"), which can originate from the heart, [lungs](https://en.wikipedia.org/wiki/Lung "Lung"), [gastrointestinal tract](https://en.wikipedia.org/wiki/Gastrointestinal_tract "Gastrointestinal tract"), [aorta](https://en.wikipedia.org/wiki/Aorta "Aorta"), and other muscles, bones and nerves surrounding the chest.[\[94\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010D-94) In addition to myocardial infarction, other causes include [angina](https://en.wikipedia.org/wiki/Angina_pectoris "Angina pectoris"), insufficient blood supply ([ischemia](https://en.wikipedia.org/wiki/Ischemia "Ischemia")) to the heart muscles without evidence of cell death, [gastroesophageal reflux disease](https://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease "Gastroesophageal reflux disease"); [pulmonary embolism](https://en.wikipedia.org/wiki/Pulmonary_embolism "Pulmonary embolism"), tumors of the lungs, [pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia"), [rib fracture](https://en.wikipedia.org/wiki/Rib_fracture "Rib fracture"), [costochondritis](https://en.wikipedia.org/wiki/Costochondritis "Costochondritis"), [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure") and other musculoskeletal injuries.[\[94\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010D-94)[\[24\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-THIRDDEF-24) Rarer severe differential diagnoses include [aortic dissection](https://en.wikipedia.org/wiki/Aortic_dissection "Aortic dissection"), [esophageal rupture](https://en.wikipedia.org/wiki/Esophageal_rupture "Esophageal rupture"), [tension pneumothorax](https://en.wikipedia.org/wiki/Tension_pneumothorax "Tension pneumothorax"), and [pericardial effusion](https://en.wikipedia.org/wiki/Pericardial_effusion "Pericardial effusion") causing [cardiac tamponade](https://en.wikipedia.org/wiki/Cardiac_tamponade "Cardiac tamponade").[\[95\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid16199332-95) The chest pain in an MI may mimic [heartburn](https://en.wikipedia.org/wiki/Heartburn "Heartburn").[\[41\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-ESC_STEMI-41) Causes of sudden-onset [breathlessness](https://en.wikipedia.org/wiki/Breathlessness "Breathlessness") generally involve the lungs or heart – including [pulmonary edema](https://en.wikipedia.org/wiki/Pulmonary_edema "Pulmonary edema"), pneumonia, [allergic](https://en.wikipedia.org/wiki/Allergy "Allergy") reactions and [asthma](https://en.wikipedia.org/wiki/Asthma "Asthma"), and pulmonary embolus, [acute respiratory distress syndrome](https://en.wikipedia.org/wiki/ARDS "ARDS") and [metabolic acidosis](https://en.wikipedia.org/wiki/Metabolic_acidosis "Metabolic acidosis").[\[94\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010D-94) There are many different causes of fatigue, and myocardial infarction is not a common cause.[\[96\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-96)
Prevention
There is a large crossover between the lifestyle and activity recommendations to prevent a myocardial infarction, and those that may be adopted as [secondary prevention](https://en.wikipedia.org/wiki/Secondary_prevention "Secondary prevention") after an initial myocardial infarction,[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) because of shared risk factors and an aim to reduce atherosclerosis affecting heart vessels.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) The [influenza vaccine](https://en.wikipedia.org/wiki/Influenza_vaccine "Influenza vaccine") also appears to protect against myocardial infarction with a benefit of 15 to 45%.[\[97\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-97)
Primary prevention
Lifestyle
Physical activity can reduce the risk of cardiovascular disease, and people at risk are advised to engage in 150 minutes of moderate or 75 minutes of vigorous intensity [aerobic exercise](https://en.wikipedia.org/wiki/Aerobic_exercise "Aerobic exercise") a week.[\[98\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG181-98) Keeping a healthy weight, drinking alcohol within the recommended limits, and [quitting smoking](https://en.wikipedia.org/wiki/Smoking_cessation "Smoking cessation") reduce the risk of cardiovascular disease.[\[98\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG181-98)
Substituting [unsaturated fats](https://en.wikipedia.org/wiki/Unsaturated_fat "Unsaturated fat") such as [olive oil](https://en.wikipedia.org/wiki/Olive_oil "Olive oil") and [rapeseed oil](https://en.wikipedia.org/wiki/Rapeseed_oil "Rapeseed oil") instead of saturated fats may reduce the risk of myocardial infarction,[\[50\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-:1-50) although there is not universal agreement.[\[51\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Chow2014-51) Dietary modifications are recommended by some national authorities, with recommendations including increasing the intake of wholegrain starch, reducing sugar intake (particularly of refined sugar), consuming five portions of fruit and vegetables daily, consuming two or more portions of fish per week, and consuming 4–5 portions of unsalted [nuts](https://en.wikipedia.org/wiki/Nut_\(fruit\) "Nut (fruit)"), [seeds](https://en.wikipedia.org/wiki/Seed "Seed"), or [legumes](https://en.wikipedia.org/wiki/Legume "Legume") per week.[\[98\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG181-98) The dietary pattern with the greatest support is the [Mediterranean diet](https://en.wikipedia.org/wiki/Mediterranean_diet "Mediterranean diet").[\[99\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-99) [Vitamins](https://en.wikipedia.org/wiki/Vitamin "Vitamin") and mineral supplements are of no proven benefit,[\[100\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-100) and neither are plant [stanols](https://en.wikipedia.org/wiki/Stanol "Stanol") or [sterols](https://en.wikipedia.org/wiki/Phytosterol "Phytosterol").[\[98\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG181-98)
[Public health](https://en.wikipedia.org/wiki/Public_health "Public health") measures may also act at a population level to reduce the risk of myocardial infarction, for example by reducing unhealthy diets (excessive salt, saturated fat, and trans-fat) including food labeling and marketing requirements as well as requirements for catering and restaurants and stimulating physical activity. This may be part of regional cardiovascular disease prevention programs or through the [health impact assessment](https://en.wikipedia.org/wiki/Health_impact_assessment "Health impact assessment") of regional and local plans and policies.[\[101\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICEPH25-101)
Most guidelines recommend combining different preventive strategies. A 2015 Cochrane Review found some evidence that such an approach might help with [blood pressure](https://en.wikipedia.org/wiki/Blood_pressure "Blood pressure"), [body mass index](https://en.wikipedia.org/wiki/Body_mass_index "Body mass index") and [waist circumference](https://en.wikipedia.org/wiki/Waist_circumference "Waist circumference"). However, there was insufficient evidence to show an effect on mortality or actual cardio-vascular events.[\[102\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-102)
Medication
[Statins](https://en.wikipedia.org/wiki/Statin "Statin"), drugs that act to lower blood cholesterol, decrease the incidence and mortality rates of myocardial infarctions.[\[103\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-103) They are often recommended in those at an elevated risk of cardiovascular diseases.[\[98\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICECG181-98)
[Aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin") has been studied extensively in people considered at increased risk of myocardial infarction. Based on numerous studies in different groups (e.g. people with or without diabetes), there does not appear to be a benefit strong enough to outweigh the risk of excessive bleeding.[\[104\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-ATTaspirin2009-104)[\[105\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-105) Nevertheless, many [clinical practice guidelines](https://en.wikipedia.org/wiki/Clinical_practice_guideline "Clinical practice guideline") continue to recommend aspirin for primary prevention,[\[106\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-106) and some researchers feel that those with very high cardiovascular risk but low risk of bleeding should continue to receive aspirin.[\[107\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-107)
Secondary prevention
There is a large crossover between the lifestyle and activity recommendations to prevent a myocardial infarction, and those that may be adopted as [secondary prevention](https://en.wikipedia.org/wiki/Secondary_prevention "Secondary prevention") after an initial myocardial infarct.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Recommendations include [stopping smoking](https://en.wikipedia.org/wiki/Smoking_cessation "Smoking cessation"), a gradual return to exercise, eating a healthy [diet](https://en.wikipedia.org/wiki/Diet_\(nutrition\) "Diet (nutrition)"), low in [saturated fat](https://en.wikipedia.org/wiki/Saturated_fat "Saturated fat") and low in [cholesterol](https://en.wikipedia.org/wiki/Cholesterol "Cholesterol"), [drinking alcohol within recommended limits](https://en.wikipedia.org/wiki/Alcohol_consumption_recommendations "Alcohol consumption recommendations"), exercising, and trying to achieve a healthy weight.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108) Exercise is both safe and effective even if people have had stents or heart failure,[\[109\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-109) and is recommended to start gradually after 1–2 weeks.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Counselling should be provided relating to medications used, and for warning signs of depression.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Previous studies suggested a benefit from [omega-3 fatty acid](https://en.wikipedia.org/wiki/Omega-3_fatty_acid "Omega-3 fatty acid") supplementation but this has not been confirmed.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108)
Medications
Following a heart attack, nitrates, when taken for two days, and [ACE-inhibitors](https://en.wikipedia.org/wiki/ACE_inhibitor "ACE inhibitor") decrease the risk of death.[\[110\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-110) Other medications include:
[Aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin") is continued indefinitely, as well as another antiplatelet agent such as clopidogrel or ticagrelor ("dual antiplatelet therapy" or DAPT) for up to twelve months.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108) If someone has another medical condition that requires anticoagulation (e.g. with [warfarin](https://en.wikipedia.org/wiki/Warfarin "Warfarin")) this may need to be adjusted based on risk of further cardiac events as well as bleeding risk.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108) In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death.[\[111\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-111)
[Beta blocker](https://en.wikipedia.org/wiki/Beta_blocker "Beta blocker") therapy such as [metoprolol](https://en.wikipedia.org/wiki/Metoprolol "Metoprolol") or [carvedilol](https://en.wikipedia.org/wiki/Carvedilol "Carvedilol") is recommended to be started within 24 hours, provided there is no acute heart failure or [heart block](https://en.wikipedia.org/wiki/Heart_block "Heart block").[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19)[\[85\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHANSTEMI2014-85) The dose should be increased to the highest tolerated.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108) Contrary to most guidelines, the use of beta blockers does not appear to affect the risk of death,[\[112\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-112)[\[113\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-113) possibly because other treatments for MI have improved. When beta blocker medication is given within the first 24–72 hours of a STEMI no lives are saved. However, 1 in 200 people were prevented from a repeat heart attack, and another 1 in 200 from having an abnormal heart rhythm. Additionally, for 1 in 91 the medication causes a [temporary decrease in the heart's ability to pump blood](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock").[\[114\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BetaNNT2015-114)
[ACE inhibitor](https://en.wikipedia.org/wiki/ACE_inhibitor "ACE inhibitor") therapy should be started within 24 hours and continued indefinitely at the highest tolerated dose. This is provided there is no evidence of worsening [kidney failure](https://en.wikipedia.org/wiki/Kidney_failure "Kidney failure"), [high potassium](https://en.wikipedia.org/wiki/Hyperkalaemia "Hyperkalaemia"), low blood pressure, or known narrowing of the [renal arteries](https://en.wikipedia.org/wiki/Renal_artery "Renal artery").[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Those who cannot tolerate ACE inhibitors may be treated with an [angiotensin II receptor antagonist](https://en.wikipedia.org/wiki/Angiotensin_II_receptor_antagonist "Angiotensin II receptor antagonist").[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108)
[Statin](https://en.wikipedia.org/wiki/Statin "Statin") therapy has been shown to reduce mortality and subsequent cardiac events and should be commenced to lower LDL cholesterol. Other medications, such as [ezetimibe](https://en.wikipedia.org/wiki/Ezetimibe "Ezetimibe"), may also be added with this goal in mind.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)
[Aldosterone antagonists](https://en.wikipedia.org/wiki/Aldosterone_antagonist "Aldosterone antagonist") ([spironolactone](https://en.wikipedia.org/wiki/Spironolactone "Spironolactone") or [eplerenone](https://en.wikipedia.org/wiki/Eplerenone "Eplerenone")) may be used if there is evidence of left ventricular dysfunction after an MI, ideally after beginning treatment with an ACE inhibitor.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108)[\[115\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid26891235-115)
Other
A [defibrillator](https://en.wikipedia.org/wiki/Defibrillator "Defibrillator"), an electric device connected to the heart and surgically inserted under the skin, may be recommended. This is particularly if there are any ongoing signs of heart failure, with a low [left ventricular ejection fraction](https://en.wikipedia.org/wiki/LVEF "LVEF") and a New York Heart Association grade II or III after 40 days of the infarction.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Defibrillators detect potentially fatal arrhythmia and deliver an electrical shock to the person to depolarize a critical mass of the heart muscle.[\[116\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Hazinski2015-116)
Management
A myocardial infarction requires immediate medical attention. Treatment aims to preserve as much heart muscle as possible, and to prevent further complications.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Treatment depends on whether the myocardial infarction is a STEMI or NSTEMI.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Treatment in general aims to unblock blood vessels, reduce blood clot enlargement, reduce ischemia, and modify risk factors with the aim of preventing future MIs.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) In addition, the main treatment for myocardial infarctions with ECG evidence of ST elevation (STEMI) include [thrombolysis](https://en.wikipedia.org/wiki/Thrombolysis "Thrombolysis") or [percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention"), although PCI is also ideally conducted within 1–3 days for NSTEMI.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) In addition to [clinical judgement](https://en.wikipedia.org/wiki/Clinical_judgement "Clinical judgement"), risk stratification may be used to guide treatment, such as with the [TIMI](https://en.wikipedia.org/wiki/TIMI_Risk_Score "TIMI Risk Score") and [GRACE](https://en.wikipedia.org/w/index.php?title=GRACE_Risk_Score&action=edit&redlink=1 "GRACE Risk Score (page does not exist)") scoring systems.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[117\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-117)
Pain
The pain associated with myocardial infarction is often treated with [nitroglycerin](https://en.wikipedia.org/wiki/Nitroglycerin_\(medication\) "Nitroglycerin (medication)"), a [vasodilator](https://en.wikipedia.org/wiki/Vasodilator "Vasodilator"), or [opioid](https://en.wikipedia.org/wiki/Opioid "Opioid") medications such as [morphine](https://en.wikipedia.org/wiki/Morphine "Morphine").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Nitroglycerin (given [under the tongue](https://en.wikipedia.org/wiki/Sublingual_administration "Sublingual administration") or [injected into a vein](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy")) may improve blood supply to the heart.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) It is an important part of therapy for its pain relief effects, though there is no proven benefit to [mortality](https://en.wikipedia.org/wiki/Case_fatality_rate "Case fatality rate").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[118\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-118) Morphine or other opioid medications may also be used, and are effective for the pain associated with STEMI.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) There is poor evidence that morphine shows any benefit to [overall outcomes](https://en.wikipedia.org/wiki/Outcome_measure "Outcome measure"), and there is some evidence of potential harm.[\[119\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-119)[\[120\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-120)
Antithrombotics
[Aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin"), an [antiplatelet drug](https://en.wikipedia.org/wiki/Antiplatelet_drug "Antiplatelet drug"), is given as a [loading dose](https://en.wikipedia.org/wiki/Loading_dose "Loading dose") to reduce the clot size and reduce further clotting in the affected artery.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) It is known to decrease mortality associated with acute myocardial infarction by at least 50%.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [P2Y12 inhibitors](https://en.wikipedia.org/wiki/P2Y12_inhibitors "P2Y12 inhibitors") such as [clopidogrel](https://en.wikipedia.org/wiki/Clopidogrel "Clopidogrel"), [prasugrel](https://en.wikipedia.org/wiki/Prasugrel "Prasugrel") and [ticagrelor](https://en.wikipedia.org/wiki/Ticagrelor "Ticagrelor") are given concurrently, also as a loading dose, with the dose depending on whether further surgical management or fibrinolysis is planned.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Prasugrel and ticagrelor are recommended in European and American guidelines, as they are active more quickly and consistently than clopidogrel.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) P2Y12 inhibitors are recommended in both NSTEMI and STEMI, including in PCI, with evidence also to suggest improved mortality.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Heparins](https://en.wikipedia.org/wiki/Heparin "Heparin"), particularly in the unfractionated form, act at several points in the [clotting cascade](https://en.wikipedia.org/wiki/Clotting_cascade "Clotting cascade"), help to prevent the enlargement of a clot, and are also given in myocardial infarction, owing to evidence suggesting improved mortality rates.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) In very high-risk scenarios, [inhibitors of the platelet glycoprotein αIIbβ3a receptor](https://en.wikipedia.org/wiki/Glycoprotein_IIb/IIIa_inhibitors "Glycoprotein IIb/IIIa inhibitors") such as [eptifibatide](https://en.wikipedia.org/wiki/Eptifibatide "Eptifibatide") or [tirofiban](https://en.wikipedia.org/wiki/Tirofiban "Tirofiban") may be used.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)
There is varying evidence on the mortality benefits in NSTEMI. A 2014 review of P2Y12 inhibitors such as [clopidogrel](https://en.wikipedia.org/wiki/Clopidogrel "Clopidogrel") found they do not change the risk of death when given to people with a suspected NSTEMI prior to PCI,[\[121\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-BMJP2Y12-121) nor do heparins change the risk of death.[\[122\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-And2014-122) They do decrease the risk of having a further myocardial infarction.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[122\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-And2014-122)
Angiogram
[](https://en.wikipedia.org/wiki/File:Myocardial_infarction.svg)
Inserting a stent to widen the artery
Primary [percutaneous coronary intervention](https://en.wikipedia.org/wiki/Percutaneous_coronary_intervention "Percutaneous coronary intervention") (PCI) is the treatment of choice for STEMI if it can be performed in a timely manner, ideally within 90–120 minutes of contact with a medical provider.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[123\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Bagai2014-123) Some recommend it is also done in NSTEMI within 1–3 days, particularly when considered high-risk.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) A 2017 review, however, did not find a difference between early versus later PCI in NSTEMI.[\[124\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-124)
PCI involves small probes, inserted through peripheral blood vessels such as the [femoral artery](https://en.wikipedia.org/wiki/Femoral_artery "Femoral artery") or [radial artery](https://en.wikipedia.org/wiki/Radial_artery "Radial artery") into the blood vessels of the heart. The probes are then used to identify and clear blockages [using small balloons](https://en.wikipedia.org/wiki/Balloon_angioplasty "Balloon angioplasty"), which are dragged through the blocked segment, [dragging away the clot](https://en.wikipedia.org/wiki/Aspiration_thrombectomy "Aspiration thrombectomy"), or [the insertion of stents](https://en.wikipedia.org/wiki/Coronary_stenting "Coronary stenting").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Coronary artery bypass grafting](https://en.wikipedia.org/wiki/Coronary_artery_bypass_grafting "Coronary artery bypass grafting") is only considered when the affected area of heart muscle is large, and PCI is unsuitable, for example with difficult cardiac anatomy.[\[125\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-125) After PCI, people are generally placed on [aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin") indefinitely and on dual antiplatelet therapy (generally aspirin and [clopidogrel](https://en.wikipedia.org/wiki/Clopidogrel "Clopidogrel")) for at least a year.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[126\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-126)
Fibrinolysis
If PCI cannot be performed within 90 to 120 minutes in STEMI then fibrinolysis, preferably within 30 minutes of arrival to hospital, is recommended.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)[\[127\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-127) If a person has had symptoms for 12 to 24 hours evidence for effectiveness of thrombolysis is less and if they have had symptoms for more than 24 hours it is not recommended.[\[128\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-128) Thrombolysis involves the administration of medication that activates the [enzymes that normally dissolve blood clots](https://en.wikipedia.org/wiki/Fibrinolysis "Fibrinolysis"). These medications include [tissue plasminogen activator](https://en.wikipedia.org/wiki/Tissue_plasminogen_activator "Tissue plasminogen activator"), [reteplase](https://en.wikipedia.org/wiki/Reteplase "Reteplase"), [streptokinase](https://en.wikipedia.org/wiki/Streptokinase "Streptokinase"), and [tenecteplase](https://en.wikipedia.org/wiki/Tenecteplase "Tenecteplase").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Thrombolysis is not recommended in a number of situations, particularly when associated with a high risk of bleeding or the potential for problematic bleeding, such as active bleeding, past [strokes](https://en.wikipedia.org/wiki/Stroke "Stroke") or bleeds into the brain, or severe [hypertension](https://en.wikipedia.org/wiki/Hypertension "Hypertension"). Situations in which thrombolysis may be considered, but with caution, include recent surgery, use of anticoagulants, pregnancy, and proclivity to bleeding.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Major risks of thrombolysis are major bleeding and [intracranial bleeding](https://en.wikipedia.org/wiki/Intracranial_bleed "Intracranial bleed").[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28) Pre-hospital thrombolysis reduces time to thrombolytic treatment, based on studies conducted in higher income countries; however, it is unclear whether this has an impact on mortality rates.[\[129\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-mccaul-129)
Other
In the past, high flow oxygen was recommended for everyone with a possible myocardial infarction.[\[85\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHANSTEMI2014-85) More recently, no evidence was found for routine use in those with normal oxygen levels and there is potential harm from the intervention.[\[130\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-130)[\[131\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-131)[\[132\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-132)[\[133\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-133)[\[134\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-134) Therefore, oxygen is currently only recommended if oxygen levels are found to be low or if someone is in respiratory distress.[\[28\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015-28)[\[85\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHANSTEMI2014-85)
If despite thrombolysis there is significant [cardiogenic shock](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock"), continued severe chest pain, or less than a 50% improvement in [ST elevation](https://en.wikipedia.org/wiki/ST_elevation "ST elevation") on the ECG recording after 90 minutes, then rescue PCI is indicated emergently.[\[135\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Wang2011-135)[\[136\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-136)
Those who have had [cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest") may benefit from [targeted temperature management](https://en.wikipedia.org/wiki/Targeted_temperature_management "Targeted temperature management") with evaluation for implementation of hypothermia protocols. Furthermore, those with cardiac arrest, and ST elevation at any time, should usually have angiography.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19) [Aldosterone antagonists](https://en.wikipedia.org/wiki/Aldosterone_antagonists "Aldosterone antagonists") appear to be useful in people who have had an STEMI and do not have heart failure.[\[137\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-137)
Rehabilitation and exercise
[Cardiac rehabilitation](https://en.wikipedia.org/wiki/Cardiopulmonary_rehabilitation "Cardiopulmonary rehabilitation") benefits many who have experienced myocardial infarction,[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) even if there has been substantial heart damage and resultant [left ventricular failure](https://en.wikipedia.org/wiki/Left_ventricular_failure "Left ventricular failure"). It should start soon after discharge from the hospital. The program may include lifestyle advice, exercise, social support, as well as recommendations about driving, flying, sports participation, stress management, and sexual intercourse.[\[108\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NICE172-108) Returning to sexual activity after myocardial infarction is a major concern for most patients, and is an important area to be discussed in the provision of holistic care.[\[138\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-138)[\[139\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-pmid20168196-139)
In the short-term, exercise-based cardiovascular rehabilitation programs may reduce the risk of a myocardial infarction, reduces a large number of hospitalizations from all causes, reduces hospital costs, improves [health-related quality of life](https://en.wikipedia.org/wiki/Health_related_quality_of_life "Health related quality of life"), and has a small effect on [all-cause mortality](https://en.wikipedia.org/wiki/All-cause_mortality "All-cause mortality").[\[140\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-140) Longer-term studies indicate that exercise-based cardiovascular rehabilitation programs may reduce cardiovascular mortality and myocardial infarction.
Prognosis
The prognosis after myocardial infarction varies greatly depending on the extent and location of the affected heart muscle, and the development and management of complications.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Prognosis is worse with older age and social isolation.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Anterior infarcts, persistent ventricular tachycardia or fibrillation, development of [heart blocks](https://en.wikipedia.org/wiki/Heart_block "Heart block"), and left ventricular impairment are all associated with poorer prognosis.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Without treatment, about a quarter of those affected by MI die within minutes and about forty percent within the first month.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16) Morbidity and mortality from myocardial infarction has, however, improved over the years due to earlier and better treatment:[\[30\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015B-30) in those who have a STEMI in the United States, between 5 and 6 percent die before leaving the hospital and 7 to 18 percent die within a year.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19)
It is unusual for babies to experience a myocardial infarction, but when they do, about half die.[\[141\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-:0-141) In the short-term, neonatal survivors seem to have a normal quality of life.[\[141\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-:0-141)
Complications
Complications may occur immediately following the myocardial infarction or may take time to develop. [Disturbances of heart rhythms](https://en.wikipedia.org/wiki/Heart_arrhythmia "Heart arrhythmia"), including [atrial fibrillation](https://en.wikipedia.org/wiki/Atrial_fibrillation "Atrial fibrillation"), [ventricular tachycardia](https://en.wikipedia.org/wiki/Ventricular_tachycardia "Ventricular tachycardia") and [fibrillation](https://en.wikipedia.org/wiki/Ventricular_fibrillation "Ventricular fibrillation") and [heart block](https://en.wikipedia.org/wiki/Heart_block "Heart block") can arise as a result of ischemia, cardiac scarring, and infarct location.[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Stroke](https://en.wikipedia.org/wiki/Stroke "Stroke") is also a risk, either as a result of [clots](https://en.wikipedia.org/wiki/Arterial_embolism "Arterial embolism") transmitted from the heart during PCI, as a result of bleeding following anticoagulation, or as a result of disturbances in the heart's ability to pump effectively as a result of the infarction.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Regurgitation of blood through the mitral valve](https://en.wikipedia.org/wiki/Mitral_regurgitation "Mitral regurgitation") is possible, particularly if the infarction causes dysfunction of the papillary muscle.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Cardiogenic shock](https://en.wikipedia.org/wiki/Cardiogenic_shock "Cardiogenic shock") as a result of the heart being unable to adequately pump blood may develop, dependent on infarct size, and is most likely to occur within the days following an acute myocardial infarction. Cardiogenic shock is the largest cause of in-hospital mortality.[\[30\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Harrisons2015B-30)[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) Rupture of the ventricular dividing wall or left ventricular wall may occur within the initial weeks.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72) [Dressler's syndrome](https://en.wikipedia.org/wiki/Dressler%27s_syndrome "Dressler's syndrome"), a reaction following larger infarcts and a cause of [pericarditis](https://en.wikipedia.org/wiki/Pericarditis "Pericarditis") is also possible.[\[72\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Reed2017-72)
[Heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure") may develop as a long-term consequence, with an impaired ability of heart muscle to pump, scarring, and an increase in the size of the existing muscle. [Aneurysm of the left ventricle myocardium](https://en.wikipedia.org/wiki/Ventricular_aneurysm "Ventricular aneurysm") develops in about 10% of MI and is itself a risk factor for heart failure, ventricular arrhythmia, and the development of [clots](https://en.wikipedia.org/wiki/Embolism "Embolism").[\[16\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Davidsons2010-16)
Risk factors for complications and death include age, [hemodynamic](https://en.wikipedia.org/wiki/Hemodynamics "Hemodynamics") parameters (such as [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), [cardiac arrest](https://en.wikipedia.org/wiki/Cardiac_arrest "Cardiac arrest") on admission, [systolic](https://en.wikipedia.org/wiki/Systole_\(medicine\) "Systole (medicine)") [blood pressure](https://en.wikipedia.org/wiki/Blood_pressure "Blood pressure"), or [Killip class](https://en.wikipedia.org/wiki/Killip_class "Killip class") of two or greater), ST-segment deviation, diabetes, serum [creatinine](https://en.wikipedia.org/wiki/Creatinine "Creatinine"), [peripheral vascular disease](https://en.wikipedia.org/wiki/Peripheral_artery_occlusive_disease "Peripheral artery occlusive disease"), and elevation of cardiac markers.[\[142\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-PEPA-142)[\[143\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-GRACE-143)[\[144\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Weir-2006-144)
Epidemiology
Myocardial infarction is a common presentation of [coronary artery disease](https://en.wikipedia.org/wiki/Coronary_artery_disease "Coronary artery disease"). The [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease;[\[145\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WHO-2004-145) with it being the leading cause of death in high- or middle-income countries and second only to [lower respiratory infections](https://en.wikipedia.org/wiki/Lower_respiratory_tract_infection "Lower respiratory tract infection") in [lower-income countries](https://en.wikipedia.org/wiki/Developing_country "Developing country").[\[145\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WHO-2004-145) Worldwide, more than 3 million people have STEMIs and 4 million have NSTEMIs a year.[\[18\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-Lancet08-18) STEMIs occur about twice as often in men as women.[\[19\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-AHA2013-19)
Rates of death from ischemic heart disease (IHD) have slowed or declined in most high-income countries, although cardiovascular disease still accounted for one in three of all deaths in the US in 2008.[\[146\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-146) For example, rates of death from cardiovascular disease have decreased almost a third between 2001 and 2011 in the United States.[\[147\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-147)
In contrast, IHD is becoming a more common cause of death in the developing world. For example, in [India](https://en.wikipedia.org/wiki/India "India"), IHD had become the leading cause of death by 2004, accounting for 1.46 million deaths (14% of total deaths) and deaths due to IHD were expected to double during 1985–2015.[\[148\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-148) Globally, [disability adjusted life years](https://en.wikipedia.org/wiki/Disability_adjusted_life_year "Disability adjusted life year") (DALYs) lost to ischemic heart disease are predicted to account for 5.5% of total DALYs in 2030, making it the second-most-important cause of disability (after [unipolar depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder")), as well as the leading cause of death by this date.[\[145\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-WHO-2004-145)
Social determinants such as [neighborhood](https://en.wikipedia.org/wiki/Neighbourhood "Neighbourhood") disadvantage, [immigration](https://en.wikipedia.org/wiki/Immigration "Immigration") status, lack of [social support](https://en.wikipedia.org/wiki/Social_support "Social support"), [social isolation](https://en.wikipedia.org/wiki/Social_isolation "Social isolation"), and access to [health services](https://en.wikipedia.org/wiki/Health_care "Health care") play an important role in myocardial infarction risk and survival.[\[149\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-149)[\[150\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-150)[\[151\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-151)[\[152\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-152) Studies have shown that low [socioeconomic status](https://en.wikipedia.org/wiki/Socioeconomic_status "Socioeconomic status") is associated with an increased risk of poorer survival. There are well-documented disparities in myocardial infarction survival by socioeconomic status, [race](https://en.wikipedia.org/wiki/Race_and_ethnicity_in_the_United_States "Race and ethnicity in the United States"), [education](https://en.wikipedia.org/wiki/Education "Education"), and census-tract-level [poverty](https://en.wikipedia.org/wiki/Poverty "Poverty").[\[153\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-153)
Race: In the U.S. [African Americans](https://en.wikipedia.org/wiki/African_Americans "African Americans") have a greater burden of myocardial infarction and other cardiovascular events. On a population level, there is a higher overall [prevalence](https://en.wikipedia.org/wiki/Prevalence "Prevalence") of risk factors that are unrecognized and therefore not treated, which places these individuals at a greater likelihood of experiencing adverse outcomes and therefore potentially higher [morbidity](https://en.wikipedia.org/wiki/Morbidity "Morbidity") and [mortality](https://en.wikipedia.org/wiki/Mortality_rate "Mortality rate").[\[154\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-154) Similarly, South Asians (including South Asians that have migrated to other countries around the world) experience higher rates of acute myocardial infarctions at younger ages, which can be largely explained by a higher prevalence of risk factors at younger ages.[\[155\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-155)
Socioeconomic status: Among individuals who live in the low-socioeconomic (SES) areas, which is close to 25% of the US population, myocardial infarctions (MIs) occurred twice as often compared with people who lived in higher SES areas.[\[156\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-156)
Immigration status: In 2018 many lawfully present [immigrants](https://en.wikipedia.org/wiki/Immigrant "Immigrant") who were eligible for coverage remained uninsured because immigrant families faced a range of enrollment barriers, including fear, confusion about eligibility policies, difficulty navigating the enrollment process, and [language](https://en.wikipedia.org/wiki/Language "Language") and [literacy](https://en.wikipedia.org/wiki/Literacy "Literacy") challenges. Uninsured [undocumented immigrants](https://en.wikipedia.org/wiki/Undocumented_immigrants_\(U.S.\) "Undocumented immigrants (U.S.)") are ineligible for coverage options due to their immigration status.[\[157\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-157)
Health care access: Lack of [health insurance](https://en.wikipedia.org/wiki/Health_insurance "Health insurance") and financial concerns about accessing care were associated with delays in seeking emergency care for acute myocardial infarction which can have significant, adverse consequences on patient outcomes.[\[158\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-158)
Education: Researchers found that compared to people with [graduate degrees](https://en.wikipedia.org/wiki/Graduate_degrees "Graduate degrees"), those with lower educational attainment appeared to have a higher [risk](https://en.wikipedia.org/wiki/Risk "Risk") of heart attack, dying from a [cardiovascular](https://en.wikipedia.org/wiki/Cardiovascular "Cardiovascular") event, and overall death.[\[159\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-159)
Society and culture
Depictions of heart attacks in popular media often include collapsing or loss of consciousness which are not common symptoms; these depictions contribute to widespread misunderstanding about the symptoms of myocardial infarctions, which in turn contributes to people not getting care when they should.[\[160\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-160)
Legal implications
At [common law](https://en.wikipedia.org/wiki/Common_law "Common law"), in general, a myocardial infarction is a [disease](https://en.wikipedia.org/wiki/Disease "Disease") but may sometimes be an [injury](https://en.wikipedia.org/wiki/Injury "Injury"). This can create coverage issues in the administration of no-fault insurance schemes such as [workers' compensation](https://en.wikipedia.org/wiki/Workers%27_compensation "Workers' compensation"). In general, a heart attack is not covered;[\[161\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-prairieview-161) however, it may be a [work-related injury](https://en.wikipedia.org/wiki/Industrial_injury "Industrial injury") if it results, for example, from unusual emotional stress or unusual exertion.[\[162\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-biia-162) In addition, in some jurisdictions, heart attacks had by persons in particular occupations such as [police officers](https://en.wikipedia.org/wiki/Police_officer "Police officer") may be classified as line-of-duty injuries by statute or policy.[\[163\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-163) In some countries or states, a person having had an MI may be prevented from participating in activity that puts other people's lives at risk, for example driving a car or flying an airplane.[\[164\]](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_note-NovaScotia-DrivingRegulations-164)
References
1. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2014_1-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2014_1-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2014_1-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2014_1-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2014_1-4)
["What Are the Signs and Symptoms of Coronary Heart Disease?"](https://web.archive.org/web/20150224034615/http://www.nhlbi.nih.gov/health/health-topics/topics/cad/signs). *www.nhlbi.nih.gov*. September 29, 2014. Archived from [the original](http://www.nhlbi.nih.gov/health/health-topics/topics/cad/signs) on 24 February 2015. Retrieved 23 February 2015.
2. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-2)**
["Heart Attack Symptoms in Women"](https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women). *American Heart Association*.
3. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013MI_3-5)
["What Is a Heart Attack?"](https://www.nhlbi.nih.gov/health/heart-attack). *www.nhlbi.nih.gov*. December 17, 2013. [Archived](https://web.archive.org/web/20150219152830/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/) from the original on 19 February 2015. Retrieved 24 February 2015.
4. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Heart2015_4-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Heart2015_4-1)
["Heart Attack or Sudden Cardiac Arrest: How Are They Different?"](http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Heart-Attack-or-Sudden-Cardiac-Arrest-How-Are-They-Different_UCM_440804_Article.jsp). *www.heart.org*. Jul 30, 2014. [Archived](https://web.archive.org/web/20150224045054/http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Heart-Attack-or-Sudden-Cardiac-Arrest-How-Are-They-Different_UCM_440804_Article.jsp) from the original on 24 February 2015. Retrieved 24 February 2015.
5. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Meh2014_5-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Meh2014_5-1)
Mehta PK, Wei J, Wenger NK (February 2015). ["Ischemic heart disease in women: a focus on risk factors"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336825). *Trends in Cardiovascular Medicine*. **25** (2): 140–51\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.tcm.2014.10.005](https://doi.org/10.1016%2Fj.tcm.2014.10.005). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4336825](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336825). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25453985](https://pubmed.ncbi.nlm.nih.gov/25453985).
6. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WHO2011_6-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WHO2011_6-1)
Mendis S, Puska P, Norrving B (2011). [*Global atlas on cardiovascular disease prevention and control*](http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1) (PDF) (1st ed.). Geneva: World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization. pp. 3–18\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-92-4-156437-3](https://en.wikipedia.org/wiki/Special:BookSources/978-92-4-156437-3 "Special:BookSources/978-92-4-156437-3")
. [Archived](https://web.archive.org/web/20140817123106/http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1) (PDF) from the original on 2014-08-17.
7. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013D_7-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013D_7-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-HLB2013D_7-2)
["How Is a Heart Attack Diagnosed?"](https://www.nhlbi.nih.gov/health/heart-attack/diagnosis). *www.nhlbi.nih.gov*. December 17, 2013. [Archived](https://web.archive.org/web/20150224044949/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/diagnosis) from the original on 24 February 2015. Retrieved 24 February 2015.
8. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Europe2012_8-8)
Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. (October 2012). ["ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation"](https://doi.org/10.1093%2Feurheartj%2Fehs215). *European Heart Journal*. **33** (20): 2569–619\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehs215](https://doi.org/10.1093%2Feurheartj%2Fehs215). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22922416](https://pubmed.ncbi.nlm.nih.gov/22922416).
9. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Oc2010_9-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Oc2010_9-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Oc2010_9-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Oc2010_9-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Oc2010_9-4)
O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, et al. (November 2010). ["Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care"](https://doi.org/10.1161%2FCIRCULATIONAHA.110.971028). *Circulation*. **122** (18 Suppl 3): S787–817. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIRCULATIONAHA.110.971028](https://doi.org/10.1161%2FCIRCULATIONAHA.110.971028). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20956226](https://pubmed.ncbi.nlm.nih.gov/20956226).
10. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-GBD2015Pre_10-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-GBD2015Pre_10-1)
Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease Injury Incidence Prevalence Collaborators) (October 2016). ["Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). *Lancet*. **388** (10053): 1545–1602\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(16)31678-6](https://doi.org/10.1016%2FS0140-6736%2816%2931678-6). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5055577](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27733282](https://pubmed.ncbi.nlm.nih.gov/27733282).
11. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-11)**
Coventry LL, Finn J, Bremner AP (2011). "Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis". *Heart & Lung*. **40** (6): 477–91\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.hrtlng.2011.05.001](https://doi.org/10.1016%2Fj.hrtlng.2011.05.001). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22000678](https://pubmed.ncbi.nlm.nih.gov/22000678).
12. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Val2011_12-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Val2011_12-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Val2011_12-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Val2011_12-3)
Valensi P, Lorgis L, Cottin Y (March 2011). ["Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: a review of the literature"](https://doi.org/10.1016%2Fj.acvd.2010.11.013). *Archives of Cardiovascular Diseases*. **104** (3): 178–88\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.acvd.2010.11.013](https://doi.org/10.1016%2Fj.acvd.2010.11.013). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21497307](https://pubmed.ncbi.nlm.nih.gov/21497307).
13. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-13)**
["What Causes a Heart Attack?"](https://web.archive.org/web/20150218075735/http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/causes). *www.nhlbi.nih.gov*. December 17, 2013. Archived from [the original](http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/causes) on 18 February 2015. Retrieved 24 February 2015.
14. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-14)**
Devlin RJ, Henry JA (2008). ["Clinical review: Major consequences of illicit drug consumption"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374627). *Critical Care*. **12** (1): 202. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1186/cc6166](https://doi.org/10.1186%2Fcc6166). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2374627](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374627). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18279535](https://pubmed.ncbi.nlm.nih.gov/18279535).
15. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-15)**
["Electrocardiogram"](https://web.archive.org/web/20170411140634/https://www.nhlbi.nih.gov/health/health-topics/topics/ekg). *NHLBI, NIH*. 9 December 2016. Archived from [the original](https://www.nhlbi.nih.gov/health/health-topics/topics/ekg) on 11 April 2017. Retrieved 10 April 2017.
16. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-8) [***j***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-9) [***k***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-10) [***l***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-11) [***m***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-12) [***n***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010_16-13)
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). *Davidson's principles and practice of medicine* (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 588–599\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7020-3085-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-3085-7 "Special:BookSources/978-0-7020-3085-7")
.
17. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Hamm2011_17-0)**
Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. (December 2011). ["ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)"](https://doi.org/10.1093%2Feurheartj%2Fehr236). *European Heart Journal*. **32** (23): 2999–3054\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehr236](https://doi.org/10.1093%2Feurheartj%2Fehr236). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21873419](https://pubmed.ncbi.nlm.nih.gov/21873419).
18. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Lancet08_18-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Lancet08_18-1)
White HD, Chew DP (August 2008). ["Acute myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931354). *Lancet*. **372** (9638): 570–84\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(08)61237-4](https://doi.org/10.1016%2FS0140-6736%2808%2961237-4). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1931354](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931354). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18707987](https://pubmed.ncbi.nlm.nih.gov/18707987).
19. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-8) [***j***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-9) [***k***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHA2013_19-10)
O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. (January 2013). ["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"](https://doi.org/10.1161%2FCIR.0b013e3182742cf6). *Circulation*. **127** (4): e362–425. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIR.0b013e3182742cf6](https://doi.org/10.1161%2FCIR.0b013e3182742cf6). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23247304](https://pubmed.ncbi.nlm.nih.gov/23247304).
20. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-20)**
Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Flaxman A, et al. (April 2014). ["The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181601). *Circulation*. **129** (14): 1493–501\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/circulationaha.113.004046](https://doi.org/10.1161%2Fcirculationaha.113.004046). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4181601](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181601). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24573351](https://pubmed.ncbi.nlm.nih.gov/24573351).
21. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-21)**
Torio C (August 2013). ["National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011"](https://hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp). *HCUP*. [Archived](https://web.archive.org/web/20170314171958/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp) from the original on 14 March 2017. Retrieved 1 May 2017.
22. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrowBraunwald20161%E2%80%933Dwight201641_22-0)** [Morrow & Braunwald 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrowBraunwald2016), pp. 1–3; [Dwight 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFDwight2016), p. 41.
23. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrowBraunwald20161%E2%80%933_23-0)** [Morrow & Braunwald 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrowBraunwald2016), pp. 1–3.
24. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-8) [***j***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-9) [***k***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-10) [***l***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-11) [***m***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-12) [***n***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-13) [***o***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-14) [***p***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-15) [***q***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-16) [***r***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-THIRDDEF_24-17)
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. (October 2012). ["Third universal definition of myocardial infarction"](https://doi.org/10.1161%2FCIR.0b013e31826e1058). *Circulation*. **126** (16): 2020–35\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIR.0b013e31826e1058](https://doi.org/10.1161%2FCIR.0b013e31826e1058). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22923432](https://pubmed.ncbi.nlm.nih.gov/22923432).
25. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEBlumenthalMargolis20074%E2%80%935_25-0)** [Blumenthal & Margolis 2007](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFBlumenthalMargolis2007), pp. 4–5.
26. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrowBohula2016295_26-0)** [Morrow & Bohula 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrowBohula2016), p. 295.
27. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrow201659%E2%80%9361_27-0)** [Morrow 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrow2016), pp. 59–61.
28. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-8) [***j***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-9) [***k***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-10) [***l***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-11) [***m***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-12) [***n***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-13) [***o***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-14) [***p***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-15) [***q***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-16) [***r***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-17) [***s***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015_28-18)
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015). *Harrison's principles of internal medicine*. McGraw Hill Education. pp. 1593–1610\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-07-180215-4](https://en.wikipedia.org/wiki/Special:BookSources/978-0-07-180215-4 "Special:BookSources/978-0-07-180215-4")
. [OCLC](https://en.wikipedia.org/wiki/OCLC_\(identifier\) "OCLC (identifier)") [923181481](https://search.worldcat.org/oclc/923181481).
29. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrow201659%E2%80%9360_29-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrow201659%E2%80%9360_29-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEMorrow201659%E2%80%9360_29-2) [Morrow 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrow2016), pp. 59–60.
30. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015B_30-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015B_30-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015B_30-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Harrisons2015B_30-3)
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015). *Harrison's Principles of Internal Medicine*. McGraw Hill Education. pp. 98–99\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-07-180215-4](https://en.wikipedia.org/wiki/Special:BookSources/978-0-07-180215-4 "Special:BookSources/978-0-07-180215-4")
. [OCLC](https://en.wikipedia.org/wiki/OCLC_\(identifier\) "OCLC (identifier)") [923181481](https://search.worldcat.org/oclc/923181481).
31. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Gupta2016_31-0)**
Gupta R, Munoz R (August 2016). "Evaluation and Management of Chest Pain in the Elderly". *Emergency Medicine Clinics of North America*. **34** (3): 523–42\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.emc.2016.04.006](https://doi.org/10.1016%2Fj.emc.2016.04.006). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27475013](https://pubmed.ncbi.nlm.nih.gov/27475013).
32. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid17208083_32-0)**
Marcus GM, Cohen J, Varosy PD, Vessey J, Rose E, Massie BM, et al. (January 2007). "The utility of gestures in patients with chest discomfort". *The American Journal of Medicine*. **120** (1): 83–9\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.amjmed.2006.05.045](https://doi.org/10.1016%2Fj.amjmed.2006.05.045). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17208083](https://pubmed.ncbi.nlm.nih.gov/17208083).
33. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEAllisonMurphy2012197Morrow201660_33-0)** [Allison & Murphy 2012](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFAllisonMurphy2012), p. 197; [Morrow 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFMorrow2016), p. 60.
34. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-ACSwomen_34-0)**
Canto JG, Goldberg RJ, Hand MM, Bonow RO, Sopko G, Pepine CJ, Long T (December 2007). "Symptom presentation of females with acute coronary syndromes: myth vs reality". *Archives of Internal Medicine*. **167** (22): 2405–2413\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/archinte.167.22.2405](https://doi.org/10.1001%2Farchinte.167.22.2405). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18071161](https://pubmed.ncbi.nlm.nih.gov/18071161).
35. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-35)**
["Heart Attack Symptoms, Risk, and Recovery"](https://www.cdc.gov/heartdisease/heart_attack.htm). *CDC.gov*. U.S. Department of Health & Human Services. Retrieved July 20, 2021.
36. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-36)**
Coventry LL, Finn J, Bremner AP (November–December 2011). "Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis". *Heart & Lung*. **40** (6): 477–491\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.hrtlng.2011.05.001](https://doi.org/10.1016%2Fj.hrtlng.2011.05.001). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22000678](https://pubmed.ncbi.nlm.nih.gov/22000678).
37. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-37)**
Chen W, Woods SL, Puntillo KA (July–August 2005). "Sex differences in symptoms associated with acute myocardial infarction: a review of the research". *Heart & Lung*. **34** (4): 240–247\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.hrtlng.2004.12.004](https://doi.org/10.1016%2Fj.hrtlng.2004.12.004). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16027643](https://pubmed.ncbi.nlm.nih.gov/16027643).
38. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-38)**
DeVon HA, Zerwic JJ (July–August 2002). "Symptoms of acute coronary syndromes: are there gender differences? A review of the literature". *Heart & Lung*. **31** (4): 235–245\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1067/mhl.2002.126105](https://doi.org/10.1067%2Fmhl.2002.126105). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12122387](https://pubmed.ncbi.nlm.nih.gov/12122387).
39. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-39)**
Ashton R, Raman D. ["Dyspnea"](http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/dyspnea/). *www.clevelandclinicmeded.com*. Cleveland Clinic. [Archived](https://web.archive.org/web/20170711084207/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/dyspnea/) from the original on 11 July 2017. Retrieved 24 May 2017.
40. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-40)**
Lilly LS (2012). [*Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty*](https://books.google.com/books?id=0lxSGJYeXikC&pg=PA172). Lippincott Williams & Wilkins. p. 172. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-4698-1668-5](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4698-1668-5 "Special:BookSources/978-1-4698-1668-5")
. [Archived](https://web.archive.org/web/20170728135942/https://books.google.com.au/books?id=0lxSGJYeXikC&pg=PA172&lpg=PA172) from the original on 2017-07-28.
41. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-ESC_STEMI_41-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-ESC_STEMI_41-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-ESC_STEMI_41-2)
Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. (December 2008). ["Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology"](https://doi.org/10.1093%2Feurheartj%2Fehn416). *European Heart Journal*. **29** (23): 2909–2945\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehn416](https://doi.org/10.1093%2Feurheartj%2Fehn416). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19004841](https://pubmed.ncbi.nlm.nih.gov/19004841).
42. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Diabetologica2004-David_42-0)**
Davis TM, Fortun P, Mulder J, Davis WA, Bruce DG (March 2004). "Silent myocardial infarction and its prognosis in a community-based cohort of Type 2 diabetic patients: the Fremantle Diabetes Study". *Diabetologia*. **47** (3): 395–399\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00125-004-1344-4](https://doi.org/10.1007%2Fs00125-004-1344-4). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [14963648](https://pubmed.ncbi.nlm.nih.gov/14963648). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [12567614](https://api.semanticscholar.org/CorpusID:12567614).
43. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-rubin_43-0)**
Rubin E, Gorstein F, Rubin R, Schwarting R, Strayer D (2001). *Rubin's Pathology — Clinicopathological Foundations of Medicine*. Maryland: Lippincott Williams & Wilkins. p. 549. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7817-4733-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7817-4733-2 "Special:BookSources/978-0-7817-4733-2")
.
44. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-FOOTNOTEGazianoGaziano201611-22_44-0)** [Gaziano & Gaziano 2016](https://en.wikipedia.org/wiki/Myocardial_infarction#CITEREFGazianoGaziano2016), p. 11-22.
45. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-EUROPEAN2012_45-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-EUROPEAN2012_45-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-EUROPEAN2012_45-2)
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. (July 2012). ["European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts)"](https://doi.org/10.1093%2Feurheartj%2Fehs092). *European Heart Journal*. **33** (13): 1635–701\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehs092](https://doi.org/10.1093%2Feurheartj%2Fehs092). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22555213](https://pubmed.ncbi.nlm.nih.gov/22555213).
46. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid=16697342_46-0)**
Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. (May 2006). ["AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute"](https://doi.org/10.1016%2Fj.jacc.2006.04.026). *Journal of the American College of Cardiology*. **47** (10): 2130–9\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jacc.2006.04.026](https://doi.org/10.1016%2Fj.jacc.2006.04.026). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16697342](https://pubmed.ncbi.nlm.nih.gov/16697342).
47. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Kivi2012_47-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Kivi2012_47-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Kivi2012_47-2)
Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L, et al. (October 2012). ["Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486012). *Lancet*. **380** (9852): 1491–7\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(12)60994-5](https://doi.org/10.1016%2FS0140-6736%2812%2960994-5). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3486012](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486012). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22981903](https://pubmed.ncbi.nlm.nih.gov/22981903).
48. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-48)**
Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT (July 2012). ["Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500). *Lancet*. **380** (9838): 219–29\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(12)61031-9](https://doi.org/10.1016%2FS0140-6736%2812%2961031-9). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3645500](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22818936](https://pubmed.ncbi.nlm.nih.gov/22818936).
49. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid=22473079_49-0)**
Steptoe A, Kivimäki M (April 2012). "Stress and cardiovascular disease". *Nature Reviews. Cardiology*. **9** (6): 360–70\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/nrcardio.2012.45](https://doi.org/10.1038%2Fnrcardio.2012.45). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22473079](https://pubmed.ncbi.nlm.nih.gov/22473079). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [27925226](https://api.semanticscholar.org/CorpusID:27925226).
50. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-:1_50-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-:1_50-1)
Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS (August 2020). ["Reduction in saturated fat intake for cardiovascular disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092457). *The Cochrane Database of Systematic Reviews*. **2020** (8) CD011737. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD011737.pub3](https://doi.org/10.1002%2F14651858.CD011737.pub3). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [8092457](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092457). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32827219](https://pubmed.ncbi.nlm.nih.gov/32827219).
51. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Chow2014_51-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Chow2014_51-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Chow2014_51-2)
Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. (March 2014). "Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis". *Annals of Internal Medicine*. **160** (6): 398–406\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7326/M13-1788](https://doi.org/10.7326%2FM13-1788). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24723079](https://pubmed.ncbi.nlm.nih.gov/24723079).
52. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-52)**
de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, et al. (August 2015). ["Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532752). *BMJ*. **351** h3978. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.h3978](https://doi.org/10.1136%2Fbmj.h3978). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4532752](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532752). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26268692](https://pubmed.ncbi.nlm.nih.gov/26268692).
53. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-53)**
["Scientific Report of the 2015 Dietary Guidelines Advisory Committee"](https://web.archive.org/web/20160503071439/http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf) (PDF). *health.gov*. Feb 2015. p. 17. Archived from [the original](https://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf) (PDF) on 2016-05-03. Retrieved 2015-03-05.
54. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Krenz2012_54-0)**
Krenz M, Korthuis RJ (January 2012). ["Moderate ethanol ingestion and cardiovascular protection: from epidemiologic associations to cellular mechanisms"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246046). *Journal of Molecular and Cellular Cardiology*. **52** (1): 93–104\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.yjmcc.2011.10.011](https://doi.org/10.1016%2Fj.yjmcc.2011.10.011). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3246046](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246046). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22041278](https://pubmed.ncbi.nlm.nih.gov/22041278).
55. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Genomics_of_Cardiovascular_Disease_55-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Genomics_of_Cardiovascular_Disease_55-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Genomics_of_Cardiovascular_Disease_55-2)
O'Donnell CJ, Nabel EG (December 2011). ["Genomics of cardiovascular disease"](https://doi.org/10.1056%2FNEJMra1105239). *The New England Journal of Medicine*. **365** (22): 2098–109\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1056/NEJMra1105239](https://doi.org/10.1056%2FNEJMra1105239). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22129254](https://pubmed.ncbi.nlm.nih.gov/22129254).
56. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Culic2007_56-0)**
Culić V (April 2007). "Acute risk factors for myocardial infarction". *International Journal of Cardiology*. **117** (2): 260–9\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.ijcard.2006.05.011](https://doi.org/10.1016%2Fj.ijcard.2006.05.011). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16860887](https://pubmed.ncbi.nlm.nih.gov/16860887).
57. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Shaw2009_57-0)**
Shaw E, Tofler GH (July 2009). "Circadian rhythm and cardiovascular disease". *Current Atherosclerosis Reports*. **11** (4): 289–95\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s11883-009-0044-4](https://doi.org/10.1007%2Fs11883-009-0044-4). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19500492](https://pubmed.ncbi.nlm.nih.gov/19500492). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [43626425](https://api.semanticscholar.org/CorpusID:43626425).
58. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Vyas2012_58-0)**
Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, et al. (July 2012). ["Shift work and vascular events: systematic review and meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406223). *BMJ*. **345** e4800. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.e4800](https://doi.org/10.1136%2Fbmj.e4800). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3406223](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406223). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22835925](https://pubmed.ncbi.nlm.nih.gov/22835925).
59. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-59)**
Janszky I, Ljung R (October 2008). ["Shifts to and from daylight saving time and incidence of myocardial infarction"](https://doi.org/10.1056%2FNEJMc0807104). *The New England Journal of Medicine*. **359** (18): 1966–8\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1056/NEJMc0807104](https://doi.org/10.1056%2FNEJMc0807104). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18971502](https://pubmed.ncbi.nlm.nih.gov/18971502). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [205040478](https://api.semanticscholar.org/CorpusID:205040478).
60. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-60)**
Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM (August 2015). ["Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494192). *The Cochrane Database of Systematic Reviews*. **2015** (8) CD011054. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD011054.pub2](https://doi.org/10.1002%2F14651858.CD011054.pub2). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[1874/340787](https://hdl.handle.net/1874%2F340787). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6494192](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494192). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26310586](https://pubmed.ncbi.nlm.nih.gov/26310586).
61. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-61)**
Bally M, Dendukuri N, Rich B, Nadeau L, Helin-Salmivaara A, Garbe E, Brophy JM (May 2017). ["Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423546). *BMJ*. **357** j1909. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.j1909](https://doi.org/10.1136%2Fbmj.j1909). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5423546](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423546). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28487435](https://pubmed.ncbi.nlm.nih.gov/28487435).
62. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-62)**
Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA (May 2016). ["Endometriosis and Risk of Coronary Heart Disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940126). *Circulation: Cardiovascular Quality and Outcomes*. **9** (3): 257–64\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIRCOUTCOMES.115.002224](https://doi.org/10.1161%2FCIRCOUTCOMES.115.002224). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4940126](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940126). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27025928](https://pubmed.ncbi.nlm.nih.gov/27025928).
63. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-63)**
Mustafic H, Jabre P, Caussin C, Murad MH, Escolano S, Tafflet M, et al. (February 2012). "Main air pollutants and myocardial infarction: a systematic review and meta-analysis". *JAMA*. **307** (7): 713–21\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.2012.126](https://doi.org/10.1001%2Fjama.2012.126). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22337682](https://pubmed.ncbi.nlm.nih.gov/22337682).
64. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-64)**
Ho AF, Wah W, Earnest A, Ng YY, Xie Z, Shahidah N, et al. (November 2018). "Health impacts of the Southeast Asian haze problem – A time-stratified case crossover study of the relationship between ambient air pollution and sudden cardiac deaths in Singapore". *International Journal of Cardiology*. **271**: 352–358\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.ijcard.2018.04.070](https://doi.org/10.1016%2Fj.ijcard.2018.04.070). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30223374](https://pubmed.ncbi.nlm.nih.gov/30223374). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [52282745](https://api.semanticscholar.org/CorpusID:52282745).
65. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-65)**
Sun Z, Chen C, Xu D, Li T (October 2018). "Effects of ambient temperature on myocardial infarction: A systematic review and meta-analysis". *Environmental Pollution*. **241**: 1106–1114\. [Bibcode](https://en.wikipedia.org/wiki/Bibcode_\(identifier\) "Bibcode (identifier)"):[2018EPoll.241.1106S](https://ui.adsabs.harvard.edu/abs/2018EPoll.241.1106S). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.envpol.2018.06.045](https://doi.org/10.1016%2Fj.envpol.2018.06.045). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30029319](https://pubmed.ncbi.nlm.nih.gov/30029319). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [51705159](https://api.semanticscholar.org/CorpusID:51705159).
66. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Chat2012_66-0)**
Chatzidimitriou D, Kirmizis D, Gavriilaki E, Chatzidimitriou M, Malisiovas N (October 2012). "Atherosclerosis and infection: is the jury still not in?". *Future Microbiology*. **7** (10): 1217–30\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2217/fmb.12.87](https://doi.org/10.2217%2Ffmb.12.87). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23030426](https://pubmed.ncbi.nlm.nih.gov/23030426).
67. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Sanchez2014_67-0)**
Sánchez-Manubens J, Bou R, Anton J (February 2014). "Diagnosis and classification of Kawasaki disease". *Journal of Autoimmunity*. 48–49: 113–7\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jaut.2014.01.010](https://doi.org/10.1016%2Fj.jaut.2014.01.010). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24485156](https://pubmed.ncbi.nlm.nih.gov/24485156).
68. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-68)**
Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC (March 2011). ["Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis"](https://doi.org/10.1016%2Fj.jacc.2010.10.011). *Journal of the American College of Cardiology*. **57** (10): 1237–47\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jacc.2010.10.011](https://doi.org/10.1016%2Fj.jacc.2010.10.011). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21145688](https://pubmed.ncbi.nlm.nih.gov/21145688).
69. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-69)**
Clarke R, Halsey J, Bennett D, Lewington S (February 2011). "Homocysteine and vascular disease: review of published results of the homocysteine-lowering trials". *Journal of Inherited Metabolic Disease*. **34** (1): 83–91\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s10545-010-9235-y](https://doi.org/10.1007%2Fs10545-010-9235-y). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21069462](https://pubmed.ncbi.nlm.nih.gov/21069462). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [8714058](https://api.semanticscholar.org/CorpusID:8714058).
70. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-70)**
Lonn E (September 2007). "Homocysteine in the prevention of ischemic heart disease, stroke and venous thromboembolism: therapeutic target or just another distraction?". *Current Opinion in Hematology*. **14** (5): 481–7\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/MOH.0b013e3282c48bd8](https://doi.org/10.1097%2FMOH.0b013e3282c48bd8). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17934354](https://pubmed.ncbi.nlm.nih.gov/17934354). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [8734056](https://api.semanticscholar.org/CorpusID:8734056).
71. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-71)**
Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, et al. (January 2017). ["ESC working group position paper on myocardial infarction with non-obstructive coronary arteries"](https://doi.org/10.1093%2Feurheartj%2Fehw149). *European Heart Journal*. **38** (3): 143–153\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehw149](https://doi.org/10.1093%2Feurheartj%2Fehw149). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[11577/3304417](https://hdl.handle.net/11577%2F3304417). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28158518](https://pubmed.ncbi.nlm.nih.gov/28158518).
72. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-7) [***i***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-8) [***j***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-9) [***k***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-10) [***l***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-11) [***m***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-12) [***n***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-13) [***o***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-14) [***p***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-15) [***q***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-16) [***r***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-17) [***s***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-18) [***t***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-19) [***u***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-20) [***v***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-21) [***w***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-22) [***x***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-23) [***y***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-24) [***z***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-25) [***aa***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-26) [***ab***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-27) [***ac***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-28) [***ad***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-29) [***ae***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-30) [***af***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-31) [***ag***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-32) [***ah***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-33) [***ai***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-34) [***aj***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Reed2017_72-35)
Reed GW, Rossi JE, Cannon CP (January 2017). "Acute myocardial infarction". *Lancet*. **389** (10065): 197–210\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(16)30677-8](https://doi.org/10.1016%2FS0140-6736%2816%2930677-8). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27502078](https://pubmed.ncbi.nlm.nih.gov/27502078). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [33523662](https://api.semanticscholar.org/CorpusID:33523662).
73. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010B_73-5)
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). *Davidson's principles and practice of medicine* (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 577–9\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7020-3085-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-3085-7 "Special:BookSources/978-0-7020-3085-7")
.
74. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid20065951_74-0)**
Woollard KJ, Geissmann F (February 2010). ["Monocytes in atherosclerosis: subsets and functions"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813241). *Nature Reviews. Cardiology*. **7** (2): 77–86\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/nrcardio.2009.228](https://doi.org/10.1038%2Fnrcardio.2009.228). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2813241](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813241). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20065951](https://pubmed.ncbi.nlm.nih.gov/20065951).
75. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-75)**
Janoudi A, Shamoun FE, Kalavakunta JK, Abela GS (July 2016). ["Cholesterol crystal induced arterial inflammation and destabilization of atherosclerotic plaque"](https://doi.org/10.1093%2Feurheartj%2Fehv653). *European Heart Journal*. **37** (25): 1959–67\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehv653](https://doi.org/10.1093%2Feurheartj%2Fehv653). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26705388](https://pubmed.ncbi.nlm.nih.gov/26705388).
76. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BUJA2005_76-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BUJA2005_76-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BUJA2005_76-2)
Buja LM (July 2005). "Myocardial ischemia and reperfusion injury". *Cardiovascular Pathology*. **14** (4): 170–5\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.carpath.2005.03.006](https://doi.org/10.1016%2Fj.carpath.2005.03.006). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16009313](https://pubmed.ncbi.nlm.nih.gov/16009313).
77. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-77)**
Algranati D, Kassab GS, Lanir Y (March 2011). ["Why is the subendocardium more vulnerable to ischemia? A new paradigm"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064294). *American Journal of Physiology. Heart and Circulatory Physiology*. **300** (3): H1090–100. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1152/ajpheart.00473.2010](https://doi.org/10.1152%2Fajpheart.00473.2010). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3064294](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064294). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21169398](https://pubmed.ncbi.nlm.nih.gov/21169398).
78. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BOLOOKI2010_78-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BOLOOKI2010_78-1)
Bolooki HM, Askari A (August 2010). ["Acute Myocardial Infarction"](http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/acute-myocardial-infarction/). *www.clevelandclinicmeded.com*. [Archived](https://web.archive.org/web/20170428050921/http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/acute-myocardial-infarction/) from the original on 28 April 2017. Retrieved 24 May 2017.
79. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AARONSON2013_79-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AARONSON2013_79-1)
Aaronson PI, Ward JP, Connolly MJ (2013). *The cardiovascular system at a glance* (4th ed.). Chichester, West Sussex: Wiley-Blackwell. pp. 88–89\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-470-65594-8](https://en.wikipedia.org/wiki/Special:BookSources/978-0-470-65594-8 "Special:BookSources/978-0-470-65594-8")
.
80. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Kutty2013_80-0)**
Kutty RS, Jones N, Moorjani N (November 2013). "Mechanical complications of acute myocardial infarction". *Cardiology Clinics* (Review). **31** (4): 519–31, vii–viii. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.ccl.2013.07.004](https://doi.org/10.1016%2Fj.ccl.2013.07.004). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24188218](https://pubmed.ncbi.nlm.nih.gov/24188218).
81. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-KlonerHale_81-0)**
Kloner R, Hale SL (15 September 2016). "Reperfusion Injury: Prevention and Management". In Morrow DA (ed.). [*Myocardial Infarction: A Companion to Braunwald's Heart Disease*](https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 286–288\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-323-35943-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-35943-6 "Special:BookSources/978-0-323-35943-6")
.
82. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-82)**
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD (January 2019). ["Fourth universal definition of myocardial infarction (2018)"](https://doi.org/10.1093%2Feurheartj%2Fehy462). *European Heart Journal*. **40** (3): 237–269\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehy462](https://doi.org/10.1093%2Feurheartj%2Fehy462). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[10044/1/73052](https://hdl.handle.net/10044%2F1%2F73052). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30165617](https://pubmed.ncbi.nlm.nih.gov/30165617).
83. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-83)**
Pickering JW, Than MP, Cullen L, Aldous S, Ter Avest E, Body R, et al. (May 2017). ["Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis"](https://www.research.manchester.ac.uk/portal/en/publications/rapid-ruleout-of-acute-myocardial-infarction-with-a-single-highsensitivity-cardiac-troponin-t-measurement-below-the-limit-of-detection\(0e2cb8e0-229a-446b-9389-7fa319a649d4\).html). *Annals of Internal Medicine*. **166** (10): 715–724\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7326/M16-2562](https://doi.org/10.7326%2FM16-2562). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28418520](https://pubmed.ncbi.nlm.nih.gov/28418520).
84. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-84)**
Chapman AR, Lee KK, McAllister DA, Cullen L, Greenslade JH, Parsonage W, et al. (November 2017). ["Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710293). *JAMA*. **318** (19): 1913–1924\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.2017.17488](https://doi.org/10.1001%2Fjama.2017.17488). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5710293](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710293). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29127948](https://pubmed.ncbi.nlm.nih.gov/29127948).
85. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHANSTEMI2014_85-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHANSTEMI2014_85-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHANSTEMI2014_85-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-AHANSTEMI2014_85-3)
Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. (December 2014). ["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"](https://doi.org/10.1161%2FCIR.0000000000000134). *Circulation*. **130** (25): e344–426. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIR.0000000000000134](https://doi.org/10.1161%2FCIR.0000000000000134). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25249585](https://pubmed.ncbi.nlm.nih.gov/25249585).
86. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-86)**
Lipinski MJ, Escárcega RO, D'Ascenzo F, Magalhães MA, Baker NC, Torguson R, et al. (May 2014). "A systematic review and collaborative meta-analysis to determine the incremental value of copeptin for rapid rule-out of acute myocardial infarction". *The American Journal of Cardiology*. **113** (9): 1581–91\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.amjcard.2014.01.436](https://doi.org/10.1016%2Fj.amjcard.2014.01.436). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24731654](https://pubmed.ncbi.nlm.nih.gov/24731654).
87. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010C_87-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010C_87-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010C_87-2)
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). *Davidson's principles and practice of medicine* (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 529–30\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7020-3085-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-3085-7 "Special:BookSources/978-0-7020-3085-7")
.
88. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-88)**
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2015). *Harrison's principles of internal medicine*. McGraw Hill Education. p. 1457. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-07-180215-4](https://en.wikipedia.org/wiki/Special:BookSources/978-0-07-180215-4 "Special:BookSources/978-0-07-180215-4")
. [OCLC](https://en.wikipedia.org/wiki/OCLC_\(identifier\) "OCLC (identifier)") [923181481](https://search.worldcat.org/oclc/923181481).
89. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-auto_89-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-auto_89-1)
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. (April 2021). ["2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation"](https://doi.org/10.1093%2Feurheartj%2Fehaa575). *European Heart Journal*. **42** (14): 1289–1367\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehaa575](https://doi.org/10.1093%2Feurheartj%2Fehaa575). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32860058](https://pubmed.ncbi.nlm.nih.gov/32860058).
90. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WISELY2017_90-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WISELY2017_90-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WISELY2017_90-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WISELY2017_90-3)
["American College of Cardiology"](http://www.choosingwisely.org/societies/american-college-of-cardiology/). *www.choosingwisely.org*. Choosing Wisely. 28 February 2017. [Archived](https://web.archive.org/web/20170728125746/http://www.choosingwisely.org/societies/american-college-of-cardiology/) from the original on 28 July 2017. Retrieved 24 May 2017.
91. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-91)**
Schinkel AF, Valkema R, Geleijnse ML, Sijbrands EJ, Poldermans D (May 2010). "Single-photon emission computed tomography for assessment of myocardial viability". *EuroIntervention*. **6** (Supplement G): G115–22. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20542817](https://pubmed.ncbi.nlm.nih.gov/20542817).
92. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG94_92-0)** [National Institute for Health and Clinical Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence "National Institute for Health and Clinical Excellence"). *[Clinical guideline cg94: Unstable angina and NSTEMI](https://www.nice.org.uk/guidance/CGcg94)*. London, 2010.
93. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-UOTW36_93-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-UOTW36_93-1)
["UOTW \#36 – Ultrasound of the Week"](https://www.ultrasoundoftheweek.com/uotw-36/). *Ultrasound of the Week*. 5 February 2015. [Archived](https://web.archive.org/web/20170509115806/https://www.ultrasoundoftheweek.com/uotw-36/) from the original on 9 May 2017. Retrieved 27 May 2017.
94. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010D_94-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010D_94-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Davidsons2010D_94-2)
Colledge NR, Walker BR, Ralston SH, Davidson LS (2010). *Davidson's principles and practice of medicine* (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 535, 539. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-7020-3085-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-7020-3085-7 "Special:BookSources/978-0-7020-3085-7")
.
95. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid16199332_95-0)**
Boie ET (November 2005). "Initial evaluation of chest pain". *Emergency Medicine Clinics of North America*. **23** (4): 937–57\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.emc.2005.07.007](https://doi.org/10.1016%2Fj.emc.2005.07.007). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16199332](https://pubmed.ncbi.nlm.nih.gov/16199332).
96. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-96)**
["Assessment of fatigue"](https://web.archive.org/web/20210828180811/https://bestpractice.bmj.com/topics/en-gb/571/differentials). *BMJ Best Practice*. 17 August 2016. Archived from [the original](http://bestpractice.bmj.com/best-practice/monograph/571/diagnosis/differential-diagnosis.html) on 28 August 2021. Retrieved 6 June 2017.
97. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-97)**
MacIntyre CR, Mahimbo A, Moa AM, Barnes M (December 2016). ["Influenza vaccine as a coronary intervention for prevention of myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256393). *Heart*. **102** (24): 1953–1956\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/heartjnl-2016-309983](https://doi.org/10.1136%2Fheartjnl-2016-309983). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5256393](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256393). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27686519](https://pubmed.ncbi.nlm.nih.gov/27686519).
98. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG181_98-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG181_98-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG181_98-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG181_98-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICECG181_98-4) [National Institute for Health and Clinical Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence "National Institute for Health and Clinical Excellence"). *[Clinical guideline 181: Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease](https://www.nice.org.uk/guidance/CG181)*. London, 2014.
99. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-99)**
Stradling C, Hamid M, Taheri S, Thomas GN (2014). "A review of dietary influences on cardiovascular health: part 2: dietary patterns". *Cardiovascular & Hematological Disorders Drug Targets*. **14** (1): 50–63\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2174/1871529x14666140701095426](https://doi.org/10.2174%2F1871529x14666140701095426). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24993125](https://pubmed.ncbi.nlm.nih.gov/24993125).
100. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-100)**
Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP (December 2013). "Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the U.S. Preventive Services Task Force". *Annals of Internal Medicine*. **159** (12): 824–34\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7326/0003-4819-159-12-201312170-00729](https://doi.org/10.7326%2F0003-4819-159-12-201312170-00729). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24217421](https://pubmed.ncbi.nlm.nih.gov/24217421). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [17366251](https://api.semanticscholar.org/CorpusID:17366251).
101. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICEPH25_101-0)**
McPherson K, et al. (June 2010). ["Prevention of cardiovascular disease – NICE public health guidance 25"](http://guidance.nice.org.uk/ph25). London: [National Institute for Health and Care Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence "National Institute for Health and Care Excellence"). [Archived](https://web.archive.org/web/20140329171156/http://guidance.nice.org.uk/PH25) from the original on 2014-03-29.
102. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-102)**
Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G (January 2011). ["Multiple risk factor interventions for primary prevention of coronary heart disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160097). *The Cochrane Database of Systematic Reviews*. **2013** (1) CD001561. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.cd001561.pub3](https://doi.org/10.1002%2F14651858.cd001561.pub3). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4160097](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160097). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21249647](https://pubmed.ncbi.nlm.nih.gov/21249647).
103. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-103)**
Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. (January 2013). ["Statins for the primary prevention of cardiovascular disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481400). *The Cochrane Database of Systematic Reviews*. **1** (1) CD004816. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD004816.pub5](https://doi.org/10.1002%2F14651858.CD004816.pub5). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6481400](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481400). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23440795](https://pubmed.ncbi.nlm.nih.gov/23440795).
104. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-ATTaspirin2009_104-0)**
Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. (May 2009). ["Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715005). *Lancet*. **373** (9678): 1849–60\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(09)60503-1](https://doi.org/10.1016%2FS0140-6736%2809%2960503-1). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2715005](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715005). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19482214](https://pubmed.ncbi.nlm.nih.gov/19482214).
105. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-105)**
Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Kandala NB, et al. (September 2013). ["Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781046). *[Health Technology Assessment](https://en.wikipedia.org/wiki/Health_Technology_Assessment_\(journal\) "Health Technology Assessment (journal)")*. **17** (43): 1–253\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3310/hta17430](https://doi.org/10.3310%2Fhta17430). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4781046](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781046). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24074752](https://pubmed.ncbi.nlm.nih.gov/24074752).
106. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-106)**
Matthys F, De Backer T, De Backer G, Stichele RV (March 2014). ["Review of guidelines on primary prevention of cardiovascular disease with aspirin: how much evidence is needed to turn a tanker?"](https://doi.org/10.1177%2F2047487312472077). *European Journal of Preventive Cardiology*. **21** (3): 354–65\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1177/2047487312472077](https://doi.org/10.1177%2F2047487312472077). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23610452](https://pubmed.ncbi.nlm.nih.gov/23610452). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [28350632](https://api.semanticscholar.org/CorpusID:28350632).
107. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-107)**
Hodis HN, Mack WJ (July 2014). "Hormone replacement therapy and the association with coronary heart disease and overall mortality: clinical application of the timing hypothesis". *The Journal of Steroid Biochemistry and Molecular Biology*. **142**: 68–75\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.jsbmb.2013.06.011](https://doi.org/10.1016%2Fj.jsbmb.2013.06.011). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23851166](https://pubmed.ncbi.nlm.nih.gov/23851166). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [30838065](https://api.semanticscholar.org/CorpusID:30838065).
108. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-2) [***d***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-3) [***e***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-4) [***f***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-5) [***g***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-6) [***h***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NICE172_108-7) [National Institute for Health and Clinical Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence "National Institute for Health and Clinical Excellence"). *[Clinical guideline 172: Secondary prevention in primary and secondary care for patients following a myocardial infarction](https://www.nice.org.uk/guidance/CG172)*. London, 2013.
109. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-109)**
Anderson L, Taylor RS (December 2014). ["Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7087435). *The Cochrane Database of Systematic Reviews*. **2021** (12) CD011273. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD011273.pub2](https://doi.org/10.1002%2F14651858.CD011273.pub2). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[10871/19152](https://hdl.handle.net/10871%2F19152). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7087435](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7087435). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25503364](https://pubmed.ncbi.nlm.nih.gov/25503364).
110. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-110)**
Perez MI, Musini VM, Wright JM (October 2009). "Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event". *The Cochrane Database of Systematic Reviews* (4) CD006743. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD006743.pub2](https://doi.org/10.1002%2F14651858.CD006743.pub2). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19821384](https://pubmed.ncbi.nlm.nih.gov/19821384).
111. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-111)**
Elmariah S, Mauri L, Doros G, Galper BZ, O'Neill KE, Steg PG, et al. (February 2015). ["Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386690). *Lancet*. **385** (9970): 792–8\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(14)62052-3](https://doi.org/10.1016%2FS0140-6736%2814%2962052-3). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4386690](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386690). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25467565](https://pubmed.ncbi.nlm.nih.gov/25467565).
112. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-112)**
Bangalore S, Makani H, Radford M, Thakur K, Toklu B, Katz SD, et al. (October 2014). ["Clinical outcomes with β-blockers for myocardial infarction: a meta-analysis of randomized trials"](https://doi.org/10.1016%2Fj.amjmed.2014.05.032). *The American Journal of Medicine*. **127** (10): 939–953\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.amjmed.2014.05.032](https://doi.org/10.1016%2Fj.amjmed.2014.05.032). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24927909](https://pubmed.ncbi.nlm.nih.gov/24927909).
113. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-113)**
Safi S, Sethi NJ, Nielsen EE, Feinberg J, Jakobsen JC, Gluud C, et al. (Cochrane Heart Group) (December 2019). ["Beta-blockers for suspected or diagnosed acute myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915833). *The Cochrane Database of Systematic Reviews*. **12** (12) CD012484. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD012484.pub2](https://doi.org/10.1002%2F14651858.CD012484.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6915833](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915833). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31845756](https://pubmed.ncbi.nlm.nih.gov/31845756).
114. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BetaNNT2015_114-0)**
Newman D (19 August 2010). ["Beta Blockers for Acute Heart Attack (Myocardial Infarction)"](http://www.thennt.com/nnt/beta-blockers-for-heart-attack/). *TheNNT.com*. [Archived](https://web.archive.org/web/20151222092449/http://www.thennt.com/nnt/beta-blockers-for-heart-attack/) from the original on 22 December 2015. Retrieved 11 December 2015.
115. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid26891235_115-0)**
Le HH, El-Khatib C, Mombled M, Guitarian F, Al-Gobari M, Fall M, et al. (2016). ["Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758660). *PLOS ONE*. **11** (2) e0145958. [Bibcode](https://en.wikipedia.org/wiki/Bibcode_\(identifier\) "Bibcode (identifier)"):[2016PLoSO..1145958L](https://ui.adsabs.harvard.edu/abs/2016PLoSO..1145958L). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1371/journal.pone.0145958](https://doi.org/10.1371%2Fjournal.pone.0145958). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4758660](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758660). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26891235](https://pubmed.ncbi.nlm.nih.gov/26891235).
116. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Hazinski2015_116-0)**
Hazinski MF, Nolan JP, Aickin R, Bhanji F, Billi JE, Callaway CW, et al. (October 2015). ["Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations"](https://doi.org/10.1161%2FCIR.0000000000000270). *Circulation* (Review). **132** (16 Suppl 1): S2–39. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIR.0000000000000270](https://doi.org/10.1161%2FCIR.0000000000000270). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26472854](https://pubmed.ncbi.nlm.nih.gov/26472854).
117. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-117)**
Hess EP, Agarwal D, Chandra S, Murad MH, Erwin PJ, Hollander JE, et al. (July 2010). ["Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900327). *CMAJ*. **182** (10): 1039–44\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1503/cmaj.092119](https://doi.org/10.1503%2Fcmaj.092119). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2900327](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900327). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20530163](https://pubmed.ncbi.nlm.nih.gov/20530163).
118. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-118)**
Reeder G (27 December 2016). ["Nitrates in the management of acute coronary syndrome"](https://www.uptodate.com/contents/nitrates-in-the-management-of-acute-coronary-syndrome). *www.uptodate.com*. [Archived](https://web.archive.org/web/20170728135423/https://www.uptodate.com/contents/nitrates-in-the-management-of-acute-coronary-syndrome) from the original on 28 July 2017. Retrieved 24 May 2017.
119. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-119)**
Yadlapati A, Gajjar M, Schimmel DR, Ricciardi MJ, Flaherty JD (December 2016). "Contemporary management of ST-segment elevation myocardial infarction". *Internal and Emergency Medicine*. **11** (8): 1107–1113\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s11739-016-1550-3](https://doi.org/10.1007%2Fs11739-016-1550-3). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27714584](https://pubmed.ncbi.nlm.nih.gov/27714584). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [23759756](https://api.semanticscholar.org/CorpusID:23759756).
120. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-120)**
McCarthy CP, Mullins KV, Sidhu SS, Schulman SP, McEvoy JW (June 2016). "The on- and off-target effects of morphine in acute coronary syndrome: A narrative review". *American Heart Journal*. **176**: 114–21\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.ahj.2016.04.004](https://doi.org/10.1016%2Fj.ahj.2016.04.004). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27264228](https://pubmed.ncbi.nlm.nih.gov/27264228).
121. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-BMJP2Y12_121-0)**
Bellemain-Appaix A, Kerneis M, O'Connor SA, Silvain J, Cucherat M, Beygui F, et al. (October 2014). ["Reappraisal of thienopyridine pretreatment in patients with non-ST elevation acute coronary syndrome: a systematic review and meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208629). *BMJ*. **349** g6269. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.g6269](https://doi.org/10.1136%2Fbmj.g6269). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4208629](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208629). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25954988](https://pubmed.ncbi.nlm.nih.gov/25954988).
122. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-And2014_122-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-And2014_122-1)
Andrade-Castellanos CA, Colunga-Lozano LE, Delgado-Figueroa N, Magee K (June 2014). ["Heparin versus placebo for non-ST elevation acute coronary syndromes"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769062). *The Cochrane Database of Systematic Reviews*. **6** (6) CD003462. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD003462.pub3](https://doi.org/10.1002%2F14651858.CD003462.pub3). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6769062](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769062). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24972265](https://pubmed.ncbi.nlm.nih.gov/24972265).
123. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Bagai2014_123-0)**
Bagai A, Dangas GD, Stone GW, Granger CB (June 2014). ["Reperfusion strategies in acute coronary syndromes"](https://doi.org/10.1161%2FCIRCRESAHA.114.302744). *Circulation Research*. **114** (12): 1918–28\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIRCRESAHA.114.302744](https://doi.org/10.1161%2FCIRCRESAHA.114.302744). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [24902975](https://pubmed.ncbi.nlm.nih.gov/24902975).
124. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-124)**
Jobs A, Mehta SR, Montalescot G, Vicaut E, Van't Hof AW, Badings EA, et al. (August 2017). "Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials". *Lancet*. **390** (10096): 737–746\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(17)31490-3](https://doi.org/10.1016%2FS0140-6736%2817%2931490-3). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28778541](https://pubmed.ncbi.nlm.nih.gov/28778541). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [4489347](https://api.semanticscholar.org/CorpusID:4489347).
125. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-125)**
Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. (October 2010). ["Guidelines on myocardial revascularization"](https://doi.org/10.1093%2Feurheartj%2Fehq277). *European Heart Journal*. **31** (20): 2501–55\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurheartj/ehq277](https://doi.org/10.1093%2Feurheartj%2Fehq277). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20802248](https://pubmed.ncbi.nlm.nih.gov/20802248).
126. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-126)**
Dalal F, Dalal HM, Voukalis C, Gandhi MM (July 2017). "Management of patients after primary percutaneous coronary intervention for myocardial infarction". *BMJ*. **358** j3237. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.j3237](https://doi.org/10.1136%2Fbmj.j3237). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28729460](https://pubmed.ncbi.nlm.nih.gov/28729460). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [46847680](https://api.semanticscholar.org/CorpusID:46847680).
127. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-127)**
Lassen JF, Bøtker HE, Terkelsen CJ (January 2013). "Timely and optimal treatment of patients with STEMI". *Nature Reviews. Cardiology*. 1. **10** (1): 41–8\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/nrcardio.2012.156](https://doi.org/10.1038%2Fnrcardio.2012.156). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23165072](https://pubmed.ncbi.nlm.nih.gov/23165072). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [21955018](https://api.semanticscholar.org/CorpusID:21955018).
128. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-128)**
Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. (November 2015). ["Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care"](https://doi.org/10.1161%2Fcir.0000000000000252). *Circulation*. **132** (18 Suppl 2): S315–67. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/cir.0000000000000252](https://doi.org/10.1161%2Fcir.0000000000000252). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26472989](https://pubmed.ncbi.nlm.nih.gov/26472989).
129. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-mccaul_129-0)**
McCaul M, Lourens A, Kredo T (September 2014). ["Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823254). *The Cochrane Database of Systematic Reviews*. **2014** (9) CD010191. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD010191.pub2](https://doi.org/10.1002%2F14651858.CD010191.pub2). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6823254](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823254). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25208209](https://pubmed.ncbi.nlm.nih.gov/25208209).
130. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-130)**
Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T (December 2016). ["Oxygen therapy for acute myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463792). *The Cochrane Database of Systematic Reviews*. **2016** (12) CD007160. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD007160.pub4](https://doi.org/10.1002%2F14651858.CD007160.pub4). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6463792](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463792). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27991651](https://pubmed.ncbi.nlm.nih.gov/27991651).
131. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-131)**
Hofmann R, James SK, Jernberg T, Lindahl B, Erlinge D, Witt N, et al. (September 2017). ["Oxygen Therapy in Suspected Acute Myocardial Infarction"](https://doi.org/10.1056%2Fnejmoa1706222). *The New England Journal of Medicine*. **377** (13): 1240–1249\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1056/nejmoa1706222](https://doi.org/10.1056%2Fnejmoa1706222). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28844200](https://pubmed.ncbi.nlm.nih.gov/28844200).
132. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-132)**
Abuzaid A, Fabrizio C, Felpel K, Al Ashry HS, Ranjan P, Elbadawi A, et al. (June 2018). ["Oxygen Therapy in Patients with Acute Myocardial Infarction: A Systemic Review and Meta-Analysis"](https://doi.org/10.1016%2Fj.amjmed.2017.12.027). *The American Journal of Medicine*. **131** (6): 693–701\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.amjmed.2017.12.027](https://doi.org/10.1016%2Fj.amjmed.2017.12.027). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29355510](https://pubmed.ncbi.nlm.nih.gov/29355510).
133. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-133)**
Sepehrvand N, James SK, Stub D, Khoshnood A, Ezekowitz JA, Hofmann R (October 2018). "Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials". *Heart*. **104** (20): 1691–1698\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/heartjnl-2018-313089](https://doi.org/10.1136%2Fheartjnl-2018-313089). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29599378](https://pubmed.ncbi.nlm.nih.gov/29599378). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [4472549](https://api.semanticscholar.org/CorpusID:4472549).
134. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-134)**
Singh A, Hussain S, Antony B (2020). ["How Much Evidence Is Needed to Conclude against the Use of Oxygen Therapy in Acute Myocardial Infarction?"](https://abstracts.isth.org/abstract/how-much-evidence-is-needed-to-conclude-against-the-use-of-oxygen-therapy-in-acute-myocardial-infarction/). *Res Pract Thromb Haemost*. **4** (Suppl 1). Retrieved 28 July 2020.
\[*[permanent dead link](https://en.wikipedia.org/wiki/Wikipedia:Link_rot "Wikipedia:Link rot")*\]
135. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Wang2011_135-0)**
Ardehali R, Perez M, Wang P (2011). [*A practical approach to cardiovascular medicine*](https://books.google.com/books?id=LZsoHMN8lM4C&pg=PA57). Chichester, West Sussex, UK: Wiley-Blackwell. p. 57. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-4443-9387-3](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4443-9387-3 "Special:BookSources/978-1-4443-9387-3")
.
136. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-136)**
Jindal SK, ed. (2011). [*Textbook of pulmonary and critical care medicine*](https://books.google.com/books?id=rAT1bdnDakAC&pg=PA1758). New Delhi: Jaypee Brothers Medical Publishers. p. 1758. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-93-5025-073-0](https://en.wikipedia.org/wiki/Special:BookSources/978-93-5025-073-0 "Special:BookSources/978-93-5025-073-0")
.
137. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-137)**
Dahal K, Hendrani A, Sharma SP, Singireddy S, Mina G, Reddy P, et al. (July 2018). ["Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145720). *JAMA Internal Medicine*. **178** (7): 913–920\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jamainternmed.2018.0850](https://doi.org/10.1001%2Fjamainternmed.2018.0850). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6145720](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145720). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29799995](https://pubmed.ncbi.nlm.nih.gov/29799995).
138. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-138)**
Rahim L, Allana S, Steinke EE, Ali F, Khan AH (November 2017). "Level of knowledge among cardiac nurses regarding sexual counseling of post-MI patients in three tertiary care hospitals in Pakistan". *Heart & Lung*. **46** (6): 412–416\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.hrtlng.2017.09.002](https://doi.org/10.1016%2Fj.hrtlng.2017.09.002). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28988654](https://pubmed.ncbi.nlm.nih.gov/28988654). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [4277993](https://api.semanticscholar.org/CorpusID:4277993).
139. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-pmid20168196_139-0)**
Jaarsma T, Steinke EE, Gianotten WL (2010). "Sexual problems in cardiac patients: how to assess, when to refer". *The Journal of Cardiovascular Nursing*. **25** (2): 159–64\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/JCN.0b013e3181c60e7c](https://doi.org/10.1097%2FJCN.0b013e3181c60e7c). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20168196](https://pubmed.ncbi.nlm.nih.gov/20168196). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [25806176](https://api.semanticscholar.org/CorpusID:25806176).
140. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-140)**
Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS (November 2021). ["Exercise-based cardiac rehabilitation for coronary heart disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8571912). *The Cochrane Database of Systematic Reviews*. **2021** (11) CD001800. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/14651858.CD001800.pub4](https://doi.org/10.1002%2F14651858.CD001800.pub4). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [8571912](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8571912). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [34741536](https://pubmed.ncbi.nlm.nih.gov/34741536).
141. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-:0_141-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-:0_141-1)
Papneja K, Chan AK, Mondal TK, Paes B (March 2017). "Myocardial Infarction in Neonates: A Review of an Entity with Significant Morbidity and Mortality". *Pediatric Cardiology*. **38** (3): 427–441\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00246-016-1556-7](https://doi.org/10.1007%2Fs00246-016-1556-7). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28238152](https://pubmed.ncbi.nlm.nih.gov/28238152). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [20779415](https://api.semanticscholar.org/CorpusID:20779415).
142. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-PEPA_142-0)**
López de Sá E, López-Sendón J, Anguera I, Bethencourt A, Bosch X (November 2002). ["Prognostic value of clinical variables at presentation in patients with non-ST-segment elevation acute coronary syndromes: results of the Proyecto de Estudio del Pronóstico de la Angina (PEPA)"](https://doi.org/10.1097%2F00005792-200211000-00004). *Medicine*. **81** (6): 434–42\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/00005792-200211000-00004](https://doi.org/10.1097%2F00005792-200211000-00004). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[20\.500.13003/14561](https://hdl.handle.net/20.500.13003%2F14561). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12441900](https://pubmed.ncbi.nlm.nih.gov/12441900). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [10268606](https://api.semanticscholar.org/CorpusID:10268606).
143. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-GRACE_143-0)**
Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. (November 2006). ["Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE)"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661748). *BMJ*. **333** (7578): 1091. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/bmj.38985.646481.55](https://doi.org/10.1136%2Fbmj.38985.646481.55). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1661748](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661748). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17032691](https://pubmed.ncbi.nlm.nih.gov/17032691).
144. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-Weir-2006_144-0)**
Weir RA, McMurray JJ, Velazquez EJ (May 2006). "Epidemiology of heart failure and left ventricular systolic dysfunction after acute myocardial infarction: prevalence, clinical characteristics, and prognostic importance". *The American Journal of Cardiology*. **97** (10A): 13F–25F. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.amjcard.2006.03.005](https://doi.org/10.1016%2Fj.amjcard.2006.03.005). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16698331](https://pubmed.ncbi.nlm.nih.gov/16698331).
145. ^ [***a***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WHO-2004_145-0) [***b***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WHO-2004_145-1) [***c***](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-WHO-2004_145-2)
World Health Organization (2008). *The Global Burden of Disease: 2004 Update*. Geneva: World Health Organization. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-92-4-156371-0](https://en.wikipedia.org/wiki/Special:BookSources/978-92-4-156371-0 "Special:BookSources/978-92-4-156371-0")
.
146. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-146)**
Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. (American Heart Association Statistics Committee and Stroke Statistics Subcommittee) (January 2012). ["Executive summary: heart disease and stroke statistics--2012 update: a report from the American Heart Association"](https://doi.org/10.1161%2FCIR.0b013e3182456d46). *Circulation*. **125** (1): 188–97\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/CIR.0b013e3182456d46](https://doi.org/10.1161%2FCIR.0b013e3182456d46). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22215894](https://pubmed.ncbi.nlm.nih.gov/22215894).
147. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-147)**
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. (January 2015). ["Heart disease and stroke statistics--2015 update: a report from the American Heart Association"](https://doi.org/10.1161%2Fcir.0000000000000152). *Circulation*. **131** (4): e29–322. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/cir.0000000000000152](https://doi.org/10.1161%2Fcir.0000000000000152). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25520374](https://pubmed.ncbi.nlm.nih.gov/25520374). "From 2001 to 2011, death rates attributable to CVD declined 30.8%."
148. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-148)**
Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S (January 2008). "Epidemiology and causation of coronary heart disease and stroke in India". *Heart*. **94** (1): 16–26\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/hrt.2007.132951](https://doi.org/10.1136%2Fhrt.2007.132951). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18083949](https://pubmed.ncbi.nlm.nih.gov/18083949). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [27117207](https://api.semanticscholar.org/CorpusID:27117207).
149. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-149)**
Coady SA, Johnson NJ, Hakes JK, Sorlie PD (July 2014). ["Individual education, area income, and mortality and recurrence of myocardial infarction in a Medicare cohort: the National Longitudinal Mortality Study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227052). *BMC Public Health*. **14** (1) 705. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1186/1471-2458-14-705](https://doi.org/10.1186%2F1471-2458-14-705). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4227052](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227052). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25011538](https://pubmed.ncbi.nlm.nih.gov/25011538).
150. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-150)**
Salomaa V, Miettinen H, Niemelä M, Ketonen M, Mähönen M, Immonen-Räihä P, et al. (July 2001). ["Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events; the FINMONICA MI Register Study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731938). *Journal of Epidemiology and Community Health*. **55** (7): 475–82\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/jech.55.7.475](https://doi.org/10.1136%2Fjech.55.7.475). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1731938](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731938). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [11413176](https://pubmed.ncbi.nlm.nih.gov/11413176).
151. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-151)**
Bucholz EM, Ma S, Normand SL, Krumholz HM (October 2015). ["Race, Socioeconomic Status, and Life Expectancy After Acute Myocardial Infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097251). *Circulation*. **132** (14): 1338–46\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/circulationaha.115.017009](https://doi.org/10.1161%2Fcirculationaha.115.017009). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5097251](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097251). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26369354](https://pubmed.ncbi.nlm.nih.gov/26369354).
152. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-152)**
Kilpi F, Silventoinen K, Konttinen H, Martikainen P (April 2016). ["Disentangling the relative importance of different socioeconomic resources for myocardial infarction incidence and survival: a longitudinal study of over 300,000 Finnish adults"](https://doi.org/10.1093%2Feurpub%2Fckv202). *European Journal of Public Health*. **26** (2): 260–6\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurpub/ckv202](https://doi.org/10.1093%2Feurpub%2Fckv202). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26585783](https://pubmed.ncbi.nlm.nih.gov/26585783).
153. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-153)**
Rosvall M, Gerward S, Engström G, Hedblad B (October 2008). ["Income and short-term case fatality after myocardial infarction in the whole middle-aged population of Malmö, Sweden"](https://doi.org/10.1093%2Feurpub%2Fckn059). *European Journal of Public Health*. **18** (5): 533–8\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1093/eurpub/ckn059](https://doi.org/10.1093%2Feurpub%2Fckn059). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18621776](https://pubmed.ncbi.nlm.nih.gov/18621776).
154. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-154)**
Graham G (2015-05-14). ["Disparities in cardiovascular disease risk in the United States"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558355). *Current Cardiology Reviews*. **11** (3): 238–45\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2174/1573403X11666141122220003](https://doi.org/10.2174%2F1573403X11666141122220003). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4558355](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558355). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25418513](https://pubmed.ncbi.nlm.nih.gov/25418513).
155. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-155)**
Joshi P (2007-01-17). ["Risk Factors for Early Myocardial Infarction in South Asians Compared With Individuals in Other Countries"](https://jamanetwork.com/journals/jama/article-abstract/205159). *JAMA*. **297** (3): 286–294\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.297.3.286](https://doi.org/10.1001%2Fjama.297.3.286). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17227980](https://pubmed.ncbi.nlm.nih.gov/17227980). Retrieved 2023-11-16.
156. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-156)**
Hamad R, Penko J, Kazi DS, Coxson P, Guzman D, Wei PC, et al. (May 2020). ["Association of Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254448). *JAMA Cardiology*. **5** (8): 899–908\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jamacardio.2020.1458](https://doi.org/10.1001%2Fjamacardio.2020.1458). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7254448](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254448). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32459344](https://pubmed.ncbi.nlm.nih.gov/32459344).
157. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-157)**
["Health Coverage of Immigrants"](https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-of-immigrants/). *KFF*. 2020-03-18. Retrieved 2021-04-09.
158. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-158)**
Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, et al. (April 2010). ["Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020978). *JAMA*. **303** (14): 1392–400\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.2010.409](https://doi.org/10.1001%2Fjama.2010.409). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [3020978](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020978). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20388895](https://pubmed.ncbi.nlm.nih.gov/20388895).
159. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-159)**
Kelli HM, Mehta A, Tahhan AS, Liu C, Kim JH, Dong TA, et al. (September 2019). ["Low Educational Attainment is a Predictor of Adverse Outcomes in Patients With Coronary Artery Disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755831). *Journal of the American Heart Association*. **8** (17) e013165. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1161/JAHA.119.013165](https://doi.org/10.1161%2FJAHA.119.013165). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6755831](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755831). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31476920](https://pubmed.ncbi.nlm.nih.gov/31476920).
160. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-160)**
Perry K, Petrie KJ, Ellis CJ, Horne R, Moss-Morris R (July 2001). ["Symptom expectations and delay in acute myocardial infarction patients"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1729795). *Heart*. **86** (1): 91–3\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1136/heart.86.1.91](https://doi.org/10.1136%2Fheart.86.1.91). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1729795](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1729795). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [11410572](https://pubmed.ncbi.nlm.nih.gov/11410572).
161. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-prairieview_161-0)** [Workers' Compensation FAQ](http://www.pvamu.edu/pages/2026.asp) [Archived](https://web.archive.org/web/20070711235600/http://www.pvamu.edu/pages/2026.asp) 2007-07-11 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine"). [Prairie View A\&M University](https://en.wikipedia.org/wiki/Prairie_View_A%26M_University "Prairie View A&M University"). Retrieved November 22, 2006.
162. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-biia_162-0)** [SIGNIFICANT DECISIONS Subject Index](http://www.biia.wa.gov/significantdecisions/contents.htm) [Archived](https://web.archive.org/web/20061206115257/http://www.biia.wa.gov/SignificantDecisions/contents.htm) 2006-12-06 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine"). Board of Industrial Insurance Appeals. Retrieved November 22, 2006.
163. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-163)**
["34 U.S. Code § 10281 - Payment of death benefits"](https://www.law.cornell.edu/uscode/text/34/10281). *Legal Information Institute (Cornell Law School)*. Retrieved 2025-07-27.
164. **[^](https://en.wikipedia.org/wiki/Myocardial_infarction#cite_ref-NovaScotia-DrivingRegulations_164-0)**
["Classification of Drivers' Licenses Regulations"](http://www.gov.ns.ca/just/regulations/regs/mvclasdl.htm). Nova Scotia Registry of Regulations. May 24, 2000. [Archived](https://web.archive.org/web/20070420191108/http://www.gov.ns.ca/just/regulations/regs/mvclasdl.htm) from the original on April 20, 2007. Retrieved April 22, 2007.
Sources
- Allison TG, Murphy JG (6 December 2012). "Stress Test Selection". In Murphy JG, Lloyd MA, Brady PA, Olsen LJ, Shields RC (eds.). [*Mayo Clinic Cardiology: Concise Textbook*](https://books.google.com/books?id=WSCRAAAAQBAJ). OUP US. pp. 196–202\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-19-991571-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-19-991571-2 "Special:BookSources/978-0-19-991571-2")
.
- Blumenthal RS, Margolis S (2007). [*Heart Attack Prevention 2007*](https://books.google.com/books?id=mM3l59uTj04C&pg=PA10). Johns Hopkins Health. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-933087-47-4](https://en.wikipedia.org/wiki/Special:BookSources/978-1-933087-47-4 "Special:BookSources/978-1-933087-47-4")
.
- Dwight J (16 June 2016). "Chest pain, breathlessness, fatigue". In Warrell D, Cox T, Firth J, Dwight J (eds.). [*Oxford Textbook of Medicine: Cardiovascular Disorders*](https://books.google.com/books?id=YqJHDAAAQBAJ). Oxford University Press. pp. 39–47\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-19-871702-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-19-871702-7 "Special:BookSources/978-0-19-871702-7")
.
- Gaziano TA, Gaziano JM (15 September 2016). "Global Evolving Epidemiology, Natural History, and Treatment Trends of Myocardial Infarction". In Morrow DA (ed.). [*Myocardial Infarction: A Companion to Braunwald's Heart Disease*](https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 11–21\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-323-35943-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-35943-6 "Special:BookSources/978-0-323-35943-6")
.
- Morrow DA, Bohula EA (15 September 2016). "Heart Failure and Cardiogenic Shock After Myocardial Infarction". In Morrow DA (ed.). [*Myocardial Infarction: A Companion to Braunwald's Heart Disease*](https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 295–313\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-323-35943-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-35943-6 "Special:BookSources/978-0-323-35943-6")
.
- Morrow DA, Braunwald E (15 September 2016). "Classification and Diagnosis of Acute Coronary Syndromes". In Morrow DA (ed.). [*Myocardial Infarction: A Companion to Braunwald's Heart Disease*](https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 1–10\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-323-35943-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-35943-6 "Special:BookSources/978-0-323-35943-6")
.
- Morrow DA (15 September 2016). "Clinical Approach to Suspected Acute Myocardial Infarction". In Morrow DA (ed.). [*Myocardial Infarction: A Companion to Braunwald's Heart Disease*](https://books.google.com/books?id=0TzrjwEACAAJ). Elsevier. pp. 55–65\. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-323-35943-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-323-35943-6 "Special:BookSources/978-0-323-35943-6")
.
Further reading
- Min Cho S, et al. (2021). "Machine learning compared with conventional statistical models for predicting myocardial infarction readmission and mortality: a systematic review". *Canadian Journal of Cardiology*. **37** (8). Elsevier: 1207–1214\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.cjca.2021.02.020](https://doi.org/10.1016%2Fj.cjca.2021.02.020). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33677098](https://pubmed.ncbi.nlm.nih.gov/33677098). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [232141652](https://api.semanticscholar.org/CorpusID:232141652).
External links
- [American Heart Association's Heart Attack web site](http://www.americanheart.org/heartattack) — Information and resources for preventing, recognizing, and treating a heart attack.
- TIMI Score for [UA/NSTEMI](http://www.mdcalc.com/timi-risk-score-for-uanstemi/) [Archived](https://web.archive.org/web/20161105220551/http://www.mdcalc.com/timi-risk-score-for-uanstemi/) 2016-11-05 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine") and [STEMI](http://www.mdcalc.com/timi-risk-score-for-stemi/) [Archived](https://web.archive.org/web/20090319073410/http://www.mdcalc.com/timi-risk-score-for-stemi) 2009-03-19 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine")
- [HEART Score for Major Cardiac Events](http://www.mdcalc.com/heart-score-for-major-cardiac-events/) [Archived](https://web.archive.org/web/20161028004807/http://www.mdcalc.com/heart-score-for-major-cardiac-events/) 2016-10-28 at the [Wayback Machine](https://en.wikipedia.org/wiki/Wayback_Machine "Wayback Machine")
- ["Heart Attack"](https://medlineplus.gov/heartattack.html). *MedlinePlus*. U.S. National Library of Medicine. |
| Shard | 152 (laksa) |
| Root Hash | 17790707453426894952 |
| Unparsed URL | org,wikipedia!en,/wiki/Myocardial_infarction s443 |