Myocardial Ischemia in Intensive Care

Aka: Myocardial Ischemia in Intensive Care, Myocardial Infarction in Critical Illness, Troponin Increase in ICU Patients, Acute Coronary Syndrome in Critical Care

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II. Epidemiology

  1. Serum Troponin Increase is common (40% of patients) in ICU patients admitted for non-cardiac causes

III. Precautions

  1. Avoid ordering Troponin In the absence of signs or symptoms of cardiac event

IV. Imaging

  1. Echocardiogram
    1. May be best non-invasive bedside tool for differentiating cause of Troponin Increase

V. Evaluation: Distinguish Type I MI (Plaque rupture) from Type II MI (demand ischemia)

  1. Type 1 Myocardial Infarction (Plaque rupture with acute coronary Occlusion)
    1. Echocardiogram with wall motion abnormalities
    2. Uncommon in the ICU if admitted for other cause
    3. Treat with Aspirin and Platelet ADP Receptor Antagonist (e.g. Plavix)
    4. Consider cardiac catheterization if possible given patient status
      1. Heparin is indicated if cardiac catheterization is planned (avoid otherwise)
  2. Type 2 Myocardial Infarction (demand ischemia with fixed lesion)
    1. Echocardiogram with hyperdynamic heart activity
    2. Manage reversible causes of ischemia (Hypoxia, Anemia, shock)
    3. Give Aspirin

VI. Resources

  1. Internet Book of Critical Care (EMCRIT.org)
    1. https://emcrit.org/ibcc/guide/

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