IBCC Episode 126 - Myocardial Ischemia

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam discuss type 1 myocardial infarction, focusing on the management of myocardial infarction concerns in the ICU. They differentiate between type 1 and type 2 MI, introduce the terminology of occlusive myocardial infarction (OMI) versus non-occlusive myocardial infarction (NOMI), and discuss the importance of determining who needs a cath lab referral. They cover clinical history, EKGs, echocardiography, and troponin assays in diagnosing myocardial infarction, and address the differential diagnosis, including PE, dissection, pericarditis, and Takotsubo cardiomyopathy. The hosts also delve into risk stratification using the Killip classification, general supportive measures, the nuances of nitroglycerin and beta-blockers, ACE inhibitors, indications and contraindications for PCI, and anticoagulation strategies, including the use of fondaparinux. Finally, they discuss the management of right ventricular MI, including hemodynamic optimization and treatment of hypoxemia, emphasizing the importance of tailored therapy and revascularization.