 Let's continue with myocardial infarctions. A myocardial infarction is most often due to an atherosclerotic plaque that ruptures within the artery. This plaque rupture allows a thrombus to form downstream of where that plaque was built up into the coronary arteries. Symptoms associated with myocardial infarction include diaphoresis, nausea and vomiting, severe retrosternal pain behind the chest, pain in the left arthacic, and or pain in the jaw. There is also shortness of breath and fatigue seen in patients having a myocardial infarction. It's important to note that often times females have different presentations of myocardial infarctions that differ from our classic symptoms, so you must be aware patients that have risk factors associated with myocardial infarction could present differently than our classic presentations that we see here. The most common location for a myocardial infarction is the left anterior descending artery. The left anterior descending artery runs along the arterioventricular septum and is also known as the widowmaker. An occlusion of this artery causes major damage within the muscle and the septal tissues of the heart. The next most common location is the right coronary artery over here on the left side of this photo. The right coronary artery supplies the right atrium, portions of the right ventricle, and the inferior and posterior portions of the heart. Finally, the third most common location for a myocardial infarction is the circumflex artery. The circumflex artery is a branch off of the left coronary artery and supplies portions of the left ventricle and the posterior side of the heart. It is important to note that patients experiencing any of these symptoms associated with a myocardial infarction should immediately chew an aspirin to help reduce the risk of further damage or furthering of the clot size in the coronary artery. We do chew this aspirin and not swallow it as chewing it allows it to be absorbed almost twice as fast as swallowing it whole. When a patient presents to the emergency department complaining of chest pain and symptoms that could be associated with a myocardial infarction, one of the common labs that are ordered includes a cardiac profile. The cardiac profile is a CKMB, or creating kinase-MB. These are typically found within the myocardium of the heart, but it is also found elsewhere in the body. And the other lab is a troponin 1. The CKMB level is mostly only relevant in reinfarction cases. As you see here, CKMB, which is the blue line, rises and falls fairly quickly after infarction, whereas the troponin levels increase greatly within that first day. They peak at 24 hours, and then it takes about 7 to 10 days for them to come back to a normal level. So a potential reinfarction on day 4 would show a positive troponin 1 level as it is still elevated from the original infarction. Checking the CKMB at that day will tell us whether or not there was a true reinfarction or if this is still residuals from the previous infarction. Along with checking blood labs, we will do a diagnostic test of an EKG or an ECG. The ECG is the gold standard test for a myocardial infarction. There are many different changes that you can see in an EKG that is indicative of a myocardial infarction, and we will discuss some of those here. On this particular EKG reading, we see in leads 2, 3, and AVF, an ST segment elevation. This indicates an inferior wall, am I?