A 66-year-old man arrives at the hospital after hours of severe chest pain. What follows allows us to trace the physiology of a myocardial infarction step by step.

We examine atherosclerosis, coronary artery obstruction, electrocardiographic changes, myocardial injury, cardiogenic shock, and mechanical complications. This clinical case illustrates why time can profoundly influence the outcome of a heart attack.

Sources and further reading:

1. Ribeiro WN, Yamada AT, Benvenuti LA. Case 4/2014: a 66-year-old man with acute myocardial infarction and death in asystole after primary coronary angioplasty. Arq Bras Cardiol. 2014;103(3):e31-e36. doi:10.5935/abc.20140129.
2. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231-2264. doi:10.1016/j.jacc.2018.08.1038.

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