Myocardial Infarction

Myocardial dysfunction
Systolic Diastolic

Decrease Tissue Decrease CO Increase LVEDP

perfusion Pulmonary congestion
Decrease SV
Pul
Hypotension Hypoxemia

Impaired O2 & Increase

Decrease coronary Ischemia Tissue hypoxia glucose delivery cellular
perfusion
demand

Compensatory Progression of myocardial

dysfunction Impaired cellular
vasoconstriction
Stasis/coagulopathy/ metabolism
complement
Monocytes/Macrophage
activation
Cytokines
>TNF-, IL-1, IL-6, IL-12, IL-18, PGE2, Death
TGF->Chemokines
>IL-8 Reoxygenation/cell injury
Activators
>Platelet activating factor (PAF)
>Neutrophil activating factor (NAF) Activation of innate immunity
>Monocytechemoattractant protein (MCP-
1)
Biomarkers/Modifiers
Antigen presentation
HLA-DR
C-reactive protein (CRP)
Procalcitonin (PCT)
Coagulation/ Complement Lymphocytes Lipopolysaccharide binding
Neutrophils TH1TH2 protein (LBP)
C3a High mobility group band-1
Adherence IL-2, IL-2R, IFN-,
C5a TNFb (HMGB-1)
>B2 integrins Thrombin Brain natriuretic peptide (BNP)
IL-4, IL-10, IL-5, IL-13
Oxidative burst D-Dimers
Neopterin (NPT)
IL-1 receptor antagonist
>Reactive oxygenspecies (ROS) Antithrombin III (IL-1ra)
Degranulation >(AT III) TNF receptors I/II (TNFR I/II)
>Elastase Activated protein
>PhospholipaseA2 (PLA2) >C (APC)
Bactericidal activity