Choose the format for the illustrated pages.

labeled diagram myocardial infarction coronary artery occlusion ischemic necrosis ECG STEMI

"myocardial infarction"[MeSH Terms] AND management

2025 ACC AHA acute coronary syndrome guideline myocardial infarction summary

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https://www.acc.org/latest-in-cardiology/journal-scans/2025/…

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mkdir -p "/tmp/workspace/myocardial-infarction-pdf/src" "/tmp/workspace/myocardial-infarction-pdf/output" && cat > "/tmp/workspace/myocardial-infarction-pdf/src/create_mi_pdf.py" <<'PY' from reportlab.lib.pagesizes import A4 from reportlab.pdfgen import canvas from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.pdfbase.pdfmetrics import stringWidth from reportlab.lib.utils import simpleSplit from math import sin, pi OUT='/tmp/workspace/myocardial-infarction-pdf/output/Myocardial_Infarction_Labeled_Diagrams.pdf' W,H=A4 M=42 navy=colors.HexColor('#102A43'); blue=colors.HexColor('#247BA0'); red=colors.HexColor('#C83E4D'); orange=colors.HexColor('#F4A261'); pale=colors.HexColor('#F5F8FA'); gray=colors.HexColor('#52616B'); dark=colors.HexColor('#243B53'); green=colors.HexColor('#2A9D8F') c=canvas.Canvas(OUT,pagesize=A4) c.setTitle('Myocardial Infarction: Illustrated Learning Pages') c.setAuthor('Orris') def header(title, subtitle=''): c.setFillColor(navy); c.rect(0,H-74,W,74,fill=1,stroke=0) c.setFillColor(colors.white); c.setFont('Helvetica-Bold',20); c.drawString(M,H-42,title) if subtitle: c.setFont('Helvetica',9.2); c.drawString(M,H-59,subtitle) def footer(n): c.setStrokeColor(colors.HexColor('#D9E2EC')); c.line(M,31,W-M,31) c.setFont('Helvetica',8); c.setFillColor(gray); c.drawString(M,18,'Educational overview - not a substitute for emergency or individual medical care') c.drawRightString(W-M,18,f'{n} / 7') def text(x,y,s,size=10,leading=14,color=dark,bold=False,width=None): c.setFillColor(color); c.setFont('Helvetica-Bold' if bold else 'Helvetica',size) lines=simpleSplit(s,'Helvetica-Bold' if bold else 'Helvetica',size,width) if width else s.split('\n') for line in lines: c.drawString(x,y,line); y-=leading return y def bullet(x,y,s,width=230, color=dark): c.setFillColor(red); c.circle(x+3,y+3,2,fill=1,stroke=0) return text(x+12,y,s,9.2,12,color,width=width) def label(x,y,s,tx,ty): c.setStrokeColor(gray); c.setLineWidth(.7); c.line(x,y,tx,ty) c.setFillColor(colors.white); c.roundRect(x-3,y-10,stringWidth(s,'Helvetica-Bold',8)+8,15,3,fill=1,stroke=0) c.setFillColor(navy); c.setFont('Helvetica-Bold',8); c.drawString(x+1,y-5,s) def heart(cx,cy,scale=1, infarct=True): # stylized anterior heart p=c.beginPath(); p.moveTo(cx,cy+60*scale); p.curveTo(cx-50*scale,cy+112*scale,cx-95*scale,cy+55*scale,cx-58*scale,cy-8*scale); p.curveTo(cx-25*scale,cy-62*scale,cx+18*scale,cy-84*scale,cx+48*scale,cy-22*scale); p.curveTo(cx+85*scale,cy+48*scale,cx+42*scale,cy+110*scale,cx,cy+60*scale); c.setFillColor(colors.HexColor('#E87878')); c.setStrokeColor(navy); c.setLineWidth(1.4); c.drawPath(p,fill=1,stroke=1) # coronary LAD and branches c.setStrokeColor(colors.HexColor('#F8E9E9')); c.setLineWidth(5*scale); c.line(cx-4*scale,cy+65*scale,cx+13*scale,cy-40*scale); c.line(cx+6*scale,cy+30*scale,cx-38*scale,cy+12*scale); c.line(cx+8*scale,cy+5*scale,cx+39*scale,cy-6*scale) c.setStrokeColor(colors.HexColor('#B71C2A')); c.setLineWidth(2.1*scale); c.line(cx-4*scale,cy+65*scale,cx+13*scale,cy-40*scale); c.line(cx+6*scale,cy+30*scale,cx-38*scale,cy+12*scale); c.line(cx+8*scale,cy+5*scale,cx+39*scale,cy-6*scale) if infarct: c.setFillColor(colors.HexColor('#8E1B2A')); c.setStrokeColor(colors.HexColor('#64121E')); c.ellipse(cx-12*scale,cy-16*scale,cx+45*scale,cy+38*scale,fill=1,stroke=1) def artery(x,y,w=300,h=76, blocked=True): # vessel cross-section longitudinal c.setFillColor(colors.HexColor('#FADBD8')); c.roundRect(x,y,w,h,h/2,fill=1,stroke=0) c.setFillColor(colors.HexColor('#FFF7F2')); c.roundRect(x+8,y+12,w-16,h-24,(h-24)/2,fill=1,stroke=0) # plaque c.setFillColor(orange); c.circle(x+w*.48,y+h*.5,h*.32,fill=1,stroke=0) c.setFillColor(colors.HexColor('#F6C26B')); c.circle(x+w*.48,y+h*.5,h*.18,fill=1,stroke=0) if blocked: c.setFillColor(colors.HexColor('#A6172A')); c.circle(x+w*.57,y+h*.5,h*.27,fill=1,stroke=0) c.setFillColor(colors.HexColor('#DC5262')); c.circle(x+w*.63,y+h*.58,h*.12,fill=1,stroke=0) def ecg(x,y,w=430,h=95): c.setStrokeColor(colors.HexColor('#CBD5E0')); c.setLineWidth(.4) for a in range(0,int(w)+1,10): c.line(x+a,y,x+a,y+h) for a in range(0,int(h)+1,10): c.line(x,y+a,x+w,y+a) # normal then STEMI pts=[] base=y+30 for i in range(0,190,4): xx=x+i; v=0 if 36<i<55: v=5*sin((i-36)/19*pi) if 75<i<83: v=-10*(i-75)/8 if 83<=i<89: v=48*(i-83)/6 if 89<=i<99: v=48-53*(i-89)/10 if 99<=i<115: v=5*sin((i-99)/16*pi) pts.append((xx,base+v)) pts += [(x+190,base),(x+215,base),(x+225,base-10),(x+232,base+48),(x+240,base+25),(x+260,base+22),(x+290,base+22),(x+315,base+15),(x+345,base+8),(x+390,base)] c.setStrokeColor(red); c.setLineWidth(2); p=c.beginPath(); p.moveTo(*pts[0]); [p.lineTo(*q) for q in pts[1:]]; c.drawPath(p) c.setFillColor(gray); c.setFont('Helvetica',8); c.drawString(x,y+h+5,'Illustrative ECG morphology only - diagnosis requires clinical ECG interpretation') # 1 header('Myocardial Infarction','Illustrated learning pages: mechanism, recognition, diagnosis, treatment and complications') text(M,H-105,'What is a myocardial infarction (MI)?',15,18,navy,True) text(M,H-130,'MI is myocardial cell death caused by prolonged acute ischemia, most often after an atherosclerotic coronary plaque ruptures or erodes and a thrombus abruptly limits coronary blood flow.',10.5,14,dark,width=300) heart(405,525,1.42,True) label(286,646,'Coronary arteries',401,611); label(455,470,'Infarcted myocardium',427,535); label(275,440,'LV apex',374,447) text(M,385,'Two major acute MI patterns',14,17,navy,True) bullet(M,358,'ST-elevation MI (STEMI): usually acute, persistent coronary occlusion. Immediate reperfusion is time-critical.',235) bullet(M,315,'Non-ST-elevation MI (NSTEMI): myocardial injury with ischemia but without persistent ST elevation; management is risk-stratified.',235) c.setFillColor(colors.HexColor('#FFF3F3')); c.roundRect(M,210,W-2*M,70,8,fill=1,stroke=0) text(M+14,256,'Emergency warning',11,14,red,True); text(M+14,238,'New or persistent chest pressure, breathlessness, sweating, nausea, collapse, or pain spreading to arm, jaw, back or upper abdomen: activate emergency services. Do not drive yourself.',9.5,12,dark,width=W-2*M-28) footer(1); c.showPage() #2 header('1. How an MI develops','Plaque disruption -> thrombosis -> ischemia -> irreversible necrosis') artery(80,565,430,75,True) label(84,664,'Artery wall',108,631); label(248,525,'Atherosclerotic plaque',287,589); label(396,520,'Superimposed thrombus',329,602); label(445,663,'Reduced/blocked lumen',416,602) # flow for xx in [95,135,175]: c.setStrokeColor(blue); c.setLineWidth(1.5); c.line(xx,602,xx+25,602); c.line(xx+25,602,xx+18,607); c.line(xx+25,602,xx+18,597) text(M,470,'Pathophysiologic sequence',14,17,navy,True) steps=[('1','Vulnerable plaque','A lipid-rich plaque with a thin fibrous cap may rupture or erode.'),('2','Platelet activation','Thrombogenic material is exposed, initiating platelet adhesion and aggregation.'),('3','Thrombus formation','A clot narrows or completely occludes the coronary artery.'),('4','Ischemia and necrosis','Oxygen deprivation causes loss of contractility, then irreversible cardiomyocyte death if prolonged.')] y=430 for n,t,d in steps: c.setFillColor(red); c.circle(M+12,y+3,12,fill=1,stroke=0); c.setFillColor(colors.white); c.setFont('Helvetica-Bold',10); c.drawCentredString(M+12,y, n) text(M+34,y+4,t,10.5,12,navy,True); text(M+34,y-11,d,9.2,12,dark,width=450); y-=70 text(M,118,'Important: an MI can arise from a lesion that was not previously severely narrowing the artery. Complete occlusion commonly produces a larger transmural infarct; partial or transient occlusion may produce subendocardial injury.',9.2,12,gray,width=W-2*M) footer(2); c.showPage() #3 header('2. Recognition and diagnosis','MI is diagnosed by a rise/fall in cardiac troponin plus evidence of acute myocardial ischemia') text(M,H-106,'Common presentations',14,17,navy,True) left=['Central pressure, heaviness or tightness','Pain radiating to arm, jaw, neck, back or epigastrium','Breathlessness, sweating, nausea or vomiting','Palpitations, syncope, sudden weakness'] y=H-135 for z in left:y=bullet(M,y,z,245);y-=10 text(320,H-106,'Atypical or silent presentations',14,17,navy,True) text(320,H-135,'Older adults, women, and people with diabetes may present predominantly with dyspnea, fatigue, indigestion-like discomfort, confusion, or no pain.',9.3,12,dark,width=220) text(M,365,'Diagnostic triad',14,17,navy,True) for x,t,d in [(M,'Clinical context','Symptoms and examination suggest acute ischemia.'),(M+170,'ECG','Serial 12-lead ECGs identify STEMI and ischemic changes.'),(M+340,'Troponin','High-sensitivity cardiac troponin rise/fall detects myocardial injury.')]: c.setFillColor(pale); c.roundRect(x,245,145,92,8,fill=1,stroke=0); text(x+10,315,t,11,13,navy,True,width=125); text(x+10,295,d,8.5,11,dark,width=125) text(M,212,'ECG concept: STEMI often shows ST-segment elevation in contiguous leads. NSTEMI may show ST depression, T-wave inversion, or a non-diagnostic ECG. A normal initial ECG does not exclude MI.',9.2,12,dark,width=W-2*M) ecg(70,92,450,85); label(352,84,'ST elevation',328,143) footer(3); c.showPage() #4 header('3. Immediate management','Acute coronary syndrome is a medical emergency: treatment is individualized by trained clinicians') text(M,H-108,'First priorities',14,17,navy,True) items=[('Rapid assessment','Vital signs, focused history, ECG within minutes, serial troponins, IV access and continuous monitoring.'),('Antithrombotic therapy','Aspirin plus a P2Y12 inhibitor and anticoagulation are used when appropriate, balancing ischemic and bleeding risk.'),('Reperfusion for STEMI','Primary percutaneous coronary intervention (PCI) is preferred when it can be delivered promptly. Fibrinolysis is considered in selected patients when PCI is not timely available and no contraindication exists.'),('Treat instability','Manage hypoxemia, pulmonary edema, arrhythmias, shock and mechanical complications. Oxygen is for hypoxemia, not routine use in all patients.')] y=H-145 for t,d in items: c.setFillColor(blue); c.roundRect(M,y-4,126,22,4,fill=1,stroke=0); text(M+7,y+2,t,9,11,colors.white,True,width=115); text(M+140,y+2,d,9.2,12,dark,width=370); y-=72 text(M,294,'Primary PCI: restoring coronary flow',14,17,navy,True) # PCI diagram c.setStrokeColor(navy);c.setLineWidth(7);c.line(110,220,460,220);c.setStrokeColor(colors.HexColor('#FADBD8'));c.setLineWidth(13);c.line(110,220,460,220);c.setStrokeColor(colors.white);c.setLineWidth(7);c.line(110,220,460,220) c.setFillColor(red);c.circle(295,220,20,fill=1,stroke=0);c.setStrokeColor(colors.HexColor('#7A0C1D'));c.setLineWidth(1);c.circle(295,220,20,fill=0,stroke=1) c.setStrokeColor(gray);c.setLineWidth(2);c.line(130,220,285,220); c.setStrokeColor(blue);c.setLineWidth(3);c.line(130,220,360,220) c.setStrokeColor(green);c.setLineWidth(2);c.rect(290,205,42,30,fill=0,stroke=1) label(115,180,'Guidewire/catheter',185,220); label(280,265,'Clot at culprit lesion',295,240); label(378,180,'Balloon/stent opens artery',311,205) text(M,125,'Do not delay emergency evaluation to self-treat. Drug selection and doses depend on diagnosis, blood pressure, bleeding risk, kidney function, prior medicines, and planned reperfusion.',9.2,12,red,True,width=W-2*M) footer(4); c.showPage() #5 header('4. Complications by timing','Continuous monitoring matters because complications can occur early or days later') # timeline c.setStrokeColor(navy);c.setLineWidth(2);c.line(90,560,510,560) for x,lab in [(105,'Minutes-hours'),(245,'Hours-days'),(390,'Days-weeks')]: c.setFillColor(navy);c.circle(x,560,6,fill=1,stroke=0);text(x-28,535,lab,9,11,navy,True) cols=[(M,465,'Electrical','Ventricular tachycardia/fibrillation\nBradyarrhythmias / AV block\nAtrial fibrillation'),(M+180,465,'Pump failure','LV failure and pulmonary edema\nCardiogenic shock\nRight ventricular infarction'),(M+360,465,'Mechanical / inflammatory','Papillary muscle rupture -> acute MR\nVentricular septal rupture\nFree-wall rupture -> tamponade\nPericarditis')] for x,y,t,d in cols: c.setFillColor(pale);c.roundRect(x,y,155,128,8,fill=1,stroke=0);text(x+10,y+105,t,11,13,red,True);text(x+10,y+85,d,8.5,12,dark,width=135) heart(262,255,1.05,True) # rupture / septal labels label(95,302,'Papillary muscle ischemia/rupture',224,278);label(378,315,'Free-wall rupture',307,304);label(374,210,'Ventricular septal rupture',270,230) text(M,113,'Other complications: mural thrombus with systemic embolism, ventricular aneurysm, recurrent ischemia/infarction, and post-MI pericarditis. New hypotension, new murmur, sudden pulmonary edema, or recurrent chest pain needs urgent reassessment.',9.3,12,dark,width=W-2*M) footer(5); c.showPage() #6 header('5. Recovery and secondary prevention','After MI, prevention focuses on recurrent-event risk reduction and recovery of function') text(M,H-110,'Before discharge and at follow-up',14,17,navy,True) steps=[('Medication plan','Antiplatelet therapy, high-intensity statin, and other evidence-based treatments are tailored to ventricular function, blood pressure, comorbidities and bleeding risk.'),('Risk-factor control','Stop tobacco, manage diabetes and blood pressure, improve diet, physical activity and sleep, and address psychosocial factors.'),('Cardiac rehabilitation','Structured supervised rehabilitation improves functional recovery and is recommended after ACS.'),('Follow-up','Review symptoms, adherence and adverse effects. Lipids and ventricular function may be reassessed according to clinical needs.')] y=H-152 for i,(a,b) in enumerate(steps): c.setFillColor(green);c.circle(M+13,y+5,14,fill=1,stroke=0);c.setFillColor(colors.white);c.setFont('Helvetica-Bold',10);c.drawCentredString(M+13,y+1,str(i+1)); text(M+38,y+6,a,11,13,navy,True);text(M+38,y-12,b,9.2,12,dark,width=440);y-=78 text(M,244,'Risk factors',14,17,navy,True) for x,t in [(M,'Modifiable','Smoking, hypertension, diabetes, dyslipidemia, obesity, inactivity, unhealthy diet'),(M+260,'Non-modifiable','Age, family history of premature coronary disease, and some genetic factors')]: c.setFillColor(colors.HexColor('#EDF6F5'));c.roundRect(x,145,240,75,8,fill=1,stroke=0);text(x+10,197,t,10.5,13,green,True);text(x+10,178,(' '.join(t and [])),8); text(x+10,176, 'Smoking, hypertension, diabetes, dyslipidemia, obesity, inactivity, unhealthy diet' if x==M else 'Age, family history of premature coronary disease, and some genetic factors',8.8,11,dark,width=220) text(M,105,'Seek emergency care for recurrent or persistent chest discomfort, worsening breathlessness, fainting, sustained palpitations, or sudden weakness.',10,13,red,True,width=W-2*M) footer(6); c.showPage() #7 header('Key takeaways and sources','For study use. Clinical decisions require local protocols and a qualified care team.') text(M,H-108,'Key takeaways',14,17,navy,True) y=H-137 for s in ['MI is acute myocardial necrosis caused by ischemia, usually from plaque disruption and coronary thrombosis.','STEMI and NSTEMI are both acute coronary syndromes; STEMI generally needs urgent reperfusion.','Diagnosis integrates symptoms, serial ECGs and cardiac troponin dynamics.','Early complications include malignant arrhythmias, heart failure/shock and mechanical rupture.','Secondary prevention includes antiplatelet and lipid-lowering therapy when indicated, cardiac rehabilitation and risk-factor control.']: y=bullet(M,y,s,490); y-=9 text(M,275,'References used to prepare this educational PDF',14,17,navy,True) refs=[ 'Robbins & Kumar Basic Pathology. Ischemic Heart Disease: Acute Plaque Change and Myocardial Infarction. Textbook library excerpts, sections around pp. 316-323.', 'Rao SV, O\'Donoghue M, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. J Am Coll Cardiol. 2025.', 'American College of Cardiology. ACC, AHA Issue New Acute Coronary Syndromes Guideline. February 27, 2025. https://www.acc.org/latest-in-cardiology/journal-scans/2025/02/27/17/01/acc-aha-issue-new-acute-coronary-syndromes-guideline', 'American Heart Association. ACC, AHA Issue New Acute Coronary Syndromes Guideline. February 27, 2025. https://newsroom.heart.org/news/acc-aha-issue-new-acute-coronary-syndromes-guideline' ] y=245 for r in refs: y=bullet(M,y,r,485);y-=8 c.setFillColor(colors.HexColor('#FFF3F3'));c.roundRect(M,72,W-2*M,55,8,fill=1,stroke=0);text(M+12,105,'Safety note',10,13,red,True);text(M+12,89,'This PDF is an educational summary, not a diagnosis or treatment plan. In an emergency, contact local emergency services immediately.',9.2,12,dark,width=W-2*M-24) footer(7);c.save() print(OUT) PY python "/tmp/workspace/myocardial-infarction-pdf/src/create_mi_pdf.py" python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/myocardial-infarction-pdf/output/Myocardial_Infarction_Labeled_Diagrams.pdf' r=PdfReader(p) print('PAGES',len(r.pages),'SIZE',__import__('os').path.getsize(p)) for i,page in enumerate(r.pages,1): print(i, (page.extract_text() or '')[:90].replace('\n',' | ')) PY

~/myocardial-infarction-pdf/src/create_mi_pdf.py

python "/tmp/workspace/myocardial-infarction-pdf/src/create_mi_pdf.py" && python - <<'PY' from pypdf import PdfReader import os p='/tmp/workspace/myocardial-infarction-pdf/output/Myocardial_Infarction_Labeled_Diagrams.pdf' r=PdfReader(p) print('PAGES',len(r.pages),'SIZE',os.path.getsize(p)) for i,page in enumerate(r.pages,1): t=(page.extract_text() or '').replace('\n',' | ') print(i, t[:150]) PY python - <<'PY' import fitz p='/tmp/workspace/myocardial-infarction-pdf/output/Myocardial_Infarction_Labeled_Diagrams.pdf' doc=fitz.open(p) for n in [0,1,2,3,4,5,6]: pix=doc[n].get_pixmap(matrix=fitz.Matrix(0.85,0.85),alpha=False) pix.save(f'/tmp/workspace/myocardial-infarction-pdf/output/preview_{n+1}.png') print('rendered previews') PY

~/myocardial-infarction-pdf/output