Handwritten medical study notes on lined paper about Heart Attack (Myocardial Infarction). The notes should look like a student's neat handwritten notebook page with: TITLE: "HEART ATTACK (Myocardial Infarction)" — underlined, written in large letters at the top DEFINITION section: "Necrosis of myocardium due to prolonged ischemia (>20-40 min). ~800,000 MIs/year in USA (1 every 40 sec)" CAUSES section with a small plaque rupture diagram arrow: - "90% due to atherosclerotic plaque rupture → thrombus → coronary occlusion" - "Plaque disruption → platelet activation → TXA2, ADP, serotonin → thrombus" - "10%: vasospasm, embolism, cocaine, vasculitis" TYPES (ACS) section with a branching tree diagram: - "STEMI — complete occlusion, ST elevation on ECG → immediate reperfusion" - "NSTEMI — partial occlusion, no ST elevation, troponin ↑" - "Unstable Angina — no troponin rise" SYMPTOMS section with small heart icon: - "Crushing chest pain radiating to L arm/jaw" - "Diaphoresis, nausea, dyspnea" - "Silent MI in diabetics & elderly" ECG CHANGES (small drawn ECG waves): - "Hyperacute T waves (earliest)" - "ST elevation → Q waves (hours-days)" - "T wave inversion (days-weeks)" BIOMARKERS with a timeline arrow: - "Troponin I/T: rises 3-6h, peaks 24-48h, gold standard" - "CK-MB: rises 4-8h, used for reinfarction" MANAGEMENT (MONA + PCI): - "M — Morphine (pain relief)" - "O — Oxygen (if SpO2 <90%)" - "N — Nitrates (sublingual GTN)" - "A — Aspirin 300mg + P2Y12 inhibitor (clopidogrel/ticagrelor)" - "STEMI → PCI within 90 min (door-to-balloon) or fibrinolytics" - "Beta-blockers, ACEI, statins — long-term" COMPLICATIONS box (dashed border): - "Arrhythmias (most common cause of death — VF)" - "Cardiogenic shock, Papillary muscle rupture" - "Dressler's syndrome (2-10 wks), LV aneurysm" Small anatomical heart diagram on right side showing LAD, RCA, LCx arteries labeled Drawn on cream/yellow lined notebook paper with blue and red ink, neat handwriting style, some words underlined or circled for emphasis