Presents with central chest pain that is classically heavy in nature, like a sensation of pressure or squeezing. Examination is variable, and findings range from normal to a critically unwell patient in cardiogenic shock.
Make a clinical diagnosis of ST-elevation myocardial infarction (STEMI) and start immediate treatment when a patient presents with symptoms suggestive of myocardial ischaemia and has persistent ST-segment elevation in at least 2 anatomically contiguous ECG leads.
A rise in cardiac-specific troponins confirms the diagnosis but do not wait for laboratory results before starting treatment.
Immediate and prompt reperfusion can prevent or minimise myocardial damage and improve the chances of survival and recovery. Primary percutaneous coronary intervention (PCI) is the best management option for most patients, with fibrinolysis reserved for those without access to timely primary PCI.
Survivors of acute MI should be closely followed up to ensure adequate modification of risk factors and optimisation of (and adherence to) pharmacotherapy for secondary prevention, and to monitor for the development of post MI complications and/or residual angina symptoms.
Acute myocardial infarction is myocardial cell death that occurs because of a prolonged mismatch between perfusion and demand. In the case of ST-elevation myocardial infarction (STEMI) this is caused predominantly by complete atherothrombotic occlusion of a coronary artery.
≥2.5 mm in men <40 years old
≥2 mm in men >40 years old
≥1.5 mm in women in V2-V3 and/or ≥1 mm in the other leads.
1 mm = 1 small square (at a standard ECG calibration of 10 mm/mV).
Contiguous ECG leads lie next to each other anatomically and indicate a specific myocardial territory.
History and exam
NIHR Clinical Lecturer in Interventional Cardiology
Brighton and Sussex Medical School
Honorary Interventional Cardiology Fellow
Royal Sussex County Hospital
AM is Section Editor, BMJ Best Practice. AM declares that he has no competing interests.
ST4 in Renal Medicine
Leeds Teaching Hospitals NHS Trust
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:
Mahi L. Ashwath MD, FACC, FASE
Director, Cardiac MRI
Clinical Associate Professor of Medicine and Radiology
Division of Cardiology
Department of Internal Medicine
University of Iowa Hospitals and Clinics
University of Iowa Health Care
Sanjay Gandhi MD, FACC, FAHA, FSCAI
Director, Endovascular Cardiology
Associate Professor of Medicine, Endovascular Cardiology
Case Western Reserve University
MLA and SG declare that they have no competing interests.
Honorary Professor of Interventional Cardiology
University of Leicester
University Hospitals of Leicester NHS Trust
Section Editor, BMJ Best Practice
Consultant Cardiologist and Electrophysiologist
Royal Brompton and Harefield Hospitals
SH declares that he has no competing interests.
Head of Editorial, BMJ Knowledge Centre
JH declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
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