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 ill patient in cardiogenic shock.
ST-elevation myocardial infarction (STEMI) is suspected when a patient presents with persistent ST-segment elevation in 2 or more anatomically contiguous ECG leads in the context of a consistent clinical history.
Creatine kinase-MB and cardiac-specific troponins confirm diagnosis. Treatment should, however, be started immediately in patients with a typical history and ECG changes, without waiting for laboratory results.
Immediate and prompt revascularization can prevent or decrease myocardial damage and decrease morbidity and mortality.
About 15% of patients in the US who have an acute myocardial infarction (MI) will die of it.
Survivors of acute MI should be closely followed up for adequate modification of risk factors and development of complications.
Myocardial infarction is myocardial cell death that occurs because of a prolonged mismatch between perfusion and demand. This is usually caused by occlusion in the coronary arteries. ST-elevation myocardial infarction (STEMI) is suspected when a patient presents with persistent ST-segment elevation in 2 or more anatomically contiguous ECG leads in the context of a consistent clinical history.
History and exam
Mahi L. Ashwath, MD, MBA, FACC, FASE, FSCMR
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
MLA declares that she has no competing interests.
Sanjay Gandhi, MD, MBA, FACC, FAHA, FSCAI
Director, Endovascular Cardiology
Associate Professor of Medicine, Endovascular Cardiology
Case Western Reserve University
SG declares that he serves on the board of Lobesity and is Governor for the Ohio Chapter of the American College of Cardiology.
Dr Mahi L. Ashwath and Dr Sanjay Gandhi would like to gratefully acknowledge Dr Thomas Vrobel, a previous contributor to this topic. TV declares that he has no competing interests.
Dale Adler, MD, FACC
Vice Chairman of Medicine for Network Development and Strategic Planning
Brigham and Women's Hospital
DA declares that he has no competing interests.
Deepak L. Bhatt, MD
Associate Professor of Medicine
Department of Cardiovascular Medicine
DLB declares that he has no competing interests.
Gregory Lip, MD, FRCP, FACC, FESC
Consultant Cardiologist and Professor of Cardiovascular Medicine
University Department of Medicine
GL declares that he has no competing interests.
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