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ST-elevation myocardial infarction

Last reviewed: 10 Nov 2024
Last updated: 15 Jul 2024

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • dyspnea
  • pallor
  • diaphoresis
  • cardiogenic shock
Full details

Other diagnostic factors

  • additional heart sounds
  • nausea and/or vomiting
  • dizziness or lightheadedness
  • distress and anxiety
  • palpitations
  • abnormal breath sounds
  • reduced consciousness
  • hypotension
  • nonclassic location or nature of pain (chest pain-equivalent symptoms)
Full details

Risk factors

  • smoking
  • hypertension
  • diabetes
  • obesity and metabolic syndrome
  • sedentary behavior and physical inactivity
  • dyslipidemia
  • chronic kidney disease
  • atherosclerosis (history of angina, MI, stroke, transient ischemic attack, peripheral vascular disease)
  • family history of premature CAD
  • age >60 years
  • cocaine use
  • depression
  • stent thrombosis or restenosis
  • sleep apnea
  • migraine
  • adverse pregnancy outcomes
Full details

Diagnostic tests

1st tests to order

  • ECG
  • coronary angiogram
  • cardiac biomarkers
  • blood glucose
  • complete blood count
  • electrolytes, BUN, and creatinine
  • C-reactive protein (CRP)
  • serum lipids
Full details

Tests to consider

  • arterial blood gas (ABG)
  • CXR
  • echocardiogram
Full details

Emerging tests

  • Cardiac myosin-binding protein C (CMyC)

Treatment algorithm

INITIAL

suspected myocardial infarction

ACUTE

hemodynamically unstable

hemodynamically stable

ONGOING

post-STEMI

Contributors

Authors

Mahi L. Ashwath, MD, MBA, FACC, FASE, FSCMR
Mahi L. Ashwath

Professor of Medicine and Radiology

Multimodality Imaging Director

Inaugural Reuben Jacobs Chair in Internal Medicine

UHS/UT Heart and Vascular Institute

San Antonio

TX

Disclosures

MLA declares that she is a consultant for Tersera.

Acknowledgements

Dr Mahi L. Ashwath would like to gratefully acknowledge Dr Thomas Vrobel and Dr Sanjay Gandhi, previous contributors to this topic.

Disclosures

TV declares that he has no competing interests.

Peer reviewers

Dale Adler, MD, FACC

Vice Chairman of Medicine for Network Development and Strategic Planning

Brigham and Women's Hospital

Boston

MA

Disclosures

DA declares that he has no competing interests.

Deepak L. Bhatt, MD

Associate Professor of Medicine

Department of Cardiovascular Medicine

Cleveland Clinic

OH

Disclosures

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

City Hospital

Birmingham

UK

Disclosures

GL declares that he has no competing interests.

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