ST-elevation myocardial infarction

Last reviewed: 3 Jan 2023
Last updated: 04 Jan 2023

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • dyspnea
  • pallor
  • diaphoresis
  • cardiogenic shock
More key diagnostic factors

Other diagnostic factors

  • nausea and/or vomiting
  • dizziness or lightheadedness
  • weakness
  • distressed
  • tachycardia
  • additional heart sounds
  • nonclassic location or nature of pain
  • reduced consciousness
  • hypotension
  • abnormal breath sounds
Other diagnostic factors

Risk factors

  • smoking
  • hypertension
  • diabetes
  • obesity
  • metabolic syndrome
  • physical inactivity
  • dyslipidemia
  • renal insufficiency
  • established coronary artery disease
  • family history of premature coronary artery disease
  • cocaine use
  • male sex
  • advanced age
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • cardiac biomarkers
  • blood glucose
  • electrolytes, BUN, and creatinine
  • serum lipids
  • chest x-ray
  • coronary angiogram
More 1st investigations to order

Investigations to consider

  • echocardiogram
More investigations to consider

Emerging tests

  • copeptin

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

Director, Cardiac MRI

Clinical Professor of Medicine and Radiology

Division of Cardiology

Department of Internal Medicine

University of Iowa Hospitals and Clinics

University of Iowa Health Care

Iowa

IA

Disclosures

MLA declares that she is the Governor for the Iowa Chapter of the American College of Cardiology.

Sanjay Gandhi, MD, MBA, FACC, FAHA, FSCAI

Director, Endovascular Cardiology

Professor of Medicine, Endovascular Cardiology

Case Western Reserve University

Cleveland

OH

Disclosures

SG declares that he has no competing interests.

Acknowledgements

Dr Mahi L. Ashwath and Dr Sanjay Gandhi would like to gratefully acknowledge Dr Thomas Vrobel, a previous contributor 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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