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ST-elevation myocardial infarction

Last reviewed: 6 Nov 2023
Last updated: 28 Mar 2023



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


suspected myocardial infarction


hemodynamically unstable

hemodynamically stable





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




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




SG declares that he has no competing interests.


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.

Peer reviewers

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

Cleveland Clinic



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




GL declares that he has no competing interests.

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