ST-elevation myocardial infarction (STEMI) 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.
STEMI is suspected when a patient presents with persistent ST-segment elevation in two or more anatomically contiguous ECG leads in the context of a consistent clinical history.
Cardiac biomarkers (e.g., 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 the irreversible necrosis of heart muscle 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 two or more anatomically contiguous ECG leads in the context of a consistent clinical history.
History and exam
Key diagnostic factors
- chest pain
- cardiogenic shock
Other diagnostic factors
- nausea and/or vomiting
- dizziness or lightheadedness
- additional heart sounds
- nonclassic location or nature of pain
- reduced consciousness
- abnormal breath sounds
- metabolic syndrome
- physical inactivity
- renal insufficiency
- established coronary artery disease
- family history of premature coronary artery disease
- cocaine use
- male sex
- advanced age
1st investigations to order
- cardiac biomarkers
- blood glucose
- electrolytes, BUN, and creatinine
- serum lipids
- chest x-ray
- coronary angiogram
Investigations to consider
suspected myocardial infarction
Mahi L. Ashwath, MD, MBA, FACC, FASE, FSCMR
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.
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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