New or presumably new transient ST-segment deviation (> 0.05 mV) or T-wave inversion (> 0. New transient mitral regurgitation, hypotension, diaphoresis, pulmonary edema or rales Known history of coronary artery disease, including myocardial infarction An EKG shows the rhythm on the screen that the wires are connected to. Reproduction of previous documented angina ST segment monitoring is done using a heart monitor or electrocardiogram (EKG ). In the future, advanced diagnostic modalities, such as myocardial perfusion imaging, may have a role in reducing unnecessary hospitalizations.įindings indicating HIGH likelihood of ACSįindings indicating INTERMEDIATE likelihood of ACS in absence of high-likelihood findingsįindings indicating LOW likelihood of ACS in absence of high- or intermediate-likelihood findingsĬhest or left arm pain or discomfort as chief symptom Early markers of acute ischemia include myoglobin and creatine kinase–MB subforms (or isoforms), when available. Troponin T or I generally is the most sensitive determinant of acute coronary syndrome, although the MB isoenzyme of creatine kinase also is used. Many low-risk patients can be discharged with appropriate follow-up. Intermediate-risk patients should undergo a structured evaluation, often in a chest pain unit. Most high-risk patients should be hospitalized. Risk stratification allows appropriate referral of patients to a chest pain center or emergency department, where cardiac enzyme levels can be assessed. Symptoms Exercise performance (functional capacity, exercise capacity) Heart rate: maximal heart rate, heart rate response Blood pressure reaction ECG reaction: ST changes, T-wave changes, arrhythmias, conduction defects Cause of termination This article will discuss each of these six parameters in detail. In acute coronary syndrome, common electrocardiographic abnormalities include T-wave tenting or inversion, ST-segment elevation or depression (including J-point elevation in multiple leads), and pathologic Q waves. This topic provides an overview of STEMI management from presentation to the period immediately after revascularization. Diagnosis requires an electrocardiogram and a careful review for signs and symptoms of cardiac ischemia. INTRODUCTION Patients with severe and acute myocardial infarction (ie, ST-elevation myocardial infarction STEMI) require rapid diagnosis and treatment to reduce the risk of death and permanent myocardial injury 1. The term “acute coronary syndrome” encompasses a range of thrombotic coronary artery diseases, including unstable angina and both ST-segment elevation and non–ST-segment elevation myocardial infarction.
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