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Diagnosis of Acute MI

Diagnosis of Acute MI. Ellis Easterling. Acute Coronary Syndrome. Three Types ST-elevation MI Non ST-elevation MI Unstable Angina. Diagnostic Criteria One of the following:. 1. Rise in cardiac troponin plus one: Ischemic symptoms Pathologic Q waves New ST-T wave changes or LBBB

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Diagnosis of Acute MI

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  1. Diagnosis of Acute MI • Ellis Easterling

  2. Acute Coronary Syndrome • Three Types • ST-elevation MI • Non ST-elevation MI • Unstable Angina

  3. Diagnostic CriteriaOne of the following: • 1. Rise in cardiac troponin plus one: • Ischemic symptoms • Pathologic Q waves • New ST-T wave changes or LBBB • Identification of intracoronary thrombus • Regional wall movement abnormality

  4. 2. CABG related MI • 3. Stent thrombosis • 4. PCI related MI • 5. Cardiac death with symptoms, ECG changes, • but happened before biomarkers measured

  5. Initial Evalulation • Chest Pain and ECG • Allow for initial risk stratification

  6. A 58 y/o man presents to the ED with mild substernal chest pain. He has a history of type II diabetes, GERD, and HTN. He doesn’t take any medication for his GERD because, as he says, “I take too many damn pills already”. An ECG is obtained which shows no abnormal rhythm or ST-segment elevation, but does show a left bundle branch block (LBBB) that wasn’t present when he came to the ED 4 months ago for the same complaint.What should the ED physician do next? • Call the cardiologist because new LBBB is suggestive of acute coronary syndrome. • Call the gastroenterologist since esophageal pH sampling is the only way to diagnose his condition. • Order a troponin since more information is needed before calling a consultation. • Prescribe omeprazole because this medication is cheap and proven for his condition. :30

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