Diagnosis of MI - Diagnosis of MI The diagnosis of STEMI is based on the presence of evolutionary changes of ST elevation in the resting ECG in patients

Diagnosis of MI - Diagnosis of MI The diagnosis of STEMI is...

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Diagnosis of MI The diagnosis of STEMI is based on the presence of evolutionary changes of ST elevation in the resting ECG in patients presenting with chest pain or its equivalent and supported by the presence of raised cardiac biomarkers. 1. History A thorough, targeted history is important in making the diagnosis of STEMI. Chest pain of STEMI begins abruptly and lasts for more than thirty minutes.6 It is usually located in the centre of the chest, and may radiate to the jaw or down the left arm. It may occur at rest or with activity. The pain may just be a tightness or heaviness in the chest, but it is usually described as a pressure, squeezing or a severe crushing pain with a sense of impending doom associated with sweating, nausea, vomiting and shortness of breath. The pain may be of a burning quality and localised to the epigastria or interscapular region resulting in a misdiagnosis. In the elderly, females and patients with diabetes, the index of suspicion has to be high because they may present with atypical symptoms such as unexplained fatigue, shortness of breath, dizziness, lightheadedness, unexplained sweating and syncope. They may not necessarily have chest pain. Other important points to note in the history are the presence of: • Previous history of ischaemic heart disease, PCI or CABG. • Risk factors for atherosclerosis. • Symptoms suggestive of previous transient ischaemic attack (TIA) or other forms of vascular disease. Upon clinical suspicion of ACS, a 12-lead ECG should be performed and interpreted immediately within 10 minutes of first medical contact (FMC).
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  • Fall '15
  • MrRosdi
  • chest pain, STEMI, cardiac biomarkers

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