myocardial infarction

1. MI presentation and diagnostic approach
Presentation:
Hx:
* chief complain is rest chest pain (substernal “main”-epigastric region “less often”) radiating to neck,
jaw, back, left shoulder, or left arm.
* others like dyspnea, nausea, vomiting, diaphoresis, or palpitations.
Examination
*general
*vital signs often unremarkable but may be:
hypertension or hypotension and tachycardia or bradycardia.
*signs of heart failure and/or cardiogenic shock.
*bradycardia is common in first hours of STEMI.
*skin
*diaphoretic
*cool skin or pallor
*neck
*jugular venous distention
*cardiac
*s3 or s4
*new murmur
*pericardial friction rub
Diagnosis:
*suspect in patients with symptoms and signs consistent with the diagnosis

2. *ECG
*ST elevation (in absence of left ventricular hypertrophy or LBBB).
*STEMI criteria in setting of LBBB includes:
-ST elevation ≥ 1mm and concordant with QRS complex
- ST elevation ≥ 5mm and discordant with QRS complex
-ST depression ≥ 1mm in V1, V2, V3
*ST depression in ≥ pericardial leads indicate transmural posterior injury
*transthoracic echocardiography
*cardiac troponin
*invasive angiography to confirm diagnosis if clinical doubt remains
Done by/
Maged Hemaid Mohamed Salem