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Acs Diagnostics

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Submitted By nicklausrivera
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STEMI
Clinical History * Usual precipitants are vigorous physical activities, emotional stress, or medical/surgical illness * Similar to angina pectoris but usually more severe and lasts longer * Can occur at rest; does not subside with cessation of activity * Heavy, squeezing, crushing pain; occasionally stabbing or burning * Involves central portion of chest and/or epigastrium * Radiation: * Arms * less common sites: abdomen, back, lower jaw, neck; can be as high as the occipital area but not below the umbilicus * Associated symptoms: * weakness, sweating, nausea, vomiting, anxiety, and sense of impending doom * In diabetics, proportion of painless STEMI is greater * In the elderly, STEMI may present as sudden-onset breathlessness * Less common presentations * Loss of consciousness, confusional state, sensation of profound weakness, appearance of arrhythmia, evidence of peripheral embolism, unexplained drop in arterial pressure
Physical Findings * Anxious and restless * Pallor associated with perspiration and coolness of extremities * Substernal chest pain > 30 mins + diaphoresis * Normal pulse rate and BP within 1st hour * ¼ of patients with anterior infarct have sympathetic hyperactivity * ½ of patients with inferior infarct have parasympathetic hyperactivity * Precordium usually quiet, apical impulse difficult to palpate * 3rd and 4th heart sounds, decreased 1st heart sound, splitting of 2nd heart sound * Carotid pulse decreased in volume * Temperatures up to 38C during first week * Arterial pulse variable

ECG * ST-segment elevation due to total occlusion of an epicardial coronary artery * May evolve Q waves transiently

Cardiac Biomarkers * Cardiac-specific troponin T (cTnT) and Cardiac-specific troponin I (cTnI) *

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