ROSEN'S Acute coronary syndrome-ECG DD of ST
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ROSEN'S Acute coronary syndrome-ECG DD of ST

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Questions and Answers

Which clinical presentation of ACS involves ischemia but not myocardial cell death?

  • Non–ST segment elevation myocardial infarction
  • Sudden cardiac death
  • Unstable angina (correct)
  • ST segment elevation myocardial infarction

    • What is the most extreme clinical manifestation of acute coronary syndrome?

  • Unstable angina
  • Non–ST segment elevation myocardial infarction
  • Sudden cardiac death (correct)
  • ST segment elevation myocardial infarction

    • Which development provided emergency clinicians with effective approaches for treating life-threatening dysrhythmias occurring due to ACS?

  • New pharmacologic agents
  • External defibrillators (correct)
  • Selective coronary arteriography
  • Cardiac pacemakers

    • Who inaugurated the era of cardiopulmonary resuscitation (CPR) in 1960?

    <p>Kouwenhoven</p> Signup and view all the answers

    Which type of myocardial infarction is characterized by myocardial cell death and ST segment elevation?

    <p>ST segment elevation myocardial infarction</p> Signup and view all the answers

    Which ACS subtype involves ischemia but not ST segment elevation?

    <p>Non–ST segment elevation myocardial infarction</p> Signup and view all the answers

    What is frequently included in the ACS spectrum of illnesses and represents the most extreme clinical manifestation of acute coronary syndrome?

    <p>Sudden cardiac death</p> Signup and view all the answers

    What provided an important tool in the management of sudden cardiac death?

    <p>Cardiopulmonary resuscitation (CPR)</p> Signup and view all the answers

    Which ACS subtype is characterized by myocardial cell death but not ST segment elevation?

    <p>Non–ST segment elevation myocardial infarction</p> Signup and view all the answers

    What is frequently involved in the ACS spectrum of illnesses and involves pulseless ventricular tachycardia or ventricular fibrillation?

    <p>Sudden cardiac death</p> Signup and view all the answers

    What has been added to the chest pain evaluation strategy as the most recent development?

    <p>High-sensitivity troponin testing</p> Signup and view all the answers

    What is the focus of the STEMI systems of care approach?

    <p>The time-sensitivity of treatment</p> Signup and view all the answers

    What is the focus of the rule-out (R/O) myocardial infarction (MI) strategy?

    <p>Detection of ACS events</p> Signup and view all the answers

    What is the primary concern when attempting to lower the missed MI rate in the ED?

    <p>Increased unnecessary testing with associated risk</p> Signup and view all the answers

    What has improved interventional success in the treatment of STEMI?

    <p>Newer stenting devices</p> Signup and view all the answers

    What is the goal of combination therapies studied for STEMI patients?

    <p>To optimize reperfusion and adjunctive therapies</p> Signup and view all the answers

    What is the primary concern when attempting to lower the missed MI rate in the ED?

    <p>Identifying and promptly treating acute myocardial infarction</p> Signup and view all the answers

    What has improved interventional success in the treatment of STEMI?

    <p>Selective coronary arteriography</p> Signup and view all the answers

    What revolutionized the management of patients with coronary artery disease, including chronic, stable presentations and acute coronary syndrome?

    <p>Selective coronary arteriography</p> Signup and view all the answers

    Who inaugurated the era of cardiopulmonary resuscitation (CPR) in 1960?

    <p>Kouwenhoven</p> Signup and view all the answers

    What is the focus of the STEMI systems of care approach?

    <p>Time-sensitivity of treatment and multidisciplinary composition of the management team</p> Signup and view all the answers

    What has improved interventional success in the treatment of STEMI?

    <p>Newer stenting devices and various platelet and coagulation system inhibitors</p> Signup and view all the answers

    What is the goal of combination therapies studied for STEMI patients?

    <p>Further optimizing reperfusion and adjunctive therapies</p> Signup and view all the answers

    What is the most recent development added to the chest pain evaluation strategy?

    <p>High-sensitivity troponin testing</p> Signup and view all the answers

    What has been added to the chest pain evaluation strategy to reduce the total evaluation time and improve throughput?

    <p>High-sensitivity troponin testing</p> Signup and view all the answers

    What is the primary concern when attempting to lower the missed MI rate in the ED?

    <p>Increased unnecessary testing with associated risk, health system costs, and less resource availability for higher-risk patients</p> Signup and view all the answers

    What is the focus of the rule-out (R/O) myocardial infarction (MI) strategy?

    <p>Shortening the total time, rendering it more efficient, and making it safer with respect to detection of ACS events</p> Signup and view all the answers

    What has revolutionized the treatment of patients with STEMI, starting in the late 1980s?

    <p>Fibrinolytic therapy and interventional catheter-based techniques</p> Signup and view all the answers

    What is the age-adjusted prevalence of coronary heart disease for men?

    <p>7.2%</p> Signup and view all the answers

    What is the leading cause of death among adults in many industrialized countries?

    <p>Heart disease</p> Signup and view all the answers

    What accounts for over 1 million deaths in the United States annually?

    <p>Ischemic heart disease</p> Signup and view all the answers

    What has contributed to a significant reduction in age-adjusted mortality from CAD in the United States and Canada?

    <p>Improved management of hypertension, hyperlipidemia, and diabetes mellitus</p> Signup and view all the answers

    What is the approximate 30-day mortality rate for patients who experience an acute myocardial infarction (AMI)?

    <p>30%</p> Signup and view all the answers

    What percentage of patients with AMI die from an ACS-related dysrhythmia within 2 hours of the event initiation?

    <p>20%</p> Signup and view all the answers

    What percentage of patients with ACS, including unstable angina (UA) and AMI, are discharged from the ED?

    <p>1%</p> Signup and view all the answers

    What percentage of patients with myocardial infarction are rehospitalized within 1 year of their index event?

    <p>45%</p> Signup and view all the answers

    What percentage of patients with acute coronary syndrome (ACS), including both unstable angina (UA) and acute myocardial infarction (AMI), are discharged from the emergency department (ED)?

    <p>5%</p> Signup and view all the answers

    What percentage of patients with AMI die within 30 days of the acute myocardial infarction?

    <p>30%</p> Signup and view all the answers

    Approximately how many persons experience an AMI every year in the United States?

    <p>900,000</p> Signup and view all the answers

    What is the primary cause for presenting to the ED among men with approximately 49 million annual ED visits in the United States?

    <p>Chest pain</p> Signup and view all the answers

    What is the age-adjusted prevalence of coronary heart disease for women?

    <p>4.2%</p> Signup and view all the answers

    What is the leading cause of death among adults in many industrialized countries?

    <p>Heart disease</p> Signup and view all the answers

    What has contributed to a significant reduction in age-adjusted mortality from CAD in the United States and Canada?

    <p>Diminished mortality from AMI</p> Signup and view all the answers

    What is the approximate percentage of deaths from cardiovascular disease that occur in women?

    <p>More than 50%</p> Signup and view all the answers

    What percentage of patients with acute coronary syndrome (ACS), including both unstable angina (UA) and acute myocardial infarction (AMI), are discharged from the emergency department (ED)?

    <p>2%</p> Signup and view all the answers

    What percentage of patients with AMI die within 30 days of the acute myocardial infarction?

    <p>30%</p> Signup and view all the answers

    What is the approximate 30-day mortality rate for patients who experience an acute myocardial infarction (AMI)?

    <p>30%</p> Signup and view all the answers

    What is the leading cause for presenting to the ED among men with approximately 49 million annual ED visits in the United States?

    <p>Chest pain</p> Signup and view all the answers

    What is the approximate percentage of deaths from cardiovascular disease that occur in women?

    <p>50%</p> Signup and view all the answers

    What is the age-adjusted prevalence of coronary heart disease for men?

    <p>7.2%</p> Signup and view all the answers

    What is the age-adjusted prevalence of heart disease?

    <p>10.6%</p> Signup and view all the answers

    What accounts for over 1 million deaths in the United States annually?

    <p>Cardiovascular disease</p> Signup and view all the answers

    Which of the following is considered a less severe manifestation of coronary heart disease?

    <p>Stable angina</p> Signup and view all the answers

    What is the most severe form of Acute Coronary Syndrome (ACS) according to some experts?

    <p>Sudden cardiac death from pulseless ventricular tachycardia or ventricular fibrillation</p> Signup and view all the answers

    Which manifestation of coronary heart disease is characterized by myocardial cell death and ST segment elevation?

    <p>STEMI</p> Signup and view all the answers

    Which of the following is a characteristic of stable angina pectoris?

    <p>It is not considered a form of acute coronary syndrome (ACS)</p> Signup and view all the answers

    What is the most severe form of acute coronary syndrome (ACS) according to some experts?

    <p>Sudden cardiac death resulting from pulseless ventricular tachycardia or ventricular fibrillation</p> Signup and view all the answers

    Which condition is characterized by myocardial cell death but not ST segment elevation?

    <p>Non-ST segment elevation myocardial infarction (NSTEMI)</p> Signup and view all the answers

    Which of the following is the most severe form of Acute Coronary Syndrome (ACS) according to some experts?

    <p>Sudden cardiac death due to pulseless ventricular tachycardia</p> Signup and view all the answers

    What is the characteristic feature of stable angina pectoris?

    <p>Transient and episodic chest discomfort</p> Signup and view all the answers

    What is the major difference between Non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI)?

    <p>Involvement of ST segment elevation on ECG</p> Signup and view all the answers

    How is unstable angina broadly defined from a semantic perspective?

    <p>Angina that is new onset or occurring at rest or with minimal exertion</p> Signup and view all the answers

    When is angina considered to be 'rest angina'?

    <p>Angina occurring at rest, lasting longer than 20 minutes, and occurring within 1 week of presentation</p> Signup and view all the answers

    What is 'new-onset angina'?

    <p>Angina of at least CCS classification class II severity, with onset within the previous 2 months</p> Signup and view all the answers

    How is 'increasing or progressive angina' diagnosed?

    <p>When a previously known anginal pattern becomes more frequent, longer in duration, or increased by one class within the previous 2 months of at least class III severity</p> Signup and view all the answers

    Which type of angina is caused by coronary artery vasospasm at rest and may be relieved by exercise or NTG?

    <p>Variant angina (Prinzmetal angina)</p> Signup and view all the answers

    Which organization developed clinical criteria for acute myocardial infarction (AMI)?

    <p>American College of Cardiology (ACC)</p> Signup and view all the answers

    What is the primary cause of acute myocardial infarction (AMI)?

    <p>Plaque rupture</p> Signup and view all the answers

    What differentiates NSTEMI from STEMI at presentation?

    <p>Elevated cardiac troponin values</p> Signup and view all the answers

    How many primary types of infarction are described by the classification of AMI?

    <p>5</p> Signup and view all the answers

    What represents the most extreme clinical manifestation of acute coronary syndrome (ACS)?

    <p>Sudden unexpected cardiac death</p> Signup and view all the answers

    Which descriptor fails to adequately describe the coronary event and its related pathophysiology?

    <p>Non-Q wave MI</p> Signup and view all the answers

    What differentiates stable angina from unstable angina?

    <p>Severity of symptoms</p> Signup and view all the answers

    What is the primary focus of diagnostic and management issues for acute myocardial infarction (AMI)?

    <p>Subtype of MI encountered</p> Signup and view all the answers

    What is the major difference between NSTEMI and STEMI in terms of myocardial injury?

    <p>Extent of myocardial cell death</p> Signup and view all the answers

    What has improved interventional success in the treatment of STEMI?

    <p>Advancements in medical technology</p> Signup and view all the answers

    What is the characteristic feature of stable angina pectoris?

    <p>Relief by exercise or NTG</p> Signup and view all the answers

    Which of the following is considered rest angina?

    <p>Angina occurring at rest, lasting longer than 20 minutes, and occurring within 1 week of presentation</p> Signup and view all the answers

    What defines new-onset angina?

    <p>Angina that is new onset or occurring at rest or with minimal exertion</p> Signup and view all the answers

    What characterizes increasing or progressive angina?

    <p>Angina that is worsening from a previously stable pain occurrence pattern</p> Signup and view all the answers

    What is the defining characteristic of unstable angina from a semantic perspective?

    <p>Angina that is new onset or occurring at rest or with minimal exertion</p> Signup and view all the answers

    What is the defining characteristic of unstable angina from a semantic perspective?

    <p>It can be severe, possibly indicating an acute myocardial infarction (AMI)</p> Signup and view all the answers

    Which type of angina is caused by coronary artery vasospasm at rest and may be relieved by exercise or NTG?

    <p>Variant angina (Prinzmetal angina)</p> Signup and view all the answers

    What represents the most extreme clinical manifestation of acute coronary syndrome (ACS)?

    <p>Acute myocardial infarction</p> Signup and view all the answers

    What is the major difference between Non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI)?

    <p>The location of myocardial cell death</p> Signup and view all the answers

    What is the characteristic feature of stable angina pectoris?

    <p>It is predictable and reproducible</p> Signup and view all the answers

    What is the focus of the STEMI systems of care approach?

    <p>Restoring blood flow to the heart muscle</p> Signup and view all the answers

    What is the differentiation between STEMI and NSTEMI important for?

    <p>Management, outcome, and prognosis for patients with AMI</p> Signup and view all the answers

    What is frequently involved in the ACS spectrum of illnesses and involves pulseless ventricular tachycardia or ventricular fibrillation?

    <p>Acute myocardial infarction</p> Signup and view all the answers

    What is the approximate 30-day mortality rate for patients who experience an acute myocardial infarction (AMI)?

    <p>20-30%</p> Signup and view all the answers

    What is the classification of AMI types based on?

    <p>Different clinical situations</p> Signup and view all the answers

    What differentiates NSTEMI from STEMI at presentation?

    <p>The presence of myocardial cell death</p> Signup and view all the answers

    What is the primary cause of acute myocardial infarction (AMI)?

    <p>Plaque rupture and thrombus formation</p> Signup and view all the answers

    Which of the following is NOT a semantic definition of unstable angina?

    <p>Angina occurring during physical activity</p> Signup and view all the answers

    How long must angina last to be considered 'rest angina'?

    <p>Longer than 20 minutes</p> Signup and view all the answers

    When is angina considered 'new-onset'?

    <p>Within the previous 2 months</p> Signup and view all the answers

    How is 'increasing or progressive angina' diagnosed?

    <p>When a previously known anginal pattern becomes more frequent or longer in duration</p> Signup and view all the answers

    What percentage of vessel stenosis usually results in ischemic symptoms at rest?

    <p>95%</p> Signup and view all the answers

    Which factor determines myocardial oxygen consumption?

    <p>Heart rate</p> Signup and view all the answers

    What is the characteristic of vulnerable, or unstable, fibro-lipid plaques?

    <p>They consist of a lipid-rich core separated from the arterial lumen by a fibromuscular cap</p> Signup and view all the answers

    What initiates the pathophysiologic process of ACS?

    <p>Rupture of vulnerable plaques</p> Signup and view all the answers

    What is the primary cause of thrombus formation in Acute Coronary Syndrome (ACS)?

    <p>Endothelial damage and atherosclerotic plaque disruption</p> Signup and view all the answers

    What makes platelet-rich thrombi more resistant to fibrinolysis in ACS?

    <p>Higher concentration of platelets</p> Signup and view all the answers

    What is the most critical factor in myocardial infarction (MI) according to angiographic studies?

    <p>Acute events of plaque rupture, platelet activation, and thrombus formation</p> Signup and view all the answers

    What is the likely consequence of extensive collateral vessel circulation in cases of acute stenosis of the coronary vessel in unstable angina (UA)?

    <p>Prevents cessation of blood flow, averting frank infarction</p> Signup and view all the answers

    What contributes to further myocardial injury in Acute Coronary Syndrome (ACS) as debris from the occlusive plaque lesion is released?

    <p>Embolization into the distal vessel</p> Signup and view all the answers

    What can the introduction of calcium, oxygen, and cellular elements into ischemic myocardium lead to?

    <p>Irreversible myocardial damage</p> Signup and view all the answers

    What is the likely role of neutrophils in reperfusion injury in Acute Coronary Syndrome (ACS)?

    <p>Occluding capillary lumens and accelerating the inflammatory response</p> Signup and view all the answers

    What is the primary cause of approximately 10% of MIs, occurring without significant underlying coronary artery disease (CAD)?

    <p>Coronary artery spasm and subsequent thrombus formation</p> Signup and view all the answers

    What further compromises blood flow after significant coronary vessel occlusion in Acute Coronary Syndrome (ACS)?

    <p>Vasospasm induced by local mediators and vasoactive substances</p> Signup and view all the answers

    What is the characteristic feature of platelet-rich thrombi in Acute Coronary Syndrome (ACS)?

    <p>Resistance to fibrinolysis</p> Signup and view all the answers

    What is the primary role of platelets in the thrombotic response to rupture of coronary artery plaque and subsequent ACS?

    <p>Major role in thrombus formation</p> Signup and view all the answers

    What determines myocardial oxygen consumption?

    <p>Heart rate, afterload, contractility, and wall tension</p> Signup and view all the answers

    At what percentage of vessel stenosis does inadequate perfusion usually result in ischemic symptoms at rest?

    <p>95%</p> Signup and view all the answers

    What characterizes stable fibrous plaques in CAD?

    <p>Produce anginal symptoms with exercise and increased myocardial oxygen consumption</p> Signup and view all the answers

    What is the composition of vulnerable, or unstable, fibro-lipid plaques in CAD?

    <p>Lipid-rich core separated from the arterial lumen by a fibromuscular cap</p> Signup and view all the answers

    Which of the following is the primary cause of approximately 10% of MIs, occurring without significant underlying coronary artery disease (CAD)?

    <p>Coronary artery spasm and subsequent thrombus formation</p> Signup and view all the answers

    What makes platelet-rich thrombi more resistant to fibrinolysis in ACS?

    <p>Presence of platelet activation and thrombus formation</p> Signup and view all the answers

    What is the major difference between NSTEMI and STEMI in terms of myocardial injury?

    <p>Extent of myocardial injury</p> Signup and view all the answers

    What represents the most extreme clinical manifestation of acute coronary syndrome (ACS)?

    <p>Complete obstruction of the vessel lumen</p> Signup and view all the answers

    What further compromises blood flow after significant coronary vessel occlusion in Acute Coronary Syndrome (ACS)?

    <p>Vasospasm induced by local mediators</p> Signup and view all the answers

    What is the primary cause of thrombus formation in Acute Coronary Syndrome (ACS)?

    <p>Endothelial damage and atherosclerotic plaque disruption</p> Signup and view all the answers

    What has revolutionized the treatment of patients with STEMI, starting in the late 1980s?

    <p>Primary percutaneous coronary intervention (PCI)</p> Signup and view all the answers

    What characterizes stable fibrous plaques in CAD?

    <p>Lack of thrombus formation</p> Signup and view all the answers

    What is the characteristic feature of stable angina pectoris?

    <p>Predictable pattern of chest discomfort</p> Signup and view all the answers

    What is the focus of the rule-out (R/O) myocardial infarction (MI) strategy?

    <p>Differentiating MI from other causes of chest pain</p> Signup and view all the answers

    What further compromises blood flow after significant coronary vessel occlusion in Acute Coronary Syndrome (ACS)?

    <p>Vasomotor hyperreactivity</p> Signup and view all the answers

    What is the characteristic of vulnerable, or unstable, fibro-lipid plaques?

    <p>High risk of rupture and thrombosis</p> Signup and view all the answers

    What determines myocardial oxygen consumption?

    <p>Heart rate, afterload, contractility, and wall tension</p> Signup and view all the answers

    At what percentage of coronary arterial vessel stenosis does inadequate perfusion usually result in ischemic symptoms at rest?

    <p>95%</p> Signup and view all the answers

    What characterizes vulnerable, or unstable, fibro-lipid plaques in CAD?

    <p>Consist of a lipid-rich core separated from the arterial lumen by a fibromuscular cap</p> Signup and view all the answers

    What initiates the pathophysiologic process of ACS?

    <p>Rupture of vulnerable, or unstable, fibro-lipid plaques</p> Signup and view all the answers

    What is the primary cause of thrombus formation in Acute Coronary Syndrome (ACS)?

    <p>Endothelial damage and atherosclerotic plaque disruption</p> Signup and view all the answers

    What further compromises blood flow after significant coronary vessel occlusion in Acute Coronary Syndrome (ACS)?

    <p>Local mediators and vasoactive substances inducing vasospasm</p> Signup and view all the answers

    What characterizes the most critical factors in the infarction in Acute Coronary Syndrome (ACS)?

    <p>Acute events of plaque rupture, platelet activation, and thrombus formation</p> Signup and view all the answers

    What is the primary cause for presenting to the ED among men with approximately 49 million annual ED visits in the United States?

    <p>Acute Coronary Syndrome (ACS)</p> Signup and view all the answers

    What further complicates blood flow after significant coronary vessel occlusion in Acute Coronary Syndrome (ACS)?

    <p>Vasomotor hyperreactivity and coronary vasospasm</p> Signup and view all the answers

    What makes platelet-rich thrombi more resistant to fibrinolysis in ACS?

    <p>Platelets play a major role in the thrombotic response to rupture of coronary artery plaque</p> Signup and view all the answers

    What is the characteristic feature of stable angina pectoris?

    <p>Pain relieved by rest or nitroglycerin</p> Signup and view all the answers

    What is the approximate percentage of deaths from cardiovascular disease that occur in women?

    <p>40%</p> Signup and view all the answers

    What characterizes stable fibrous plaques in CAD?

    <p>Less than 50% stenotic</p> Signup and view all the answers

    What provided an important tool in the management of sudden cardiac death?

    <p>Angiographic studies</p> Signup and view all the answers

    What characterizes increasing or progressive angina?

    <p>Becomes more frequent, prolonged, or severe</p> Signup and view all the answers

    What is the primary role of platelets in the thrombotic response to rupture of coronary artery plaque and subsequent ACS?

    <p>Play a major role in the thrombotic response</p> Signup and view all the answers

    What is the primary challenge in diagnosing ACS in the prehospital setting?

    <p>Limited adjunctive diagnostic tools</p> Signup and view all the answers

    Which population may exhibit less remarkable ACS presentations?

    <p>Women</p> Signup and view all the answers

    What is a nontraditional symptom of ACS frequently exhibited by diabetic patients?

    <p>Dyspnea</p> Signup and view all the answers

    What is the impact of prehospital 12-lead ECG on paramedic scene time?

    <p>Increases by only 1 to 3 minutes</p> Signup and view all the answers

    What is the primary challenge in diagnosing ACS in the prehospital setting?

    <p>Limited availability of adjunctive diagnostic tools</p> Signup and view all the answers

    What offers high specificity and positive predictive value for STEMI in patients with atraumatic chest pain?

    <p>Prehospital 12-lead ECG</p> Signup and view all the answers

    What are nontraditional symptoms of ACS frequently exhibited by diabetic patients?

    <p>Dyspnea</p> Signup and view all the answers

    What do older adults commonly note as the primary manifestation of ACS?

    <p>Extreme weakness</p> Signup and view all the answers

    What is a common atypical symptom of Acute Coronary Syndrome (ACS) frequently exhibited by diabetic patients?

    <p>Dyspnea</p> Signup and view all the answers

    What is the primary manifestation of ACS in older adults, according to the text?

    <p>Extreme weakness</p> Signup and view all the answers

    What is the key challenge in diagnosing ACS in the prehospital setting?

    <p>Chest pain being a poor predictor of AMI diagnosis</p> Signup and view all the answers

    What is the impact of prehospital 12-lead ECG on paramedic scene time, according to the text?

    <p>Increases by only 1 to 3 minutes</p> Signup and view all the answers

    Which symptom is the most common angina equivalent presentation in ACS?

    <p>Dyspnea</p> Signup and view all the answers

    What should raise suspicion of ACS in the absence of a known history of gastroesophageal reflux disease?

    <p>Heartburn</p> Signup and view all the answers

    Which symptoms are very uncommon sole presenting symptoms in ACS?

    <p>Nausea, emesis, anxiety, and fatigue</p> Signup and view all the answers

    What is a common misdiagnosis in cases of missed AMI?

    <p>Gastroesophageal and upper gastrointestinal (GI) maladies</p> Signup and view all the answers

    Which term refers to a tightening sensation, not necessarily a pain?

    <p>Angina</p> Signup and view all the answers

    Which structures can be involved in the radiation of discomfort associated with angina pectoris?

    <p>Neck, jaw, shoulders, or arms</p> Signup and view all the answers

    Which symptoms are characteristically associated with angina pectoris?

    <p>Nausea, vomiting, diaphoresis, weakness</p> Signup and view all the answers

    What are the usual locations for discomfort associated with angina pectoris?

    <p>Substernal or precordial</p> Signup and view all the answers

    Which of the following is a characteristic feature of angina pectoris?

    <p>Discomfort described as a tightness or pressure</p> Signup and view all the answers

    What structures can be involved in the radiation of discomfort associated with angina pectoris?

    <p>Both arms and shoulders</p> Signup and view all the answers

    Which symptoms are characteristically associated with angina pectoris?

    <p>Nausea and diaphoresis</p> Signup and view all the answers

    What is a term used to describe symptoms that arise without chest discomfort as a presenting pattern of known ischemic coronary disease?

    <p>Atypical angina</p> Signup and view all the answers

    Which symptom is the most common angina equivalent presentation of ACS?

    <p>Dyspnea</p> Signup and view all the answers

    What should raise suspicion of ACS in the absence of a known history of gastroesophageal reflux disease?

    <p>Heartburn</p> Signup and view all the answers

    Which presenting complaint may occasionally occur as the single presenting complaint in the ACS patient, especially in the extreme older patient population?

    <p>Excessive fatigue</p> Signup and view all the answers

    What is a common misdiagnosis in cases of missed AMI?

    <p>Upper gastrointestinal maladies</p> Signup and view all the answers

    What is a possible atypical feature of pain in ACS?

    <p>Pleuritic or positional pain</p> Signup and view all the answers

    Which factor is associated with presentations of ACS that do not feature classic anginal pain?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What symptom is notably present in patients with AMI below age 85?

    <p>Dyspnea</p> Signup and view all the answers

    What percentage of ED patients ultimately diagnosed with AMI did not have chest pain on presentation?

    <p>One-third</p> Signup and view all the answers

    What is the most common anginal equivalent complaint in patients older than 85 years?

    <p>Dyspnea</p> Signup and view all the answers

    Which population is at heightened risk for ACS and presenting with anginal equivalents?

    <p>Patients with diabetes mellitus</p> Signup and view all the answers

    What is a significant risk factor for AMI without a classic chest pain presentation?

    <p>Female sex</p> Signup and view all the answers

    What symptom is less likely to be attributed to cardiac symptoms by women?

    <p>Indigestion</p> Signup and view all the answers

    What is a disparity in treatment approaches related to race and ethnicity in patients with acute manifestations of coronary heart disease?

    <p>Underrecognized symptoms in ACS</p> Signup and view all the answers

    What characteristic is associated with worse outcomes in ACS presentations without classic anginal chest pain?

    <p>Delayed diagnosis and treatment</p> Signup and view all the answers

    What is the primary focus of diagnostic and management issues for acute myocardial infarction (AMI)?

    <p>Recognizing varied presentations of ACS</p> Signup and view all the answers

    What should emergency clinicians consider for all patients presenting with any chest discomfort, shortness of breath, weakness, dizziness, nausea, or vomiting?

    <p>The diagnosis of ACS</p> Signup and view all the answers

    Which symptom may serve as an anginal equivalent in patients with ACS?

    <p>Dyspnea</p> Signup and view all the answers

    What is a common feature of ACS presentations without classic anginal chest pain?

    <p>Dementia</p> Signup and view all the answers

    What percentage of ED patients ultimately diagnosed with AMI did not have chest pain on presentation?

    <p>33%</p> Signup and view all the answers

    What symptoms are notably present in patients below age 85 with AMI?

    <p>Dyspnea, stroke, weakness, and altered mental status</p> Signup and view all the answers

    What is a common atypical symptom of Acute Coronary Syndrome (ACS) frequently exhibited by diabetic patients?

    <p>All of the above</p> Signup and view all the answers

    Which age group is more likely to have an anginal equivalent complaint, especially dyspnea?

    <p>Patients aged 85 years and older</p> Signup and view all the answers

    What is a significant risk factor for AMI without a classic chest pain presentation?

    <p>Female sex</p> Signup and view all the answers

    What is a disparity in treatment approaches related to in patients with acute manifestations of coronary heart disease?

    <p>Race and ethnicity</p> Signup and view all the answers

    What is the approximate increased in-hospital mortality for patients aged 85 years and older compared to those aged 65 years or younger?

    <p>10%</p> Signup and view all the answers

    What do women with AMI frequently attribute their cardiac symptoms to?

    <p>Anxiety</p> Signup and view all the answers

    What is a heightened risk factor for ACS and presenting with anginal equivalents?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What is more likely to occur in older adults due to physiologic stress from another acute condition (e.g., trauma, infection)?

    <p>Concurrent coronary ischemia</p> Signup and view all the answers

    What are common findings in patients with severe forms of unstable angina (UA) and acute myocardial infarction (AMI)?

    <p>Bradycardia, tachycardia, hypotension, and pulmonary edema</p> Signup and view all the answers

    What is the real incidence of reproducible chest wall tenderness in ACS?

    <p>Extremely rare</p> Signup and view all the answers

    What percentage of patients with acute myocardial infarction (AMI) experience bradydysrhythmia and atrioventricular (AV) conduction blocks?

    <p>25% to 30%</p> Signup and view all the answers

    What findings are associated with the ill ACS patient?

    <p>Pale appearance, anxiety, and diaphoresis</p> Signup and view all the answers

    What is the response pattern of atropine in symptomatic bradydysrhythmias in the first few hours after inferior STEMI?

    <p>Atropine tends to be responsive</p> Signup and view all the answers

    What is the prognosis for patients with AV block in the setting of anterior STEMI?

    <p>Poor response to therapy and poor prognosis</p> Signup and view all the answers

    When does primary ventricular fibrillation commonly occur in patients with AMI?

    <p>Within the first 4 hours of AMI</p> Signup and view all the answers

    How is cardiogenic shock defined in the context of acute myocardial infarction (AMI)?

    <p>End-organ hypoperfusion resulting from decreased cardiac output unresponsive to restoration of adequate preload</p> Signup and view all the answers

    What is a common finding in patients with severe forms of unstable angina (UA) and acute myocardial infarction (AMI)?

    <p>Pale appearance, anxiety, and diaphoresis</p> Signup and view all the answers

    What is the real incidence of reproducible chest wall tenderness in patients with ACS?

    <p>Extremely rare</p> Signup and view all the answers

    What is the occurrence rate of bradydysrhythmia and atrioventricular (AV) conduction blocks in patients with AMI?

    <p>25% to 30%</p> Signup and view all the answers

    What is the significance of sinus bradycardia in the context of AMI?

    <p>It is usually seen</p> Signup and view all the answers

    Which type of bradydysrhythmias in the setting of AMI tend not to respond to atropine?

    <p>Conduction abnormalities appearing beyond 24 hours of AMI</p> Signup and view all the answers

    What is the estimated percentage of patients with AMI who experience primary ventricular fibrillation within the first 4 hours?

    <p>60%</p> Signup and view all the answers

    What is cardiogenic shock defined as in the context of acute myocardial infarction (AMI)?

    <p>End-organ hypoperfusion resulting from decreased cardiac output unresponsive to restoration of adequate preload</p> Signup and view all the answers

    Which statement is true regarding tachydysrhythmias in the setting of AMI?

    <p>Tachydysrhythmias may be atrial or ventricular in origin and not all require treatment</p> Signup and view all the answers

    What is a potentially life-threatening condition that should be strongly considered when evaluating a patient for nontraumatic chest pain?

    <p>Pulmonary embolism</p> Signup and view all the answers

    Which condition is considered a non–life-threatening cause of nontraumatic chest pain, but can lead to significant morbidity?

    <p>Costochondritis</p> Signup and view all the answers

    What condition is included in the differential diagnosis of ACS and is characterized by various gastrointestinal maladies?

    <p>Esophageal perforation</p> Signup and view all the answers

    Which of the following is a non–life-threatening cause of nontraumatic chest pain?

    <p>Costochondritis</p> Signup and view all the answers

    What should be strongly considered when evaluating a patient for nontraumatic chest pain?

    <p>Pulmonary embolism</p> Signup and view all the answers

    Which condition is characterized by myocardial cell death but not ST segment elevation?

    <p>Non-STEMI</p> Signup and view all the answers

    What ECG finding is diagnostic for ST-elevation myocardial infarction (STEMI)?

    <p>New ST elevation of greater than 1 mm in at least two contiguous leads</p> Signup and view all the answers

    What ECG finding indicates an increased cardiovascular risk in the context of ACS?

    <p>Total ST segment deviation</p> Signup and view all the answers

    What does ST segment elevation on ECG establish candidacy for in the management of ACS?

    <p>Emergent reperfusion therapy</p> Signup and view all the answers

    Why is rhythm determination essential in the context of ACS?

    <p>To identify compromising dysrhythmias</p> Signup and view all the answers

    What is a limitation of the diagnostic abilities of the ECG in ACS?

    <p>Individual variations in coronary anatomy and preexisting coronary disease</p> Signup and view all the answers

    What is emphasized as the most important diagnostic study for patients with chest symptoms?

    <p>The patient’s reported history and the emergency clinician’s interpretation of that history</p> Signup and view all the answers

    What is a key consideration regarding the interpretation of a single ECG in isolation?

    <p>It is neither 100% sensitive nor 100% specific for AMI</p> Signup and view all the answers

    What can be misleading when evaluating a currently asymptomatic patient with a history of intermittent anginal chest pain?

    <p>A normal or nonspecifically abnormal ECG</p> Signup and view all the answers

    What is important to consider about the elapsed time from symptom onset to normal ECGs in ruling out AMI?

    <p>It does not necessarily rule out an AMI even up to 12 hours after symptom onset</p> Signup and view all the answers

    What can happen to patients with an initial nondiagnostic ECG who later develop AMI during hospitalization?

    <p>They are often pain-free or minimally uncomfortable on initial ED presentation</p> Signup and view all the answers

    What should not be overemphasized when evaluating a currently asymptomatic patient with a history of intermittent anginal chest pain?

    <p>A normal or nonspecifically abnormal ECG</p> Signup and view all the answers

    What remains uncertain despite morphologic changes that may occur in ACS?

    <p>Current clinical use of ECG information</p> Signup and view all the answers

    Which ECG finding is diagnostic for ST-elevation myocardial infarction (STEMI)?

    <p>New ST elevation of greater than 1 mm in at least two contiguous leads, except for leads V2 and V3</p> Signup and view all the answers

    What ECG finding may indicate an increased cardiovascular risk in the context of ACS?

    <p>Total ST segment deviation</p> Signup and view all the answers

    What does the presence of LBBB on ECG suggest in the context of ACS?

    <p>Diagnosis of STEMI</p> Signup and view all the answers

    What does the ST segment elevation on ECG establish in the context of ACS?

    <p>Candidacy for emergent reperfusion therapy</p> Signup and view all the answers

    What is the role of the ECG in diagnosing ACS?

    <p>It may be normal or nonspecifically abnormal in early ACS events</p> Signup and view all the answers

    What limits the diagnostic abilities of the ECG in ACS?

    <p>Variations in coronary anatomy and preexisting coronary disease</p> Signup and view all the answers

    What should not be overemphasized when interpreting a normal or nonspecifically abnormal ECG?

    <p>The elapsed time from symptom onset to the normal ECG</p> Signup and view all the answers

    What is the most important diagnostic study for patients with an initial nondiagnostic ECG?

    <p>The patient's reported history and interpretation by the emergency clinician</p> Signup and view all the answers

    What is a potential consequence of relying solely on a single ECG for diagnosing ACS?

    <p>Missing early ACS events, including AMI</p> Signup and view all the answers

    What is often seen in patients with an initial nondiagnostic ECG who later develop AMI during hospitalization?

    <p>&quot;Pain-free&quot; or minimally uncomfortable presentation at first</p> Signup and view all the answers

    What is one limitation of using a single ECG to rule out AMI?

    <p>High negative predictive value but not 100% sensitive even up to 12 hours after symptom onset</p> Signup and view all the answers

    What remains uncertain about the current clinical use of ECG information in diagnosing ACS?

    <p>The diagnostic abilities of the ECG</p> Signup and view all the answers

    What is emphasized as more important than a single ECG for diagnosing ACS?

    <p>Patient's reported history and interpretation by emergency clinician</p> Signup and view all the answers

    What is a common finding in ECGs of adults with chest pain?

    <p>ST segment elevation</p> Signup and view all the answers

    What is a characteristic of the ST segment elevation in 'benign early repolarization' (BER)?

    <p>Concave morphology</p> Signup and view all the answers

    How is ST segment elevation of 'benign early repolarization' (BER) different from the pathologic ST segment elevation of STEMI?

    <p>BER is a normal finding, while STEMI is a dynamic phenomenon</p> Signup and view all the answers

    What should be used as the baseline when measuring ST segment elevation?

    <p>The most definable, constant baseline evident on the ECG</p> Signup and view all the answers

    What is the earliest electrocardiographic finding in STEMI?

    <p>Hyperacute T wave</p> Signup and view all the answers

    In addition to acute ischemia, what else can cause tall T waves on an ECG?

    <p>Hyperkalemia</p> Signup and view all the answers

    What morphologic variations of ST segment elevation can be seen in STEMI?

    <p>&quot;Tombstoned&quot; elevation</p> Signup and view all the answers

    What characterizes the upsloping portion of the ST segment in STEMI?

    <p>&quot;Progresses as it elevates&quot;</p> Signup and view all the answers

    What is the earliest electrocardiographic finding in STEMI?

    <p>Hyperacute T wave</p> Signup and view all the answers

    What may be included in the differential diagnosis of the tall T wave seen in acute ischemia?

    <p>Hyperkalemia</p> Signup and view all the answers

    What morphologic variations of ST segment elevation can be seen as STEMI progresses?

    <p>&quot;Tombstoned&quot; elevation</p> Signup and view all the answers

    What is a potential cause for concave or scooped elevation of the ST segment in STEMI?

    <p>Ischemia in specific myocardial regions</p> Signup and view all the answers

    What is the baseline typically used when measuring ST segment elevation on an ECG?

    <p>TP segment</p> Signup and view all the answers

    In what population is 'benign early repolarization' (BER) commonly seen?

    <p>Young males</p> Signup and view all the answers

    What differentiates normal ST segment elevation from the pathologic ST segment elevation of STEMI?

    <p>The latter is a dynamic phenomenon</p> Signup and view all the answers

    What type of ST segment elevation morphology is atypical for STEMI?

    <p>Concave morphology</p> Signup and view all the answers

    Which type of myocardial infarction is characterized by myocardial cell death and ST segment elevation?

    <p>STEMI</p> Signup and view all the answers

    Where is the reciprocal ST segment depression best seen in an inferior MI?

    <p>Lead aVL</p> Signup and view all the answers

    What do reciprocal changes in the setting of STEMI increase?

    <p>Specificity of ECG in AMI</p> Signup and view all the answers

    In which leads may anterior STEMI feature reciprocal ST segment depression?

    <p>Leads II, III, or aVF</p> Signup and view all the answers

    What does ST segment depression generally represent in ED patients with chest pain or anginal equivalent?

    <p>Subendocardial ischemia</p> Signup and view all the answers

    What type of contour is less frequently associated with ischemic ST segment depression?

    <p>Upsloping</p> Signup and view all the answers

    In which condition can subendocardial ischemic ST segment depression be diffuse, spanning anterior and inferior leads?

    <p>Unstable angina or NSTEMI</p> Signup and view all the answers

    Which condition is included in the differential diagnosis of ST segment depression?

    <p>Pulmonary embolism</p> Signup and view all the answers

    Which ECG finding may indicate reciprocal ST segment depression with STEMI?

    <p>ST segment elevation in leads V8 and V9</p> Signup and view all the answers

    In which type of MI is reciprocal ST segment depression more frequently manifested in lead aVL?

    <p>Inferior MI</p> Signup and view all the answers

    Which ECG finding characterizes reciprocal changes in the setting of STEMI?

    <p>ST segment depression in lead III</p> Signup and view all the answers

    Where is reciprocal ST segment depression best seen in the case of inferior MI?

    <p>Lead aVL</p> Signup and view all the answers

    Which of the following is a less frequently associated contour with ischemic ST segment depression?

    <p>Upsloping</p> Signup and view all the answers

    In the context of Acute Coronary Syndrome (ACS), which condition may cause ST segment depression and can be a differential diagnosis?

    <p>Pulmonary embolism</p> Signup and view all the answers

    What type of ECG finding is diagnostic for ST-elevation myocardial infarction (STEMI)?

    <p>ST segment elevation</p> Signup and view all the answers

    Which condition can mimic ischemic ST segment depression on an ECG?

    <p>Ventricular hypertrophy</p> Signup and view all the answers

    In which leads are T waves normally upright?

    <p>Leads I, II, and V3 to V6</p> Signup and view all the answers

    Which type of T wave inversions is associated with Wellens syndrome?

    <p>Deep symmetrical (type I) or biphasic (type II) T wave changes in the anterior precordial leads</p> Signup and view all the answers

    Where are T wave vectors normally variable?

    <p>Leads III, aVL, and aVF</p> Signup and view all the answers

    How are T wave inversions of ACS classically described?

    <p>Narrow and symmetrical</p> Signup and view all the answers

    In which leads are T waves normally upright?

    <p>Leads I, II, and V3 to V6</p> Signup and view all the answers

    Which type of T wave inversions are classically narrow and symmetrical in ACS?

    <p>Deep symmetrical T wave inversions (type I)</p> Signup and view all the answers

    In which leads are T waves normally inverted?

    <p>Lead aVR</p> Signup and view all the answers

    Where may T waves be normally inverted in addition to lead V1?

    <p>Lead V2</p> Signup and view all the answers

    Which leads primarily reflect septal involvement in anterior infarctions?

    <p>Leads V1 and V2</p> Signup and view all the answers

    In anterior STEMI, reciprocal ST segment depression may occur in which leads?

    <p>Leads III and aVF</p> Signup and view all the answers

    ST segment elevation in lead aVR should prompt consideration of occlusion of which artery?

    <p>Left main coronary artery</p> Signup and view all the answers

    Which artery is likely to be involved when the ST segment elevation extends to leads I and aVL?

    <p>First diagonal branch of the left anterior descending artery</p> Signup and view all the answers

    Which artery is usually responsible for serving the inferior wall of the heart and AV node?

    <p>Right coronary artery</p> Signup and view all the answers

    What ECG finding indicates occlusion of the left circumflex coronary artery or first diagonal?

    <p>ST elevation in leads I and aVL with reciprocal ST segment depression in leads III, aVF, and V1</p> Signup and view all the answers

    What is the characteristic ECG finding associated with de Winter ECG pattern?

    <p>Prominent T waves with J point depression producing ST segment depression seen in the precordial leads, coupled with ST segment elevation in lead aVR</p> Signup and view all the answers

    What may ST segment elevation in lead V1 in the presence of an inferior MI suggest?

    <p>Concomitant right ventricular infarction</p> Signup and view all the answers

    What is the characteristic feature of high lateral infarctions?

    <p>ST elevation in leads I and aVL suggesting occlusion of the left circumflex coronary artery or first diagonal</p> Signup and view all the answers

    What is the characteristic ECG finding associated with lateral infarctions?

    <p>Changes in some or all of the lateral leads I, aVL, V5, and V6 with reciprocal ST segment depression seen in leads III, aVF, and V1</p> Signup and view all the answers

    What is indicated by ST segment depression in leads V1 to V3 during an inferior MI?

    <p>Reciprocal change</p> Signup and view all the answers

    What may be associated with diffuse endocardial ischemia due to hypoperfusion?

    <p>ST segment elevation greater in lead III than in lead II, accompanied by ST segment depression in lead aVL</p> Signup and view all the answers

    What is suggested by greater ST segment elevation occurring alongside greater elevation occurring on either leads aVR or V1?

    <p>Left main disease when occurring alongside greater ST segment elevation occurs on either leads aVR or V1</p> Signup and view all the answers

    Which leads primarily reflect changes in septal involvement in anterior infarctions?

    <p>V1 and V2</p> Signup and view all the answers

    In anterior STEMI, which leads may show reciprocal ST segment depression?

    <p>III and aVF</p> Signup and view all the answers

    Which artery serves the anterior wall and its occlusion can lead to anterior or anterolateral STEMI?

    <p>Left anterior descending artery</p> Signup and view all the answers

    What is a high-risk presentation in ACS that should prompt consideration of occlusion of the left main coronary artery?

    <p>ST segment elevation in lead aVR</p> Signup and view all the answers

    Which leads primarily reflect septal involvement in an anterior myocardial infarction?

    <p>V1 and V2</p> Signup and view all the answers

    In anterior STEMI, reciprocal ST segment depression may occur in which leads?

    <p>III and aVF</p> Signup and view all the answers

    Which artery is likely to be involved when the ST segment elevation extends to leads I and aVL in anterior wall STEMI?

    <p>First diagonal branch of the left anterior descending artery</p> Signup and view all the answers

    What should prompt consideration of occlusion of the left main coronary artery in a patient with ACS symptoms?

    <p>ST segment elevation in lead aVR</p> Signup and view all the answers

    What is the characteristic ECG finding associated with de Winter ECG pattern?

    <p>Prominent T waves with J point depression producing ST segment depression in precordial leads, coupled with ST segment elevation in lead aVR</p> Signup and view all the answers

    What has been added to the chest pain evaluation strategy to reduce the total evaluation time and improve throughput?

    <p>Prehospital 12-lead ECG</p> Signup and view all the answers

    What is emphasized as more important than a single ECG for diagnosing ACS?

    <p>Serial ECGs</p> Signup and view all the answers

    What is indicated by ST segment depression in leads V1 to V3 during an inferior MI?

    <p>Reciprocal change</p> Signup and view all the answers

    What do older adults commonly note as the primary manifestation of ACS?

    <p>Chest discomfort</p> Signup and view all the answers

    What ECG findings are suggestive of acute posterior myocardial infarction?

    <p>Horizontal ST segment depression and an upright T wave</p> Signup and view all the answers

    Where does the culprit lesion causing posterior infarctions most commonly occur?

    <p>Right coronary artery</p> Signup and view all the answers

    What percentage of acute myocardial infarction (AMI) cases demonstrate elevated ST segments only in accessory leads, posterior leads V7 through V9?

    <p>5%</p> Signup and view all the answers

    Why is diagnosing acute posterior myocardial infarction challenging with a 12-lead ECG?

    <p>No electrodes are placed directly over the heart’s posterior wall</p> Signup and view all the answers

    What percentage of all AMIs are estimated to be posterior infarctions?

    <p>15%</p> Signup and view all the answers

    Which leads may show reciprocal ST segment changes in the context of acute posterior myocardial infarction?

    <p>Leads V1 to V3</p> Signup and view all the answers

    What combination of findings in leads V1 to V3 increases the diagnostic accuracy for acute posterior MI?

    <p>Horizontal ST segment depression with an upright T wave</p> Signup and view all the answers

    Where may the culprit lesion be located in cases of posterior infarctions?

    <p>Right coronary artery, its posterior descending branch, or left circumflex artery</p> Signup and view all the answers

    What is the association between right ventricular infarctions and inferior MI?

    <p>Right ventricular infarctions are usually associated with inferior MI</p> Signup and view all the answers

    What percentage of inferior infarctions have associated infarction of the right ventricle?

    <p>One-third</p> Signup and view all the answers

    In what type of MI may an anterior MI involve some right ventricular infarction?

    <p>Anterior MI</p> Signup and view all the answers

    In what percentage of inferior infarctions is there associated infarction of the right ventricle?

    <p>Less than 33%</p> Signup and view all the answers

    Which type of myocardial infarction is right ventricular infarction usually associated with?

    <p>Inferior or inferoposterior MI</p> Signup and view all the answers

    What is the likelihood of right ventricular infarction occurring in isolation?

    <p>Rarely occurs in isolation</p> Signup and view all the answers

    Study Notes

    Unstable Angina and Acute Myocardial Infarction Definitions

    • Unstable angina (UA) is different from stable angina and can be severe, possibly indicating an acute myocardial infarction (AMI), and should be treated aggressively in such cases.
    • UA can be defined by the patient's presentation and from a pathophysiologic perspective, involving plaque rupture, thrombus formation, and vasospasm.
    • Variant angina, also known as Prinzmetal angina, is caused by coronary artery vasospasm at rest and may be relieved by exercise or NTG.
    • Acute myocardial infarction involves myocardial cell death with necrosis, and clinical criteria have been developed by the American College of Cardiology (ACC) and European Society for Cardiology (ESC).
    • Myocardial injury is defined by elevated cardiac troponin values, and myocardial infarction is when there is acute myocardial injury with specific symptoms, electrocardiographic abnormalities, imaging evidence, or angiographic evidence.
    • The classification of AMI includes types 1 through 5, each representing different clinical situations.
    • The five primary types of infarction are described by the classification: spontaneous MI, MI secondary to ischemia, sudden unexpected cardiac death, MI associated with coronary instrumentation, and MI associated with coronary artery bypass grafting.
    • Diagnostic and management issues for AMI differ depending on the subtype of MI encountered.
    • Serum markers and ECG abnormalities classify AMI at presentation as either NSTEMI or STEMI, with important implications for management, outcome, and prognosis.
    • Previous descriptors, such as transmural, non-transmural, Q wave, and non-Q wave MI, fail to adequately describe the coronary event and its related pathophysiology, electrocardiographic presentation, and pathologic outcome.
    • The differentiation between STEMI and NSTEMI has important implications in management, outcome, and prognosis for patients with AMI.

    Unstable Angina and Acute Myocardial Infarction Definitions

    • Unstable angina (UA) is different from stable angina and can be severe, possibly indicating an acute myocardial infarction (AMI), and should be treated aggressively in such cases.
    • UA can be defined by the patient's presentation and from a pathophysiologic perspective, involving plaque rupture, thrombus formation, and vasospasm.
    • Variant angina, also known as Prinzmetal angina, is caused by coronary artery vasospasm at rest and may be relieved by exercise or NTG.
    • Acute myocardial infarction involves myocardial cell death with necrosis, and clinical criteria have been developed by the American College of Cardiology (ACC) and European Society for Cardiology (ESC).
    • Myocardial injury is defined by elevated cardiac troponin values, and myocardial infarction is when there is acute myocardial injury with specific symptoms, electrocardiographic abnormalities, imaging evidence, or angiographic evidence.
    • The classification of AMI includes types 1 through 5, each representing different clinical situations.
    • The five primary types of infarction are described by the classification: spontaneous MI, MI secondary to ischemia, sudden unexpected cardiac death, MI associated with coronary instrumentation, and MI associated with coronary artery bypass grafting.
    • Diagnostic and management issues for AMI differ depending on the subtype of MI encountered.
    • Serum markers and ECG abnormalities classify AMI at presentation as either NSTEMI or STEMI, with important implications for management, outcome, and prognosis.
    • Previous descriptors, such as transmural, non-transmural, Q wave, and non-Q wave MI, fail to adequately describe the coronary event and its related pathophysiology, electrocardiographic presentation, and pathologic outcome.
    • The differentiation between STEMI and NSTEMI has important implications in management, outcome, and prognosis for patients with AMI.

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