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Questions and Answers
What is the preferred biomarker for determining myocardial infarction?
What is the preferred biomarker for determining myocardial infarction?
Cardiac troponin
T wave inversion is the first manifestation of acute coronary occlusion.
T wave inversion is the first manifestation of acute coronary occlusion.
True (A)
What do ST segment changes in an ECG represent in the context of acute cardiac ischemia?
What do ST segment changes in an ECG represent in the context of acute cardiac ischemia?
- Acute coronary occlusion (correct)
- Acute cardiac hypertrophy
- Acute cardiac inflammation
- Acute cardiac arrhythmia
Cardiac troponin levels don't begin to rise until ____ hours post myocardial infarction.
Cardiac troponin levels don't begin to rise until ____ hours post myocardial infarction.
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Study Notes
New Onset Severe Angina
- Characterized by increasing angina frequency and duration in previously diagnosed angina patients
ECG Interpretation
- 12-lead ECG should be obtained within 10 minutes of ED arrival
- ST segment changes indicate acute cardiac ischemia
- ST segment changes (≥ 0.05 mV) or T-wave inversion in 2 or more contiguous leads are diagnostic criteria
- ECG provides information on infarct location and size
- Areas of infarction do not produce electrical activity
- T-wave changes are the first manifestation of acute coronary occlusion (ischemia)
- T-wave inversion occurs first, followed by ST segment changes
- ST segment depression indicates lengthening of repolarization (NSTE-ACS), suggesting non-fully occluded vessels
- ST segment elevation indicates injury from ischemia extending from subendocardial to subepicardial regions (transmural ischemia), suggesting fully occluded vessels and STEMI
Laboratory Tests
- Cardiac troponin is the preferred biomarker for cardiac injury
- Troponin levels do not rise until 6 hours post-MI
- Elevated troponin levels can last up to 10-14 days
- Creatine Kinase MB fraction (CK-MB) and myoglobin are less sensitive and not recommended for myocardial infarction diagnosis
- B-type natriuretic peptide (BNP) can be added to the diagnostic panel
Diagnosis
- No cardiac biomarkers: Unstable Angina
- Positive cardiac biomarkers: NSTEMI
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