Open AccessEarly Diagnosis and Management of Non ST-Segment Elevation Acute Myocardial Infarction
Author(s) -
Sang Min Park,
Sung Kee Ryu,
Mi-seung Shin
Publication year - 2022
Publication title -
the korean journal of medicine
Language(s) - English
Resource type - Journals
eISSN - 2289-0769
pISSN - 1738-9364
DOI - 10.3904/kjm.2022.97.2.108
Subject(s) - medicine , myocardial infarction , cardiology , troponin , chest pain , revascularization , percutaneous coronary intervention , cardiac catheterization , myocardial infarction diagnosis , emergency department , st segment , acute coronary syndrome , coronary artery disease , electrocardiography , psychiatry
Acute myocardial infarction (MI) is a cardiovascular disease with high mortality. Acute MI is usually divided into ST-segment elevation MI (STEMI) and non ST-segment elevation MI (NSTEMI) based on the electrocardiogram (ECG). NSTEMI is often misdiagnosed in patients presenting to emergency departments with acute chest pain because its clinical course varies and is atypical compared to STEMI. The symptoms can be vague and the ECG is often not diagnostic. In this setting, an early accurate diagnosis and risk stratification could improve the mortality of patients with NSTEMI. Cardiac biomarkers such as high-sensitivity cardiac troponin (hs-cTn) help to diagnose NSTEMI. Serial hs-cTn assays should be considered to differentiate other conditions, especially in an ambiguous clinical situation. If acute MI is strongly suspected based on the symptoms, ECG, and cardiac biomarkers, catheterization laboratory activation should be timely considered to evaluate the coronary arteries and possible revascularization with percutaneous or surgical strategies depending on risk factors. After successful revascularization, antianginal medications, risk factor control, and early recognition of heart failure are essential to improve the cardiovascular prognosis.