Narrative Review: Myocardial Infarction
Jump to navigation
Jump to search
|
Narrative Review |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2] Arzu Kalayci, M.D. [3]
To download narrative review template, click here.
| Site | Patient | AE | Complication | Event date | AE code |
|---|---|---|---|---|---|
| xxx | xxx | x | MM/DD/YYYY | xxx |
Patient summary
Admission date: MM/DD/YYYY
Demographic: [age] year old [gender]
Symptoms (Check from below items):
- Chest pain:
- Duration of chest pain
- Typical Angina Pectoris
- Stable Angina Pectoris
- Unstable Angina Pectoris: O New chest pain O Accelerating O Rest pain
- Prinzmetal’s (Variant) Angina
- Atypical Angina Pectoris
- Non Cardiac Chest Pain
- No Chest Pain
- Symptoms other than chest pain: [explain]
EKG finding (MM/DD/YYYY at XX:XX):
- ST-Elevation ( O Anterior O Inferior O Lateral O Posterior)
- ST-Depression
- T inversion
- LBBB ( New Old Unspecified)
- Pathologic Q Wave
- Ventricular Paced Rhythm
- Other
Heart Biomarkers:
| Date | Time | CKMB (normal ratio) | Troponin (normal ratio) |
| MM/DD/YYYY | XX:XX | ||
| MM/DD/YYYY | XX:XX | ||
| MM/DD/YYYY | XX:XX |
Universal Definition of Myocardial Infarction:
(Check only one)
O Type 1 (Spontaneous)
O Type 2 (Secondary)
O Type 3 (Sudden cardiac death)
O Type 4a (Peri-PCI)
O Type 4b (Stent thrombosis)
O Type 4c (Stent restenosis)
O Type 5 (Peri-CABG)
Echocardiogram / Date:
- Trans-Thoracic Echocardiogram (TTE):
- Left Ventricular Ejection Fraction:
- Left Ventricular Size:
- Mitral regurgitation - Severity:
- Mitral stenosis - Severity:
- Aortic stenosis - Severity:
- Aortic regurgitation - Severity:
- Tricuspid regurgitation - Severity:
- Tricuspid stenosis - Severity:
- Pulmonary artery systolic pressure:
- Regional wall motion abnormalities:
- Absence or reduction of systolic thickening
- Decreased motion: hypokinetic, akinetic, dyskinetic (systolic bulging) and aneurysmal
- Complications:
- Systolic and diastolic dysfunction
- Acute MR from papillary muscle rupture
- Ventricular septal defect
- Pericardial effusion
- Tamponade from free wall rupture
- Mural thrombus
- Ventricular aneurysm and pseudoaneurysm
- Regional wall motion abnormalities:
- Trans-Oesophageal Echocardiogram (TOE):
Myocardial Infarction Ischemic Symptoms/Angina/ACS
O Type 1: Spontaneous
- Note: Don’t adjudicate just on biomarkers
- Spontaneous clinical syndrome; Rise and fall in cardiac biomarkers, preferably troponin with at least one value >99th percentile;
- And at least one of the following:
- Symptoms of myocardial ischemia
- New or presumed new significant ST-segment –T wave (ST–T) changes or new LBBB on the ECG
- Development of pathological Q waves on the ECG
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- Identification of an intracoronary thrombus by angiography or autopsy.
- And at least one of the following:
O Type 2: Ischemic Imbalance
- Spontaneous clinical syndrome; a condition other than CAD contributes to an imbalance; myocardial oxygen and/or demand (coronary endothelial dysfunction, coronary artery spasm, coronary embolism, tachy/bradyarrhythias, anemia, respiratory failure, hypotension/hypertension (with or without LVH; Rise and fall in cardiac biomarkers, preferably troponin with at least one value >99th percentile;
- AND at least one of the following:
- Symptoms of myocardial ischemia
- New or presumed new significant ST-segment–T wave (ST–T) changes or new LBBB on the ECG
- Development of pathological Q waves on the ECG
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- AND at least one of the following:
O Type 3: Sudden Cardiac Death
- Symptoms suggest myocardial ischemia present,
- AND with (presumed) new ischemic changes or new LBBB on ECG
- Death occurs before biomarkers can be obtained or could rise; or (in rare cases) were not collected.
- AND with (presumed) new ischemic changes or new LBBB on ECG
O Type 4a: Related to percutaneous coronary intervention (PCI)
- MI defined by elevation of cTn values >5 x 99th percentile URL in patients with normal baseline values (<99th percentile URL) or a rise of cTn values >20% if the baseline values are elevated and are stable or falling.
- AND at least one of the following:
- (i) symptoms suggestive of myocardial ischemia, or
- (ii) new ischemic ECG changes or new LBBB, or
- (iii) angiographic loss of patency of a major coronary artery or a side branch or persistent slow- or no-flow or embolization, or
- (iv) imaging demonstration of new loss of viable myocardium or new regional wall motion abnormality are required.
- AND at least one of the following:
O Type 4b: Related to stent thrombosis
- MI detected by coronary angiography or autopsy in the setting of myocardial ischemia and with a rise and/ or fall of cardiac biomarkers values
- AND at least one value above the 99th percentile URL.
O Type 4c: Related to stent restenosis
- ≥ 50% stenosis at coronary angiography or a complex lesion associated with a rise and/or fall of cTn values >99th percentile upper reference limit and no other significant obstructive CAD of greater severity following:
- Initially successful stent deployment or
- Dilatation of a coronary artery stenosis with balloon angioplasty (<50%).
O Type 5: CABG Related
- MI associated with and occurring within 48 hours of CABG surgery with elevated biomarkers >10 x 99th percentile of URL in subjects with normal baseline values < or =99th percentile URL.
- AND at least one of the following:
- New pathological Q waves, new LBBB on ECG
- Angiographic new graft or new native coronary artery occlusion.
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- AND at least one of the following:
Procedure
- Index Procedure Date/Time: MM/DD/YYYY at XX:XX [insert date and time]
- Index Procedure Detail:
- On [insert date and time] the subject underwent a [select surgical correction] for [select etiology].
- Enter access site details
- The site reported that there were/were not procedural complication(s).
Event(s)
Event (1):
- Site Reported Event Onset Date: MM/DD/YYYY
- Event summary:
- Symptoms and sign:
- Subject presented with [sign and symptom] on MM/DD/YYYY.
- Important characteristics of the chief complaint such as severity, site, and duration.
- Other important symptoms related to the chief complaint.
- Symptoms and sign:
- Past Medical History: [eg. CAD, Severe mitral stenosis, former tobacco use, dyslipidemia, ...]
- Past Surgical History: [including date]
- Medications: [relevant to the event not all]
- Physical assessment:
- Vital signs
- Positive physical examinations or related negative examinations.
Event (2):
- Site Reported Event Onset Date: MM/DD/YYYY
- Event summary:
- Symptoms and sign:
- Subject presented with [sign and symptom] on MM/DD/YYYY.
- Important characteristics of the chief complaint such as severity, site, and duration.
- Other important symptoms related to the chief complaint.
- Symptoms and sign:
- Past Medical History: [eg. CAD, Severe mitral stenosis, former tobacco use, dyslipidemia, ...]
- Past Surgical History: [including date]
- Medications: [relevant to the event not all]
- Physical assessment:
- Vital signs
- Positive physical examinations or related negative examinations.
Other Laboratory data and Imaging
- CXR / date:
- Other relevant imaging and diagnostic tests / dates
Consults
- Date and time of consult
- Suggested treatments
Clinical course
- Date and time of events
- Patient condition got worse or better.
- Discharge summary
Treatment and outcome
- List of relevant medical treatments
- Outcome [Discharge / Hospice / Death]