Non ST Elevation Myocardial Infarction: Diagnosis
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Laboratory Findings
Electrolyte and Biomarker Studies
If there is an elevation of a marker of myocardial necrosis (CK-MB or troponin), then the patient does not have unstable angina, but instead has a syndrome of either ST elevation MI or Non ST elevation MI depending upon the EKG changes.
Electrocardiogram
The resting electrocardiogram may show either
- No changes
- Flipped T waves
- ST Depression as shown to the right. ST depression carries the poorest prognosis.
Chest X Ray
A Chest X Ray is critical to aid in the exclusion of aortic dissection.
A mediastinal mass consistent with a cancer may be present, but it is unlikely to present with a syndrome of accelerating chest pain.
Differential Diagnosis of Chest Pain
Cardiovascular
- Acute Aortic Dissection
- Acute Coronary Syndrome
- Angina
- Aortic Aneurysm
- Aortic Stenosis
- Arryhthmias
- Bland-White-Garland Syndrome
- Cardiac tamponade
- Cor pulmonale
- Coronary Heart Disease
- Dressler's syndrome (postpericardiotomy)
- Functional cardiac problems
- Hypertrophic Cardiomyopathy
- Mitral valve prolapse
- Myocarditis
- Non ST Elevation Myocardial Infarction
- Pericardial tamponade
- Pericarditis
- ST Elevation Myocardial Infarction
References
- PMID 16046952
- PMID 17692756
- Bickley, LS (2003). Bates' Guide to Physical Examination and History Taking. Lippincott: Philadelphia, PA. ISBN 0781735114