The following applies to patients with acute chest pain and suspected ACS. Clinical triad in right ventricular infarction : hypotension, elevated jugular venous pressure, clear lung fields Ĭlassically, it has been taught that STEMI manifests with more severe symptoms than NSTEMI, but this is not always the case.More common in inferior wall infarction.Autonomic symptoms (e.g., nausea, diaphoresis).Atypical presentations : more likely in elderly, diabetic individuals, and women.New heart murmur on auscultation (e.g., new S 4 ).Symptoms of CHF (e.g., orthopnea, pulmonary edema) or cardiogenic shock (e.g., hypotension, tachycardia, cold extremities).The peak time of occurrence is usually in the morning.Symptom relief after administration of nitrates is not a diagnostic criterion for cardiac ischemia.Commonly radiates to left chest, arm, shoulder, neck, jaw, and/or epigastrium.Typical: dull, squeezing pressure and/or tightness.STEMI) is determined based on ECG findings. Unstable angina is differentiated from MI by the presence of positive troponins, while the type of MI ( NSTEMI vs. Subtypes of ACS cannot be differentiated based on clinical presentation alone. See “ Acute management checklist for STEMI.”.Adjunctive medical therapy similar to NSTE-ACS.See “ Acute management checklist for NSTE-ACS.”.Anticoagulants, antiplatelet therapy (e.g., aspirin, ADP receptor inhibitors).Invasive management depends on risk stratification (e.g., TIMI score).ST elevations (in two contiguous leads) or new left bundle branch block with strong clinical suspicion of myocardial ischemia.Normal or nonspecific (e.g., ST depression, loss of R wave, T-wave inversion).Affects the full thickness of the myocardium ( transmural infarction).Classically due to complete occlusion of a coronary artery.Affects the inner layer of the heart ( subendocardial infarction).Classically due to partial occlusion of a coronary artery.Partial occlusion of coronary vessel → decreased blood supply → ischemic symptoms without infarction.Autonomic symptoms may be present: diaphoresis, syncope, palpitations, nausea, and/or vomiting.Severe, persistent, and/or worsening ( crescendo angina). Occurring at rest/with minimal exertion and is usually not relieved by rest or nitroglycerin.Symptoms are not reproducible/predictable.Acute myocardial ischemia that is severe enough to cause ST-segment elevations on ECG.
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