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Furthermore, the patient should have intravenous access and oxygen supplementation if oxygen saturation is less than 91%. It utilizes the clinician’s suspicion, patient risk factors, ECG diagnostics, and troponin level to determine the “risk level.”Īll patients with STEMI and NSTEMI require immediately chewed aspirin 160 mg to 325 mg.

The HEART score has been validated and popularized. Given the poor sensitivity of ECG for STEMI, troponins are almost universally used for patients with a suspicious clinical history. There are diagnostic guidelines that can assist the practitioner in determining whether further testing is useful in identifying patients with NSTEMI. ECG without acute changes or any abnormalities is common in NSTEMI.

Serial ECGs can be helpful here as well to look for dynamic changes. Patients with typical chest pain should be investigated for NSTEMI with subtle abnormalities on ECG, including ST-depressions and T wave changes. Patients that present with myocardial infarction may not have diagnostic ST-elevation ECG abnormalities. Wellens noted deeply biphasic T waves in V2, V3 and found they are often predictive of an impending proximal left anterior descending artery occlusion, which may lead to devastating anterior wall myocardial infarction. Isolated ST-elevations in aVR are indicative of left main coronary artery occlusion in the appropriate clinical setting. Sgarbosa described criteria that can assist the physician or practitioner in diagnosing STEMI in these patients. Often, there are ST depressions that are visualized in opposite anatomical regions of the myocardium.ĮCG diagnosis of STEMI can be difficult, particularly in patients with a left bundle branch block and pacemakers.

When present, findings of ST-elevations greater than 2 mm in two contiguous leads on ECG (inferior: leads II, III, aVF septal equal V1, V2 anterior: V3, V4 lateral: I, aVL, V5, V6) are indicative of an ST-elevation myocardial infarction. For example, peaked T-waves on ECG, known as “hyperacute T waves,” often indicate early ischemia and will progress to ST elevation. Right-sided, posterior lead placement, and repeat ECG testing can increase ECG sensitivity. The ECG is highly specific for MI (95% to 97%), yet not sensitive (approximately 30%). All of these presentations should prompt ECG testing, as well. Elderly patients more often have shortness of breath as their presenting symptom for myocardial infarction. Women often have atypical symptoms such as abdominal pain or dizziness and may present without chest pain at all. Early and rapid ECG testing should be employed in all patients presenting with chest pain.

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