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[4] [6] Unstable angina is considered to be present in patients with ischemic symptoms suggestive of an acute coronary syndrome and no change in troponin levels, with or without changes indicative of ischemia (e.g., ST segment depression or transient elevation or new T wave inversion) on electrocardiograms. [4]
Acute coronary syndrome is subdivided in three scenarios depending primarily on the presence of electrocardiogram (ECG) changes and blood test results (a change in cardiac biomarkers such as troponin levels): [4] ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), or unstable angina. [5]
Other commonly acknowledged criteria necessary for diagnosis include characteristic EKG changes and mild to modest elevation in cardiac troponin. [48] Transient apical ballooning syndrome or takotsubo cardiomyopathy is found in 1.7–2.2% of patients presenting with acute coronary syndrome. [1]
In contrast, ST elevation is transmural (or full thickness) ischemia; Non Q-wave myocardial infarction [3] Reciprocal changes in acute Q-wave myocardial infarction (e.g., ST depression in leads I & aVL with acute inferior myocardial infarction) [3] ST segment depression and T-wave changes may be seen in patients with unstable angina
Elevated troponin levels are prognostically important in many of the conditions in which they are used for diagnosis. [ 36 ] In a community-based cohort study indicating the importance of silent cardiac damage, troponin I has been shown to predict mortality and first coronary heart disease event in men free from cardiovascular disease at ...
An ECG, which is a recording of the heart's electrical activity, may confirm an ST elevation MI , if ST elevation is present. [8] [15] Commonly used blood tests include troponin and less often creatine kinase MB. [7] Treatment of an MI is time-critical. [16] Aspirin is an appropriate immediate treatment for a suspected MI. [9]
Differential diagnosis of troponin elevation includes acute infarction, severe pulmonary embolism causing acute right heart overload, heart failure, myocarditis. Troponins can also calculate infarct size but the peak must be measured in the 3rd day. After myocyte injury, troponin is released in 2–4 hours and persists for up to 7 days.
12-lead electrocardiogram showing ST-segment elevation (orange) in I, aVL and V1-V5 with reciprocal changes (blue) in the inferior leads, indicative of an anterior wall myocardial infarction. The primary purpose of the electrocardiogram is to detect ischemia or acute coronary injury in broad, symptomatic emergency department populations.