Narrative Review: Myocardial Infarction: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 96: Line 96:


'''Echocardiogram / Date:'''
'''Echocardiogram / Date:'''
* Trans-Thoracic Echocardiogram (TTE):  Left Ventricular Ejection fraction   Left Ventricular Size  Mitral regurgitation - severity  Mitral stenosis - severity Aortic valve stenosis - severity  Aortic regurgitation - severity  
* Trans-Thoracic Echocardiogram (TTE):  
 
** Left Ventricular Ejection fraction   
** Left Ventricular Size  Mitral regurgitation - severity  
** Mitral stenosis - severity  
** Aortic valve stenosis - severity  
** Aortic regurgitation - severity  
 
** Regional wall motion abnormalities:  
** Regional wall motion abnormalities:  
*** Absence or reduction of systolic thickening  
*** Absence or reduction of systolic thickening  

Revision as of 19:21, 26 June 2018

Narrative Review

Narrative Review: Death

Narrative Review: Stroke

Narrative Review: Myocardial Infarction

Narrative Review: Acute Kidney Injury

Narrative Review: Bleeding

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

Patients 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)


Past Medical History: [eg. CAD, severe mitral stenosis, former tobacco use, dyslipidemia, ...]

Past Surgical History: [including date]

Medications: [relevant to the event not all]

Echocardiogram / Date:

  • Trans-Thoracic Echocardiogram (TTE):  
    • Left Ventricular Ejection fraction  
    • Left Ventricular Size Mitral regurgitation - severity  
    • Mitral stenosis - severity
    • Aortic valve stenosis - severity  
    • Aortic regurgitation - severity
    • 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
  • 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.

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

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.

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.

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

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.
    • 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 compliant.
    • 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]