Narrative Review: Myocardial Infarction: Difference between revisions

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__NOTOC__
__NOTOC__
{{Narrative Review}}
{{Narrative Review}}
{{CMG}}; {{AE}}{{MJ}}
{{CMG}}; {{AE}}{{MJ}} {{AKK}}
 
'''To download narrative review template, click [[:File:Narrative review-Template.pdf|here]].'''


{| class="wikitable"
{| class="wikitable"
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|x
|x
|
|
|mm/dd/YYYY
|MM/DD/YYYY
|xxx
|xxx
|}
|}


== Demographic / Medical history  ==
== Patient summary ==
* '''Demographic:''' [age] year old [gender]
'''Admission date:''' MM/DD/YYYY
* '''Past Medical History:''' [eg. CAD, severe mitral stenosis, former tobacco use, dyslipidemia, ...]
 
* '''Past Surgical History:''' [including date]
'''Demographic:''' [age] year old [gender]
* '''Medications:''' [relevant to the event not all]
 
'''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: ====
{| class="wikitable"
|'''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)
 
 
'''Echocardiogram / Date:'''
* '''Trans-Thoracic Echocardiogram (TTE):'''  
 
** Left Ventricular Ejection Fraction:   
** Left Ventricular Size: 
** Mitral regurgitation - Severity:  
** Mitral stenosis - Severity:
** Aortic stenosis - Severity:  
** Aortic regurgitation - Severity:
** Tricuspid regurgitation - Severity:
** Tricuspid stenosis - Severity:
** Pulmonary artery systolic pressure:
 
** 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 ==
== Procedure ==
* '''Index Procedure Date/Time''': mm/dd/YYYY at xx:xx  [insert date and time]
* '''Index Procedure Date/Time''': MM/DD/YYYY at XX:XX [insert date and time]
* '''Index Procedure Detail''':   
* '''Index Procedure Detail''':   
** On [insert date and time] the subject underwent a [select surgical correction] for [select etiology].  
** On [insert date and time] the subject underwent a [select surgical correction] for [select etiology].  
** Enter access site details
** Enter access site details
** Baseline MR severity was classified as [select none, trace, mild, mild-moderate, moderate, moderate-severe-severe] and post-implant MR was classified as [select severity].
** The site reported that there were/were not procedural complication(s).
** The site reported that there were/were not procedural complication(s).
== Event(s)==
== Event(s)==
'''Event (1):'''
'''Event (1):'''
*'''Site Reported Event Onset Date:''' mm/dd/YYYY
*'''Site Reported Event Onset Date:''' MM/DD/YYYY  


*'''Event summary''':
*'''Event summary''':
**Symptoms and sign: Subject presented with [sign and symptom] on mm/dd/YYYY.
**'''Symptoms and sign''':
**Important characteristics of the chief complaint such as severity, site, and duration.
***Subject presented with [sign and symptom] on MM/DD/YYYY.
**Other important symptoms related to the chief complaint.
***Important characteristics of the chief complaint such as severity, site, and duration.
**Physical assessment:
***Other important symptoms related to the chief complaint.
 
**'''Past Medical History:''' [eg. CAD, Severe mitral stenosis, former tobacco use, dyslipidemia, ...]
**'''Past Surgical History:''' [including date]
**'''Medications:''' [relevant to the event not all]
**'''Physical assessment:'''
***Vital signs
***Vital signs
***Positive physical examinations or related negative examinations.
***Positive physical examinations or related negative examinations.
'''Event (2):'''
'''Event (2):'''
*'''Site Reported Event Onset Date:''' mm/dd/YYYY
*'''Site Reported Event Onset Date:''' MM/DD/YYYY  
*'''Event summary''':
*'''Event summary''':
**Symptoms and sign: Subject presented with [sign and symptom] on mm/dd/YYYY.
**'''Symptoms and sign''':
**Important characteristics of the chief complaint such as severity, site, and duration.
***Subject presented with [sign and symptom] on MM/DD/YYYY.
**Other important symptoms related to the chief compliant.
***Important characteristics of the chief complaint such as severity, site, and duration.
**Physical assessment:
***Other important symptoms related to the chief complaint.
 
**'''Past Medical History:''' [eg. CAD, Severe mitral stenosis, former tobacco use, dyslipidemia, ...]
**'''Past Surgical History:''' [including date]
**'''Medications:''' [relevant to the event not all]
**'''Physical assessment:'''
***Vital signs
***Vital signs
***Positive physical examinations or related negative examinations.
***Positive physical examinations or related negative examinations.
== Laboratory data and Imaging ==
== Other Laboratory data and Imaging ==
* '''Lab studies:'''
** Troponin levels and timing:
{| class="wikitable"
|'''Date'''
|'''Time'''
|'''CKMB nl: (ratio)'''
|'''Troponin nl: (ratio)'''
|-
|mm/dd/YYYY
|xx:xx
|
|
|-
|mm/dd/YYYY
|xx:xx
|
|
|-
|mm/dd/YYYY
|xx:xx
|
|
|}
** Other laboratory:
*** Date/ name/ value [ as a list ]
 
* '''ECG’s:'''
{| class="wikitable"
!Date
!Time
!Finding
|-
|mm/dd/YYYY
|xx:xx
|
|-
|mm/dd/YYYY
|xx:xx
|
|-
|mm/dd/YYYY
|xx:xx
|
|}
* '''ECHO/ date:'''
** Trans-thoracic:
** Trans-esophagus:
* '''CXR / date:'''  
* '''CXR / date:'''  
* '''Other relevant imaging and diagnostic tests / date:'''
* '''Other relevant imaging and diagnostic tests / dates'''


== Consults ==
== Consults ==
Line 108: Line 204:


== Clinical course ==
== Clinical course ==
* Date and time of events,
* Date and time of events  
* Patient condition got worse or better.
* Patient condition got worse or better.
* Discharge summary


== Treatment and outcome ==
== Treatment and outcome ==
* List of relevant medical treatments
* List of relevant medical treatments
* Out come [Discharge / Hospice / Death]
* Outcome [Discharge / Hospice / Death]

Latest revision as of 00:42, 27 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

Patient 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)


Echocardiogram / Date:

  • Trans-Thoracic Echocardiogram (TTE):  
    • Left Ventricular Ejection Fraction:  
    • Left Ventricular Size:
    • Mitral regurgitation - Severity:  
    • Mitral stenosis - Severity:
    • Aortic stenosis - Severity:  
    • Aortic regurgitation - Severity:
    • Tricuspid regurgitation - Severity:
    • Tricuspid stenosis - Severity:
    • Pulmonary artery systolic pressure:
    • 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.
    • Past Medical History: [eg. CAD, Severe mitral stenosis, former tobacco use, dyslipidemia, ...]
    • Past Surgical History: [including date]
    • Medications: [relevant to the event not all]
    • 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 complaint.
    • Past Medical History: [eg. CAD, Severe mitral stenosis, former tobacco use, dyslipidemia, ...]
    • Past Surgical History: [including date]
    • Medications: [relevant to the event not all]
    • 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]
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