Narrative Review: Myocardial Infarction

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]