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]

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:
  • Typical Angina Pectoris
    • Stable Angina Pectoris
    • Unstable Angina Pectoris
    • Prinzmetal’s (Variant) Angina
  • Atypical Angina Pectoris
  • Non Cardiac Chest Pain

• Symptoms other than chest pain: [explain]

EKG finding (MM/DD/YYYY at XX:XX):

• ST-Elevation ( Anterior Inferior Lateral Posterior)
• ST-Depression
• T inversion
• LBBB ( New Old Unspecified)
• Pathologic Q Wave
• Ventricular Paced Rhythm
• Other

Heart biomarkers:

Date	Time	CKMB (NL ratio)	Troponin (NL ratio)
MM/DD/YYYY	XX:XX
MM/DD/YYYY	XX:XX
MM/DD/YYYY	XX:XX

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 No Biomarkers

• 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. In addition, either (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 with at least one value above the 99th percentile URL.

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

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

Past Surgical History: [including date]

Medications: [relevant to the event not all]

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
  • 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).

 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

• ECHO/ date:
  • Trans-thoracic:
  • Trans-esophagus:
• CXR / date:
• Other relevant imaging and diagnostic tests / date:

Consults

• Date and time of consult
• Suggested treatments

Clinical course

• Date and time of events
• Patient condition got worse or better.

Treatment and outcome

• List of relevant medical treatments
• Outcome [Discharge / Hospice / Death]