Narrative Review: Myocardial Infarction

Site	Patient	AE	Complication	Event date	AE code
xxx	xxx	x		xx/xx/xxxx	xxx

Demographic / Medical history

• [age] year old [gender]
• Past Medical History: [eg. CAD, Severe mitral stenosis, former tobacco use, dyslipidemia, ...]

Procedure

• Index Procedure Date/Time: xx/xx/xxxx 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

• Event:
• Site Reported Event Onset Date: xx/xx/xxxx
• Event summary:
  • Symptoms and sign: Subject presented with [sign and symptom] on xx/xx/xxxx.
  • Important characteristics of the chief complaint such as severity, site, and duration.
  • Other important symptoms related to the chief compliant.
  • Physical assessment:
  • Vital sign
  • Positive physical examinations or related negative examinations.

Laboratory data and Imaging

• Lab studies:
  • Troponin levels and timing:

Date	Time	CKMB nl: (ratio)	Troponin nl: (ratio)
xx/xx/xxx	xx:xx
xx/xx/xxx	xx:xx
xx/xx/xxx	xx:xx

• • Other laboratory:
    • Date/ name/ value [ as a list ]

• ECG’s:

Date	Time	Finding
xx/xx/xxx	xx:xx
xx/xx/xxx	xx:xx
xx/xx/xxx	xx:xx

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

Outcome

[Discharge / Hospice / Death]