ST분절비상승 급성심근경색증의 초기 진단 및 치료와 예후 관리
Early Diagnosis and Management of Non ST-Segment Elevation Acute Myocardial Infarction
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Acute myocardial infarction (MI) is a cardiovascular disease with high mortality. Acute MI is usually divided into ST-segment elevation MI (STEMI) and non ST-segment elevation MI (NSTEMI) based on the electrocardiogram (ECG). NSTEMI is often misdiagnosed in patients presenting to emergency departments with acute chest pain because its clinical course varies and is atypical compared to STEMI. The symptoms can be vague and the ECG is often not diagnostic. In this setting, an early accurate diagnosis and risk stratification could improve the mortality of patients with NSTEMI. Cardiac biomarkers such as high-sensitivity cardiac troponin (hs-cTn) help to diagnose NSTEMI. Serial hs-cTn assays should be considered to differentiate other conditions, especially in an ambiguous clinical situation. If acute MI is strongly suspected based on the symptoms, ECG, and cardiac biomarkers, catheterization laboratory activation should be timely considered to evaluate the coronary arteries and possible revascularization with percutaneous or surgical strategies depending on risk factors. After successful revascularization, antianginal medications, risk factor control, and early recognition of heart failure are essential to improve the cardiovascular prognosis.
Abstract
Acute myocardial infarction (MI) is a cardiovascular disease with high mortality. Acute MI is usually divided into ST-segment elevation MI (STEMI) and non ST-segment elevation MI (NSTEMI) based on the electrocardiogram (ECG). NSTEMI is often misdiagnosed in patients presenting to emergency departments with acute chest pain because its clinical course varies and is atypical compared to STEMI. The symptoms can be vague and the ECG is often not diagnostic. In this setting, an early accurate diagnosis and risk stratification could improve the mortality of patients with NSTEMI. Cardiac biomarkers such as high-sensitivity cardiac troponin (hs-cTn) help to diagnose NSTEMI. Serial hs-cTn assays should be considered to differentiate other conditions, especially in an ambiguous clinical situation. If acute MI is strongly suspected based on the symptoms, ECG, and cardiac biomarkers, catheterization laboratory activation should be timely considered to evaluate the coronary arteries and possible revascularization with percutaneous or surgical strategies depending on risk factors. After successful revascularization, antianginal medications, risk factor control, and early recognition of heart failure are essential to improve the cardiovascular prognosis.
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