Diagnostic Criteria and Initial Management of Myocardial Infarction

Diagnostic Criteria

The European Society of Cardiology recommends that chest pain lasting 20 minutes or more, not responding to nitroglycerin, often radiating to neck, lower jaw, or left arm, is a diagnostic criterion for myocardial infarction 1
Alternative presentations, especially in elderly patients, such as fatigue, dyspnea, faintness, or syncope, should be considered as potential symptoms of myocardial infarction 1
The American College of Cardiology suggests that immediate 12-lead ECG is essential and should be obtained within 10 minutes of arrival, with ST-segment elevation ≥1 mm in contiguous leads indicating thrombotic coronary occlusion and need for immediate reperfusion 2
The European Society of Cardiology recommends that blood sampling for cardiac biomarkers should be performed routinely, but should not delay reperfusion therapy, and that troponin is a useful biomarker for diagnosis 1

The European Society of Cardiology recommends providing oxygen therapy for patients with arterial oxygen saturation <90% 3
The American College of Cardiology suggests administering aspirin 160-325 mg orally immediately 2
The American College of Cardiology recommends giving sublingual nitroglycerin (unless systolic BP <90 mmHg or heart rate <50 or >100 bpm) 2
The European Society of Cardiology suggests that primary PCI is preferred for patients with cardiac arrest and ST-segment elevation 3
The American College of Cardiology recommends that door-to-needle time for fibrinolytic therapy should be ≤30 minutes 5

The American College of Cardiology recommends that community education about MI symptoms and seeking emergency care is crucial 6
The European Society of Cardiology suggests that emergency medical systems should have trained personnel with physician-directed protocols 6
The American College of Cardiology recommends that critically ill patients should be taken to hospitals with cardiac catheterization and surgical capabilities 6

The European Society of Cardiology recommends primary PCI for resuscitated cardiac arrest patients with ECG consistent with STEMI 3
The European Society of Cardiology suggests that targeted temperature management is indicated for patients who remain unresponsive after resuscitation 3
The European Society of Cardiology recommends close attention to anticoagulation in patients with hypothermia 3