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Acute Coronary Syndrome: Myocardial Infarction, Emergency Medicine

Josh W. Joseph and Shamai A. Grossman Reviewed 06/2017



  • Imbalance in myocardial blood supply and oxygen requirement

  • Acute coronary syndrome (ACS) encompasses a spectrum of disease processes:

    • Unstable angina pectoris

    • Acute myocardial infarcti...


Signs and Symptoms

  • Chest pain:

    • Most common presentation of MI

    • Substernal pressure

    • Heaviness

    • Squeezing

    • Burning sensation

    • Tightness

  • Anginal equivalents (MI without chest pain):

    • Abdominal pain

    • Syncope

    • Dia...



  • IV access

  • Aspirin

  • Oxygen

  • Cardiac monitoring

  • Sublingual nitroglycerin for symptom relief

  • 12-lead ECG, if possible, with transmission or results relayed to receiving hospital

Initial Stabilization/Therapy



Admission Criteria

  • Patients with an AMI require hospital admission.

  • If the diagnosis is unclear, admission to the hospital or an ED observation unit may be useful for serial cardiac...

Pearls and Pitfalls

  • Goal of thrombolytic therapy is a 30 min door to needle time if PCI not possible.

  • New or presumably new LBBB at presentation occurs infrequently, and should not be considered diagno...

Additional Reading

  • Filippo  C, Giovanna  L. Pathogenesis of acute coronary syndromes. J Am Coll Cardiol.  2013;61:1–11.

  • Hartman  SM, Barros  AJ, Brady  WJ. The use of a 4-step algorithm in the ele...



  • 410.90 Acute myocardial infarction, unspecified site, episode of care unspecified

  • 410.91 Acute myocardial infarction of unspecified site, initial episode of care

  • 410.92 Acute myocardial infarc...

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