How is an initial evaluation of acute myocardial infarction (MI, heart attack) performed in the emergency department?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Because acute coronary syndrome (ACS) is a spectrum of conditions, initial evaluation to establish a working diagnosis is crucial, as this will dictate management owing to some differences in management steps and timelines for each component of the ACS spectrum.

All patients presenting to the the emergency department with symptoms suggestive of acute myocardial infarction (MI) should be evaluated with a targeted history and focused physical examination (see Presentation). A 12-lead electrocardiogram (ECG) interpreted by an experienced physician should be completed within 10 minutes of arrival, in addition to establishing intravenous (IV) access.

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