Early identification of patients with acute myocardial infarction

Abstract

In conclusion, early identification of AMI requires the utilization of three main criteria: (1) History and physical examination; (2) 12-lead electrocardiography, and (3) serum protein markers of myocardial cell death. The history may indicate admission for AMI exclusion or unstable angina, although these data remain largely subjective. The physical examination provides few clues in subtle presentations of myocardial cell death, and instead identifies patients with left ventricular dysfunction, often with failure. The 12-lead ECG is an insensitive early indicator of AMI, often identifying 50% or fewer of these patients. Currently, thrombolytic therapy or invasive catheterization techniques such as PTCA are based on 12-lead depictions of acute injury patterns. Finally, serum markers of AMI, particularly myoglobin, CPK-MM isoforms, and new monoclonal antibody assays for CPK-MB may allow early identification of patients with AMI with nondiagnostic ECGs.