Case 1:

JF is a 42-year old previously healthy farmer who presented with sudden onset central chest pain of one hour duration to the ED. The pain is associated with sweating and radiates to the left arm and jaw. The area of discomfort is about the size of the fist.

Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

 

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Question 2 of 39:

This patient should have a targeted clinical examination and a 12-lead EKG within 10 minutes of presenting to the emergency department.

You clicked 'False'

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All patients with acute MI should have a clinical and electrocardiographic evaluation ideally within 10 minutes and certainly not >20 minutes from presentation. The ECG and a history of ischemic-type chest pain remain the primary methods for screening patients with acute myocardial infarction. The 12-lead ECG in the ED is the center of the decision pathway because of the strong evidence that ST-segment elevation MI identifies patients who benefit from reperfusion therapy.

The ECG will show ST segment elevation or Q waves not known to be old in about 40 to 45% of patients with acute MI. An additional 30 to 40% of patients will have ST segment depression or T wave inversion not known to be old on the initial ECG. In patients with ischemic type chest discomfort, ST-segment elevation on the ECG has a specificity of 91% and a sensitivity of 46% for diagnosing AMI. Mortality increases with the number of ECG leads showing ST elevation.

Current data does not support the administration of thrombolytic agents to patients without ST elevation or new left bundle branch block, and the benefit of PTCA remains uncertain in these patients.

 
 
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