What is the diagnosis for a patient with acute chest pain, diaphoresis, and ECG changes consistent with inferior STEMI (ST-elevation myocardial infarction)?

From the Guidelines

The patient's diagnosis is acute inferior STEMI (ST-elevation myocardial infarction).

Key Diagnostic Features

• The patient presents with acute chest pain and diaphoresis, which are classic symptoms of myocardial infarction 1.
• The ECG changes are consistent with inferior STEMI, showing ST-segment elevation in inferior leads 1.
• The patient's clinical presentation and ECG findings are consistent with acute myocardial infarction (MI) with persistent ST-segment elevation 1.

Diagnostic Considerations

• The diagnosis of STEMI is based on the presence of ST-segment elevation on the ECG, which is diagnostic of acute STEMI 1.
• The patient's symptoms and ECG findings are consistent with inferior STEMI, which requires immediate attention and treatment 1.
• The use of risk scores, such as the HEART score, can help identify patients with a high probability of ACS, but in this case, the diagnosis is clear based on the ECG findings 1.

Treatment Implications

• The patient requires immediate coronary catheterization and invasive restoration of flow to restore blood flow to the affected area of the heart 1.
• The patient has already received aspirin, clopidogrel, unfractionated heparin, and morphine, which are standard treatments for STEMI 1.

From the Research

Diagnosis of Acute Chest Pain

The diagnosis for a patient with acute chest pain, diaphoresis, and ECG changes consistent with inferior STEMI (ST-elevation myocardial infarction) involves several steps:

• The patient's symptoms, such as chest discomfort at rest, diaphoresis, and ECG changes, are consistent with acute coronary syndromes (ACS) 2.
• The ECG is essential in diagnosing STEMI, and it should be performed immediately (within 10 minutes of presentation) to distinguish between STEMI and non-ST-segment elevation ACS (NSTE-ACS) 2, 3.
• STEMI is caused by complete coronary artery occlusion and accounts for approximately 30% of ACS 2.
• The diagnosis of STEMI can be confirmed by the presence of ST-segment elevation on the ECG, and the patient should undergo rapid reperfusion with primary percutaneous coronary intervention (PCI) within 120 minutes to reduce mortality 2.
• However, other conditions, such as aortic dissection, can mimic STEMI and should be considered in the differential diagnosis 4, 5.
• Point-of-care ultrasound (POCUS) can be a useful diagnostic tool to help differentiate aortic dissection from a primary myocardial infarction 4.
• A thorough history and physical examination, as well as laboratory tests, are crucial in diagnosing the cause of acute chest pain 6.

Differential Diagnosis

The differential diagnosis for acute chest pain includes:

• Cardiac chest pain, such as STEMI or NSTE-ACS 2, 6.
• Non-cardiac chest pain, such as musculoskeletal or gastrointestinal disorders 6.
• Aortic dissection, which can mimic STEMI 4, 5.
• Other conditions that can cause ST-segment elevation, such as pericarditis or pulmonary embolism 5.

Treatment

The treatment for STEMI involves:

• Rapid reperfusion with primary PCI within 120 minutes to reduce mortality 2.
• Fibrinolytic therapy with alteplase, reteplase, or tenecteplase at full dose for patients younger than 75 years without contraindications, followed by transfer to a facility with the goal of PCI within the next 24 hours 2.
• Antithrombotic therapy, such as heparin or bivalirudin, to prepare the patient for PCI 3.