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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Myocardial Infarction
Akbar A. Panju, Brenda R. Hemmelgarn, Gordon H. Guyatt, David L. Simel
For the first group of patients, which includes those with MI and ST-segment elevation or left...


Topics Discussed: angina pectoris, chest pain, chest pain, acute, diagnostic process, grading recommendations, myocardial infarction, st-segment elevation mi

Excerpt: "Cardiac ischemic chest pain presents in a spectrum of conditions, including angina, unstable angina, and MI. Angina is defined as a discomfort in the chest or adjacent areas, caused by myocardial ischemia, usually brought on by exertion, and associated with a disturbance of myocardial function, but without myocardial necrosis.1 Various grading systems of the severity of angina pectoris have been developed. The classification proposed by the Canadian Cardiovascular Society,2 outlined in Table 35-1, is a practical one adopted in a variety of settings.Determining the correct diagnosis is imperative to administering the appropriate therapy. The available therapeutic options create the categories for patients presenting to the emergency department with chest pain or other symptoms suggesting cardiac ischemia. Three distinct management strategies determine the diagnostic groupings clinicians use currently (Figure 35-1)...."
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