Narrative Review: Myocardial Infarction
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# Patient summary
Admission date: MM/DD/YYYY
Demographic:  year old 
Symptoms (Check from below items):
- Chest pain:
Duration of chest pain
Typical Angina Pectoris
Stable Angina Pectoris
Unstable Angina Pectoris: O New chest pain O Accelerating O Rest pain
Prinzmetals (Variant) Angina
Atypical Angina Pectoris
Non Cardiac Chest Pain
No Chest Pain
- Duration of chest pain
- Typical Angina Pectoris
Stable Angina Pectoris
Unstable Angina Pectoris: O New chest pain O Accelerating O Rest pain
Prinzmetals (Variant) Angina
- Stable Angina Pectoris
- Unstable Angina Pectoris: O New chest pain O Accelerating O Rest pain
- Prinzmetals (Variant) Angina
- Atypical Angina Pectoris
- Non Cardiac Chest Pain
- No Chest Pain
- Symptoms other than chest pain: 

### EKG finding (MM/DD/YYYY at XX:XX):
- ST-Elevation ( O Anterior   O Inferior   O Lateral   O Posterior)
- ST-Depression
- T inversion
- LBBB ( New Old Unspecified)
- Pathologic Q Wave
- Ventricular Paced Rhythm
- Other

### Heart Biomarkers:

### Universal Definition of Myocardial Infarction:
(Check only one)
O  Type 1     (Spontaneous)
O  Type 2     (Secondary)
O  Type 3     (Sudden cardiac death)
O  Type 4a   (Peri-PCI)
O  Type 4b   (Stent thrombosis)
O  Type 4c   (Stent restenosis)
O  Type 5     (Peri-CABG)
Echocardiogram / Date:
- Trans-Thoracic Echocardiogram (TTE):
- Left Ventricular Ejection Fraction:    
Left Ventricular Size:
Mitral regurgitation - Severity:  
Mitral stenosis - Severity:
Aortic stenosis - Severity:  
Aortic regurgitation - Severity:
Tricuspid regurgitation - Severity:
Tricuspid stenosis - Severity:
Pulmonary artery systolic pressure:
- Left Ventricular Ejection Fraction:
- Left Ventricular Size:
- Mitral regurgitation - Severity:
- Mitral stenosis - Severity:
- Aortic stenosis - Severity:
- Aortic regurgitation - Severity:
- Tricuspid regurgitation - Severity:
- Tricuspid stenosis - Severity:
- Pulmonary artery systolic pressure:
- Regional wall motion abnormalities:
Absence or reduction of systolic thickening
Decreased motion: hypokinetic, akinetic, dyskinetic (systolic bulging) and aneurysmal
Complications:
Systolic and diastolic dysfunction
Acute MR from papillary muscle rupture
Ventricular septal defect
Pericardial effusion
Tamponade from free wall rupture
Mural thrombus
Ventricular aneurysm and pseudoaneurysm
- Regional wall motion abnormalities:
Absence or reduction of systolic thickening
Decreased motion: hypokinetic, akinetic, dyskinetic (systolic bulging) and aneurysmal
- Absence or reduction of systolic thickening
- Decreased motion: hypokinetic, akinetic, dyskinetic (systolic bulging) and aneurysmal
- Complications:
Systolic and diastolic dysfunction
Acute MR from papillary muscle rupture
Ventricular septal defect
Pericardial effusion
Tamponade from free wall rupture
Mural thrombus
Ventricular aneurysm and pseudoaneurysm
- Systolic and diastolic dysfunction
- Acute MR from papillary muscle rupture
- Ventricular septal defect
- Pericardial effusion
- Tamponade from free wall rupture
- Mural thrombus
- Ventricular aneurysm and pseudoaneurysm
- Trans-Oesophageal Echocardiogram (TOE):

# Myocardial Infarction Ischemic Symptoms/Angina/ACS
O Type 1: Spontaneous
- Note: Dont adjudicate just on biomarkers
- Spontaneous clinical syndrome; Rise and fall in  cardiac biomarkers, preferably troponin with at least one value >99th percentile;
And at least one of the following:
Symptoms of myocardial ischemia
New or presumed new significant ST-segment T wave (STT) changes or new LBBB on the ECG
Development of pathological Q waves on the ECG
Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
Identification of an intracoronary thrombus by angiography or autopsy.
- And at least one of the following:
Symptoms of myocardial ischemia
New or presumed new significant ST-segment T wave (STT) changes or new LBBB on the ECG
Development of pathological Q waves on the ECG
Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
Identification of an intracoronary thrombus by angiography or autopsy.
- Symptoms of myocardial ischemia
- New or presumed new significant ST-segment T wave (STT) changes or new LBBB on the ECG
- Development of pathological Q waves on the ECG
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- Identification of an intracoronary thrombus by angiography or autopsy.
O Type 2: Ischemic Imbalance
- Spontaneous clinical syndrome; a condition other than CAD contributes to an imbalance; myocardial oxygen and/or demand (coronary endothelial dysfunction, coronary artery spasm, coronary embolism, tachy/bradyarrhythias, anemia, respiratory failure, hypotension/hypertension (with or without LVH; Rise and fall in cardiac biomarkers, preferably troponin with at least one value >99th percentile;
AND at least one of the following:
Symptoms of myocardial ischemia
New or presumed new significant ST-segmentT wave (STT) changes or new LBBB on the ECG
Development of pathological Q waves on the ECG
Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- AND at least one of the following:
Symptoms of myocardial ischemia
New or presumed new significant ST-segmentT wave (STT) changes or new LBBB on the ECG
Development of pathological Q waves on the ECG
Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- Symptoms of myocardial ischemia
- New or presumed new significant ST-segmentT wave (STT) changes or new LBBB on the ECG
- Development of pathological Q waves on the ECG
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
O Type 3: Sudden Cardiac Death
- Symptoms suggest myocardial ischemia present,
AND with (presumed) new ischemic changes or new LBBB on ECG
Death occurs before biomarkers can be obtained or could rise; or (in rare cases) were not collected.
- AND with (presumed) new ischemic changes or new LBBB on ECG
Death occurs before biomarkers can be obtained or could rise; or (in rare cases) were not collected.
- Death occurs before biomarkers can be obtained or could rise; or (in rare cases) were not collected.
O Type 4a: Related to percutaneous coronary intervention (PCI)
- MI defined by elevation of cTn values >5 x 99th percentile URL in patients with normal baseline values (20% if the baseline values are elevated and are stable or falling.
AND at least one of the following:
(i) symptoms suggestive of myocardial ischemia, or
(ii) new ischemic ECG changes or new LBBB, or
(iii) angiographic loss of patency of a major coronary artery or a side branch or persistent slow- or no-flow or embolization, or
(iv) imaging demonstration of new loss of viable myocardium or new regional wall motion abnormality are required.
- AND at least one of the following:
(i) symptoms suggestive of myocardial ischemia, or
(ii) new ischemic ECG changes or new LBBB, or
(iii) angiographic loss of patency of a major coronary artery or a side branch or persistent slow- or no-flow or embolization, or
(iv) imaging demonstration of new loss of viable myocardium or new regional wall motion abnormality are required.
- (i) symptoms suggestive of myocardial ischemia, or
- (ii) new ischemic ECG changes or new LBBB, or
- (iii) angiographic loss of patency of a major coronary artery or a side branch or persistent slow- or no-flow or embolization, or
- (iv) imaging demonstration of new loss of viable myocardium or new regional wall motion abnormality are required.
O Type 4b: Related to stent thrombosis
- MI detected by coronary angiography or autopsy in the setting of myocardial ischemia and with a rise and/ or fall of cardiac biomarkers values
AND at least one value above the 99th percentile  URL.
- AND at least one value above the 99th percentile  URL.
O Type 4c: Related to stent restenosis
-  50% stenosis at coronary angiography or a complex lesion associated with a rise and/or fall of cTn values >99th percentile upper reference limit and no other significant obstructive CAD of greater severity following:
Initially successful stent deployment or
Dilatation of a coronary artery stenosis with balloon angioplasty (<50%).
- Initially successful stent deployment or
- Dilatation of a coronary artery stenosis with balloon angioplasty (<50%).
O Type 5: CABG Related
- MI associated with and occurring within 48 hours of CABG surgery with elevated biomarkers >10 x 99th percentile of URL in subjects with normal baseline values < or =99th percentile URL.
AND at least one of the following:
New pathological Q waves, new LBBB on ECG
Angiographic new graft or new native coronary artery occlusion.
Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- AND at least one of the following:
New pathological Q waves, new LBBB on ECG
Angiographic new graft or new native coronary artery occlusion.
Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- New pathological Q waves, new LBBB on ECG
- Angiographic new graft or new native coronary artery occlusion.
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality

# Procedure
- Index Procedure Date/Time: MM/DD/YYYY at XX:XX 
- Index Procedure Detail:
On  the subject underwent a  for .
Enter access site details
The site reported that there were/were not procedural complication(s).
- On  the subject underwent a  for .
- Enter access site details
- The site reported that there were/were not procedural complication(s).

# Event(s)
Event (1):
- Site Reported Event Onset Date: MM/DD/YYYY
- Event summary:
Symptoms and sign:
Subject presented with  on MM/DD/YYYY.
Important characteristics of the chief complaint such as severity, site, and duration.
Other important symptoms related to the chief complaint.
- Symptoms and sign:
Subject presented with  on MM/DD/YYYY.
Important characteristics of the chief complaint such as severity, site, and duration.
Other important symptoms related to the chief complaint.
- Subject presented with  on MM/DD/YYYY.
- Important characteristics of the chief complaint such as severity, site, and duration.
- Other important symptoms related to the chief complaint.
- Past Medical History: 
Past Surgical History: 
Medications: 
Physical assessment:
Vital signs
Positive physical examinations or related negative examinations.
- Past Medical History: 
- Past Surgical History: 
- Medications: 
- Physical assessment:
Vital signs
Positive physical examinations or related negative examinations.
- Vital signs
- Positive physical examinations or related negative examinations.
Event (2):
- Site Reported Event Onset Date: MM/DD/YYYY
- Event summary:
Symptoms and sign:
Subject presented with  on MM/DD/YYYY.
Important characteristics of the chief complaint such as severity, site, and duration.
Other important symptoms related to the chief complaint.
- Symptoms and sign:
Subject presented with  on MM/DD/YYYY.
Important characteristics of the chief complaint such as severity, site, and duration.
Other important symptoms related to the chief complaint.
- Subject presented with  on MM/DD/YYYY.
- Important characteristics of the chief complaint such as severity, site, and duration.
- Other important symptoms related to the chief complaint.
- Past Medical History: 
Past Surgical History: 
Medications: 
Physical assessment:
Vital signs
Positive physical examinations or related negative examinations.
- Past Medical History: 
- Past Surgical History: 
- Medications: 
- Physical assessment:
Vital signs
Positive physical examinations or related negative examinations.
- Vital signs
- Positive physical examinations or related negative examinations.

# Other Laboratory data and Imaging
- CXR / date:
- Other relevant imaging and diagnostic tests / dates

# Consults
- Date and time of consult
- Suggested treatments

# Clinical course
- Date and time of events
- Patient condition got worse or better.
- Discharge summary

# Treatment and outcome
- List of relevant medical treatments
- Outcome