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Value peaks at 12 hours after pain onset but value will be rising before this
Interval testing is used in non-STEMI patients to look for a significant change for diagnosis of MI (or exclusion in low risk patients with normal ECG)
It is usually tested at presentation and 1-3 hours later
The definition of βsignificant changeβ varies depending on the assay used
A normal valueΒ β₯6 hours post-pain onset rules out MI
High-risk (rise and fall in troponin compatible with NSTEMI, dynamic ischaemic changes, GRACE score >140) β early PCI (<24h)
Non-high risk β selective PCI
Other points
All patients should have an echocardiogram to assess LV function
Check electrolytes regularly and ensure patients are on cardiac monitoring while in hospital
STEMI patients with complete revascularisation may be discharged after 2-3 days; low-risk NSTEMI patients with complete revascularisation may be discharged within 24 hours
In which ECG leads would ST changes be present in for each of the following myocardial infarctions? Which coronary artery would be involved for each? 1. Inferior 2. Anteroseptal 3. Anterolateral 4. Lateral 5. Posterior