II. Course: Hospital
- See Goldman Criteria for ICU Chest Pain Admission
- Angiography, Angioplasty and stenting has modified the inpatient ACS protocol dramatically
- Prior protocols with prolonged hospital stays, ICU admits and prolonged Heparin have been replaced
- Evaluation prior to discharge
- Echocardiogram prior to discharge
- Consider sub-maximal stress test prior to discharge
- See Post Myocardial Infarction Evaluation
III. Disposition: Discharge Planning
IV. Complications
- Post-MI Pericarditis (common)
V. Prognosis: Serum markers for worse prognosis
- C-Reactive Protein (CRP) increased
- White Blood Cell Count increased (Leukocytosis)
VI. Prognosis: Risk of subsequent infarction or death
- Age over 70 years
- Left Ventricular Ejection Fraction under 40%
- Congestive Heart Failure
- Residual ischemia
- Ventricular ectopy (>10 PVCs per minute)
- Non Q-Wave infarction
- Diabetes Mellitus
- Anterior Myocardial Infarction
- Hypertension
-
Major Depression increases mortality within 4 months
- Beck Depression Inventory Score <4: 2.6% mortality
- Beck Depression Inventory Score 4-9: 17.1% mortality
- Beck Depression Inventory Score >10: 23.3% mortality
- Bush (2001) Am J Cardiol 88:337-41 [PubMed]