MDM - Non-ST Elevation Myocardial Infarction (NSTEMI)

[##]-year-old [male/female] with [chest pain/shortness of breath/etc.] with history and exam consistent with non-ST elevation myocardial infarction (NSTEMI).

Initial consideration in this patient included myocardial infarction with and without ST segment elevation (STEMI, NSTEMI), aortic dissection, aortic aneurysm, pulmonary embolism (PE), pericarditis, myocarditis, coronary artery spasm, cardiac contusion, and pneumothorax among others.

Patient presented with complaint of [chest pain/dyspnea/fatigue] with EKG obtained [on arrival in the ED/in the field] showing no evidence of ST elevations [and/but ST segment depressions in leads ##/V#-V# concerning for anterior/lateral/inferior ischemia].  Initial labs obtained to include a troponin [additional labs] and notable for [elevated troponin/etc.].  Aortic dissection considered to be unlikely in patient without [radiation of pain to back, tearing quality of pain, maximal pain at onset, pulse deficit, associated neurologic symptoms, mediastinal widening on chest x-ray] or other suggestive findings.

Dr. [Name] of Cardiology consulted [and evaluated the patient at the bedside/reviewed the EKG and history] and agreed with diagnosis of NSTEMI.  Patient received Aspirin [162/324] mg in the [field/ED].  Patient treated with [Nitroglycerine/Morphine] with improvement noted in [chest pain/dyspnea].  Anticoagulation initiated in the ED with [Heparin/Lovenox after discussion with Cardiology].

We discussed admission to [CCU/ICU/catheterization lab] with Dr. [Name] of Cardiology for NSTEMI [with/without high risk features].  We discussed concern for NSTEMI and plan for transfer for [admission to CCU/ICU with plan for initiation of anticoagulation/transfer to cardiac catheterization lab for percutaneous intervention (PCI)] with associated risk and benefits, and the patient demonstrated understanding and agreement.

MDM - ST Elevation Myocardial Infarction (STEMI)

[##]-year-old [male/female] with [chest pain/shortness of breath/etc.] with history and exam consistent with [inferior/anterior/lateral/posterior] ST elevation myocardial infarction (STEMI).

Initial consideration in this patient included myocardial infarction with and without ST segment elevation (STEMI, NSTEMI), aortic dissection, aortic aneurysm, pulmonary embolism (PE), pericarditis, myocarditis, coronary artery spasm, cardiac contusion, and pneumothorax among others.

Patient noted to have symptoms concerning for acute MI [in triage/by EMS] with EKG obtained [within 10 minutes of arrival/in the field] showing evidence consistent with STEMI.  STEMI Code activated upon recognition of consistent EKG findings in symptomatic patient [in the field/in the ED].  Initial labs obtained to include a troponin [additional labs] and notable for [elevated troponin/etc.].  Aortic dissection considered to be unlikely in patient without [radiation of pain to back, tearing quality of pain, maximal pain at onset, pulse deficit, associated neurologic symptoms, mediastinal widening on chest x-ray] or other suggestive findings.

Dr. [Name] of Cardiology evaluated [the patient at the bedside/the EKG and history] and agreed with diagnosis of STEMI with plan for transfer to the Cardiac Cath Lab for percutaneous intervention (PCI).  Patient received Aspirin [162/324] mg in the [field/ED].  Patient treated with [Nitroglycerine/Morphine] with improvement noted in chest pain.  Patient received [dual] platelet therapy [after discussion with Cardiology/per STEMI pathway] with [Clopidogrel/Prasugrel/Ticagrelor/Eptifibatide/Abciximab ### mg].  Anticoagulation initiated in the ED with Heparin [after discussion with Cardiology/per STEMI pathway].

We discussed concern for STEMI and plan for transfer for PCI with associated risk and benefits, and the patient demonstrated understanding and provided verbal [and written] consent.  Patient was [discussed with/evaluated at the bedside by] Dr. [Name] of Cardiology who agreed with need for transfer for PCI at this time.