Differential Diagnostic of ST Elevation Miocard Infarct 1.

Unstable Angina : >Most commonly presents with chest pain and/or shortness of breath, although typical symptoms may be present. >Initial risk stratification and management depends on the clinical features and ECG. >ECG typically shows ST segment depression and T-wave inversion, but may be normal. >Acute management includes antiplatelet and antithrombotic therapy to reduce the extent of myocardial damage and complications. >Long-term management includes reduction of risk factors and medication to prevent recurrence. 2. Non STEMI : Part of the acute coronary syndrome spectrum. Caused by a partial or near-complete thrombosis or embolisation of a coronary artery resulting in compromised blood flow to myocardium with subsequent myocardial injury.

Patients typically present with chest pressure/discomfort lasting at least several minutes, accompanied by sweating, dyspnoea, nausea, and/or anxiety. Symptoms are indistinguishable from those of unstable angina. However, non-ST-elevation MI is differentiated from unstable angina by a rise of cardiac markers and/or ischaemic ECG changes. ECG is the first-line investigation in all patients and should not be delayed for history, examination, or other tests. Early stratification and treatment with anti-ischaemic (beta-blockers, nitrates), anticoagulant (heparin), and antiplatelet agents (aspirin and clopidogrel) is needed. Higher-risk patients should be considered for an early invasive strategy (coronary angiography and revascularisation in <48-72 hours). In patients for whom an early invasive strategy is planned, clopidogrel or a glycoprotein IIb/IIIa inhibitor should be added. Complications are progression or worsening of MI, heart failure, cardiogenic shock, arrhythmias, and death. 3. Aortic Dissection Patients typically present with tearing chest pain, notably between the shoulder blades. They can be in considerable distress and haemodynamically unstable. Peripheral pulses may be unequal or absent distally. 4. Pulmonary Embolism Patients classically present with acute onset of sharp stabbing chest pain that is pleuritic in nature and associated with SOB.

A background of increased clotting tendency, such as known inheritable thrombophilia or connective tissue disease; known deep venous thrombosis (DVT); or previous PE increases the likelihood of the diagnosis. Other risk factors include recent prolonged immobilisation and limb trauma.

5. Pneumothorax Patients present with sudden onset of pleuritic chest discomfort and SOB. Tachycardia, hypotension, and cyanosis suggest a tension pneumothorax. Known underlying medical conditions that predispose to pneumothorax, such as chronic obstructive pulmonary disease, connective tissue disease, or recent chest trauma, may support this diagnosis. 6. Myocarditis Patients often have a recent history of influenza-like illness or underlying autoimmune condition such as SLE. They are likely to be young and often do not have risk factors for CAD. Myocarditis is more likely to present with symptoms of cardiac failure than with chest pain.