1. Acute heart attack means myocardial ischemia with an evidence of myocardial injury or necrosis.
2. The diagnosis is made with rise and fall of heart enzymes, typical symptoms, suggestive ECG changes, or echocardiography evidence of new regional wall motion abnormality.
3. One should do ECG, take proper history of chest pain & dop physical examination within 10 minutes of patient arrival.
4. Measure serum troponin blood test at arrival and repeat the test at 6-9 hours if the blood test is negative.
5. Measure 2nd blood test earlier than six hours in patients who are highly suspected of having ongoing NSTEMI ( a type of heart attack).
6. Measure third troponin at 12-24 hours if the index of suspicion is high but the first two blood tests are negative.
7. Measure CKMB blood test when the troponin assay is not available.
8. Diagnose acute heart attack in patients who have undergone recent angioplasty or bypass surgery by measuring troponin blood test before and after the procedure. The baseline troponin has to have been normal.
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