Most common imaging technique used is echocardiography

      Most
common imaging technique used is echocardiography which   detect abnormality in function and structure of heart and help to          confirm diagnosis or myocardial
infarction and rule out other possible causes
(ACC & AHA, 2014; ACCF & AHA, 2013; ESC, 2016; ESC,        2017; Ministry of Health Malaysia, 2011;
Ministry of Health   Malaysia; 2014; Thygesen
et al., 2012).

d) Imaging

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ECG is
one major and most common diagnostic tools for myocardial          infarction which needs to be conducted
within 10 minutes of clinical         manifestation
of myocardial injury and repeated (ACC & AHA, 2014;    ACCF & AHA, 2013; ESC, 2016; ESC, 2017; Ministry of Health   Malaysia, 2011; Ministry of Health Malaysia;
2014; Thygesen
et al., 2012). Abnormality of ST-segment, mainly, PR segment,
QRS             complex, Q-waves or
presence of left bundle branch block (LBBB) indicates
cardiac injury (ACC & AHA, 2014; ACCF & AHA, 2013;           ESC, 2016; ESC, 2017; Ministry of Health
Malaysia, 2011; Ministry of         Health
Malaysia; 2014; Thygesen et al., 2012). The ST-segment     readings differentiate ST-elevation myocardial
infarction (STEMI) from non-ST-elevation
myocardial infarction (NSTEMI), where ST-          elevation
can range from ?1.0mm to 2.0mm in STEMI and ST-       depression
or T-wave inversion in NSTEMI (ACC & AHA, 2014;   ACCF & AHA, 2013; ESC, 2016; ESC, 2017;
Ministry of Health       Malaysia, 2011;
Ministry of    Health Malaysia; 2014; Thygesen
et al.,         2012)

c) ECG

CKMB is an isoenzyme of creatine kinase, was
one the earliest method to detect cardiac injury within 2 to 3 hours (Collinson & Chamberlain; 2001). It has less sensitivity and
specificity to myocardial infarction as CKMB can be found in skeletal muscle, gastrointestinal
tissue and uterus, and can rise for other clinical problems like renal failure,
trauma and rhabdomyolysis (Babuin &
Jaffe, 2005). Since it is elevated for shorter period compared to Troponin (I
or T), it is useful to detect reinfarction (ACC & AHA, 2014; ACCF &
AHA, 2013; ESC, 2016;          ESC, 2017;
Ministry of Health Malaysia, 2011; Ministry of Health Malaysia; 2014).

ii) Creatine kinase-MB (CKMB)

     This test is the most vital diagnostic
measures in the current          guidelines
that can be detected within 3 to 4 hours after myocardial             incidence (ACC & AHA, 2014; ACCF
& AHA, 2013; ESC, 2016;          ESC,
2017; Ministry of Health Malaysia, 2011; Ministry of Health      Malaysia; 2014; Thygesen
et al., 2012).
Troponin (I or T) are found          in actin filament of myocardium and released to blood after          myocardium injury (Babuin & Jaffe,
2005). As Troponin (I or T)           only
found in cardiac muscle, released into the blood with greater      percentage and remain elevated days, compared
to CKMB, this   make    them a better sensitivity and specificity test
to myocardial   infarction (Babuin &
Jaffe, 2005; Panteghini et
al., 1999; Thygesen            et
al., 2012).  

i) Troponin (I or T)

This is the most prominent detection and
diagnostic tools for myocardial infarction as clinical symptoms and
abnormal ECG may be absence in some myocardial cases (Babuin & Jaffe, 2005; Thygesen
et al., 2012). Detection for cardiac injury is when an increase
of one measurement above the 99th percentile of URL (ACC
& AHA, 2014; ACCF & AHA, 2013; ESC, 2016; ESC, 2017; Ministry of Health
Malaysia, 2011; Ministry of Health Malaysia; 2014; Thygesen
et al., 2012). The 2 type of cardiac biomarkers usually
tested are Troponin (I or T) and CKMB (Thygesen et al., 2012).

b) Blood cardiac biomarkers

Most
common ischaemic symptom for myocardial infarction is chest             pain with sudden onset, which can be
felt as pressured, tightness or           burning,
which can be last for more than 10 minutes and can radiate to            other part like left arm, jaw, back
and shoulder (ACC & AHA,      2014; ACCF & AHA, 2013; ESC, 2016; ESC, 2017; Ministry of      Health Malaysia, 2011; Ministry of Health
Malaysia; 2014;          Thygesen
et al., 2012).  Other symptoms includes shortness of breath,   nausea and vomiting, dizziness, weakness, and
sweating (ACC & AHA,    2014; ACCF & AHA, 2013; ESC, 2016; ESC, 2017; Ministry of        Health Malaysia, 2011; Ministry of Health
Malaysia; 2014;     Thygesen
et al., 2012).

a) Ischaemic symptoms

The four main diagnostic measures in the national
and international guidelines are as following:

The definition and diagnostic measures in the
recent national and international guidelines on myocardial infarction mostly correlates
with the third universal definition of myocardial infarction was published by
the ESC, ACCF, AHA and WHF which was published on 2012 (Thygesen
et al., 2012).
The main diagnostic measures is to detect myocardial necrosis which was the
elevation of cardiac troponin with addition of at least one other clinical
manifestation of myocardial infarction such as ischaemic symptoms, abnormal ECG
readings of the ST segment, T-wave, or Q-wave, and imaging (Thygesen et al., 2012). Detection before
possible incidence of myocardial infarction included in this document which are
Q-wave abnormality and imaging findings (Thygesen
et al., 2012).
Revascularisation related myocardial infarction diagnostic measures and other
imaging technique like magnetic resonance imaging (MRI) are highlighted as well
(Thygesen et al., 2012).

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