In this post, I link to Who Needs the Cath Lab/Cards Consult? [accessed 12-10-2021] A guideline from the Steve Smith’s EKG Blog and the EMCrit Podcast.
What follows is the introduction to the above 16 page pdf.
Activate the Lab for unambiguous STEMI (only clear STEMIs have a 90 minute CMS mandate)
Get Cardiology or Interventional Consultation for more complicated cases: difficult ECGs, subtle ST elevation, ST depression with ongoing symptoms, STEMI “Equivalents”.
This requires a systematic approach, with buy-in from Cardiology that they will respond immediately to such requests for help. What do they get out of it? Fewer false positive
activations and more activations for the subtle cases that need it.
Know that the ACC/AHA guidelines for NonSTEMI recommend < 2 hour cath for: 1) refractory ischemia 2) ischemia with hemodynyamic or electrical instability
Proviso: Many cardiologists do not understand these subtle ECG findings or pseudo-STEMI patterns.
You must be a strong advocate! If you are worried, get serial ECGs, compare with an old ECG, and get a high quality contrast echocardiogram exam. Persistent occlusion of a significant epicardial coronary artery will nearly always have a wall motion abnormality if the echo quality is good, is done with contrast, and is read by an expert.