Initial diagnosis
Name ADMD
Chapter MINAP/Admission
Definition
This is a working diagnosis whose primary purpose is to identify those patients with a diagnosis of definite ST elevation MI. This includes an initial diagnosis made by an ambulance paramedic crew or other clinician in a position to provide definitive treatment. Do not change initial diagnosis on the basis of further duration ECGs or enzymes / markers. (See 2.03 ECG determining treatment)
Data Type Categorical
Data sources MINAP
Repeated No
Valid event date range 01/01/2003 - 08/06/2009
Agreed 01/12/2010 (Revision 9.1)
Category DefinitionNotes
1 Definite myocardial infarction Diagnosis based on unequivocal changes of infarction on initial ECG (ST elevation or new LBBB) and appropriate history and are thus eligible for consideration for reperfusion treatment. LBBB of uncertain duration should be recordeed as Acute coronary syndrome.
3 Acute coronary syndrome Covers all the suspected acute coronary syndromes including cases previously categorised as 2. Probable infarction. Confirmation of diagnosis awaits results of troponin assay. Should be used where there is a strong likelihood of infarction on history and an abnormal ECG without significant ST elevetion or LBBB withiut ST segment elevation.
4 Chest pain ? cause Single episode of chest pain thought to be cardiac in nature where admission was thought to be appropriate to exclude an ischaemic event. This covers all other admissions where no clear initial diagnosis has been made, but where there is an index of suspiciontaht the syndrome may be ischaemic in nature.
5 Other initial diagnosis Other (usually non-cardiac0 diagnosis such as acute aortic dissection, pancreatitis, etc where symptoms are subsequently found to be a manifestation of acute cardiac ischaemia. Use where patient is already in hospital.
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