Step 1: Recognize that we know nothing about treating MI in ICU patients.
Step 2: Checking a troponin level on every ICU patient isn’t wise.
Step 3: Clinical history and EKG is a reasonable way to screen for ischemia in ICU patients.
Step 4: Troponin elevation is often not due to MI at all.
Step 5: Most myocardial infarctions in the ICU are type-2 MIs.
Step 6: Heparin infusion is not beneficial unless the patient is scheduled for cardiac catheterization.
Step 7: Prophylactic dose fondaparinux is a reasonable approach to anticoagulate a type-1 MI patient who isn’t going for cardiac catheterization.