**22. Diagnosis**

When diagnosing MI in children it can be useful to request consultation from adult cardiologists experienced with MI. The anamnesis, laboratory tests and imaging methods should be used to full benefit in diagnosis. Even if the anamnesis does not have such a satisfactory role in Paediatric diagnosis as it does for adults, information must be obtained about the character and radiation of the pain, especially from school-age children and adolescents. The determination of CHD, previous surgical interventions because of the CHD in the anamnesis aortic stenosis, hypertrophic cardiomyopathy, patients underwent operation for transposition of great artery particularly have additional risks for MI [76].

In the physical examination, the determination of weak pulse, dyspnoea, rhythm irregularity, sudden paroxysmal abdominal pain, gallop rhythm, cold extremities and shock should suggest MI [2]. The determination of PR segment depression on ECG, ST segment elevation together with the J point in at least two adjacent derivations, deep and/or wide Q-wave in at least one derivation, T-wave changes, ventricular arrhythmia and cardiac block should suggest a diagnosis of MI [14].

On echocardiography, segmentary wall movement abnormalities, a reduction in left ventricle functions, papillary muscle rupture and left ventricle free wall rupture are valuable for diagnosis [24, 77]. In the laboratory examination, elevation in troponin levels and increased CKMB levels are important for diagnosis.

Coronary angiography is the standard diagnostic method for MI [35]. The application of coronary angiography should be considered in patients with high troponin levels and findings in the anamnesis suggestive of MI. It must also not be forgotten that coronary angiography in MI cases related to vasoconstrictor substance intake, could be normal [63].
