Acute Coronary Syndrome—With ST-Elevation

Question 1

Mx of an acute STEMI:

Answer 1

1. 12 lead ECG
2. IV access
3. Bloods: FBC, U&E, glucose, lipids, cardiac enzymes
4. Quick Hx of cardiovascular disease + risk factors for IHD
5. Exam: BP, PR, JVP, murmurs, signs of CCF
6. CI to PCI or fibrinolysis?
7. ASA 300 mg PO stat
8. Morphine 5–10mg IV + anti-emetic - Metoclopramide 10mg IV
9. PCI available within 120min - YES = primary PCI; NO = Fibrinolysis

Question 2

ECG criteria for thrombolysis:

Answer 2

1. ST elevation >1mm in 2 or more limb leads or >2mm in 2 or more chest leads
2. New LBBB
3. Posterior changes: Deep ST depression and tall R waves in leads V1 to V3.

Question 3

Contraindications to thrombolysis:

Answer 3

1. Previous intracranial haemorrhage
2. Ischaemic stroke <6 months
3. Cerebral malignancy or AVM
4. Recent major trauma/surgery/head injury (<3wks)
5. GI bleeding (<1 month)
6. Known bleeding disorder
7. Aortic dissection
8. Non-compressible punctures <24h - liver biopsy, LP