myocardial ischaemia

Question 1

typical presentation of myocardial schema

Answer 1

Patients with myocardial ischaemia will usually describe central chest pain or discomfort which is dull, heavy or compressing in nature and radiates to their neck, jaw or arms

Question 2

atypical myocardial schema presentations

Answer 2

ū Sharp or non-specific pain.
ū Epigastric (upper abdominal) pain.
ū Burning or indigestion-like pain.
ū Pain in the tongue or mouth.
ū Breathlessness without pain.
ū A feeling of impending doom.

Question 3

STEMI criteria

Answer 3

a) More than or equal to 2 mm of ST elevation in two or more leads V1-3, or
b) More than or equal to 1 mm of ST elevation in two or more contiguous
leads in any other area (V4-6, l, ll, lll, aVL or aVF), or
c) More than or equal to 1 mm of ST elevation in two or more contiguous
posterior leads (V7-9), or
d) Left bundle branch block that is known to be new.

Question 4

t wave changes in stemi

Answer 4

a) Early in STEMI the T waves may be tall and peaked. These are often referred to as hyperacute T waves.
b) As STEMI progresses (over hours to a few days) the T waves may reduce and then invert.
c) Myocardial ischaemia without STEMI is often associated with flattened or inverted T waves

Question 5

pathological Q wave characteristics

Answer 5

a) A Q wave that is one third (or more) of the height of the R wave and/or greater than 0.03 seconds wide is considered pathological.
b) STEMI with a pathological Q wave is associated with increased tissue damage and higher mortality.

Question 6

non STEMI causes of dst depression

Answer 6

• Bundle branch block
• Left ventricular hypertrophy
• Ventricular paced rhythm
• Digoxin toxicity
• Tachycardia/rate-related
• Post-electrical cardioversion
• Non-ACS myocardial injury

Question 7

non stemi causes of elevation

Answer 7

• Acute pericarditis
• Benign early repolarisation
• Left ventricular aneurysm
• Bundle branch block (left and right)
• Left ventricular hypertrophy
• Ventricular paced rhythm
• Cardiomyopathy
• Acute myocarditis
• Hypothermia
• Hyperkalaemia
• Post-electrical cardioversion
• Non-ACS myocardial injury
• CNS injury
• Brugada syndrome
• Pre-excitation syndrome

Question 8

reperfusion pathways:

Answer 8

a) Use the primary PCI pathway if transport to a hospital with facilities for immediate PCI can clearly occur within 90 minutes of the diagnosis of STEMI being made.
b) Use the fibrinolytic therapy pathway if transport to a hospital with facilities for immediate PCI cannot clearly occur within 90 minutes of the diagnosis of STEMI being made.
c) Seek clinical advice if the most appropriate reperfusion pathway or hospital destination is not clear.

Question 9

CAS call for STEMI

Answer 9

*
Commence transport as soon as possible.
Phone the STEMI coordinator as soon as possible (preferably before leaving the scene) and inform them of the patient’s details:

Surname, age and NHI.
Time of symptom onset and summary of the patient’s overall condition. 12 lead ECG findings.
Expected time of arrival.
Ensure there is explicit discussion if there are any contraindications or cautions present from the fibrinolytic therapy/PCI checklist.