ST segment elevation ACS. Etiology, pathomechanism, D

Question 1

STEMI: prognosis

Answer 1

• 30-50% of patients die before hospitalization

- 66% die in 2 hr

Question 2

STEMI: pathomechanism

Answer 2

• total obstruction for 3 to 6 hours, -> causing a transmural ischemia

Question 3

STEMI: S, D, Differential diagnosis

Answer 3

• same as a non-ST ACS

Question 4

STEMI: T, pre-hospital

Answer 4

• MONA

Question 5

STEMI: T, hospital

Answer 5

• MONA + BASC (BB, ACEi, Statin, Clopidogrel)
• Invasive: emergency PCI STEMI < 2h, if no PCI, then thrombolysis.
  The time to put the first ballon has to be <120mins so that there’s still viable myocardium
• Fibrinolytic therapy -> streptokinase, tPA

Question 6

STEMI: subsequent treatment

Answer 6

• rest 48h
• exercise, daily ECG+ biomarkers 2-3 days
• thromboembolism prophylaxis (heparin…)
• BACS
• exercise ECG

Question 7

Post-ACS therapy

Answer 7

• manage reversible risk factors
• ACEi / ARB
• clopidogrel (+ aspirin): 1 month (bare metal stent), 12 months (drug eluting stent)
• GPIIb/IIIa inhibitors for at least 18-24 months after PCI
• statins