STEMI

Question 1

STEMI S/SX

Answer 1

• chest pain/discomfort, SOB, N/V, weakness
• ECG : ST elevation
• Elevated troponin (cardiac enzymes +)

Question 2

STEMI goals of care

Answer 2

Reperfusion therapy
- PCI within 90 min of medical contact
or CABG
- if not 90 min, fibrinolytics should be administered within 30 min of presentation

Question 3

STEMI stabilization

Answer 3

MONAS

Question 4

PCI interventions

Answer 4

1. Stent placement–> ASA for life + P2Y12 antagonist
2. Thromboectomy : Thrombus aspiration (take out clot), then stent placement
3. Percutaneous transluminal coronary angioplasty (PTCA): “plain old balloon angioplasty”- balloon expansion and at least temporary displacement of occlusion at site of lesion

Question 5

ASA + P2Y12 agtagonist dosing

Answer 5

1. ASA 81 mg PO 
\+
2. Clopidogrel 75 mg QD
- LD: 300-600 mg 
-DDI: PPI
- lower risk of bleeding

3, Prasugrel 5-10 mg QD

• LD: 60 mg
• CI: stroke
• risk: 75+ yrs old

4. Ticagrelor 90 mg BID
   - LD: 180 mg

Question 6

STEMI discharge meds

Answer 6

1. ASA
2. P2Y12 inhibitor
3. Statin
4. BB
5. If EF <40%, ACEI/ARB AND aldosterone antagonist (spironolactone)

Question 7

P2Y12 receptor blocker MOA

Answer 7

Inhibits binding of ADP to P2Y12 platelet receptor and decreases platelet aggregation

Clop & prasu: irreversible inhibition
Tica: reversible inhibition