STEMI Flashcards
Risk factors
Same as NSTEMI
Pathophysiology
Thrombus in the coronary artery causes complete occlusion or near complete occlusion. The myocardial area of ischaemia is transmural, involving the entire thickness of the myocardium from the endocardium towards the epicardium.
Aetiology
Atherosclerosis
Coronary spasm
Coronary embolism
Chest trauma
Spontaneous coronary or aortic dissection
Signs
Pallor
Diaphoresis
Low grade fever
LeVine’s sign
Symptoms
Acute central chest pain lasting > 20 mins
Associated with nausea
Diaphoresis
Dyspnoea
Palpitations
Diagnosis
ECG - hyperacute T waves + ST elevation or new LBBB
T wave inversion and pathological Q waves follow over hours to days
Cardiac enzymes - Myoglobulin, Troponin T+I, Creatinine Kinase MB
CXR - Cardiomegaly, Pulmonary oedema
Acute Treatment
MONAC - in ambulance
Morphine 5-10mg
Oxygen (if SaO2 < 95%)
Nitrates (GTN)
Clopidogrel antiplatelet drug
Symptoms onset within 12 hours AND access to PCI 120 mins of first medical contact
- Emergency PCI
- Injectable anticoagulant and further anti platelet therapy = Bivalirudin, if not available use enoxaparin
If PCI not available in 120 mins)
- Thrombolysis = Tissue plasminogen activators = TENECTOPLASE/ALTEPLASE
Do not use thrombolysis in ST depression alone, T wave inversion alone or normal ECG (Contraindicated in previous cranial haemorrhage, ischemic stroke < 6 months, cerebral malignancy or AVM, major head trauma
ACS Complications
Death
Rupture of the heart (LV free wall rupture)
Edema (Heart Failure due to vent fibrillation)
Arrhythmias + Aneurysm = first 24 hours
Dressler’s syndrome = 2-3 weeks post MI = localised immune response + causes pericarditis = pleuritic chest pain, low grade fever + pericardial rub on auscultation. Can cause pericardial effusion + rarely cardiac tamponade (where fluid constricts the heart + prevents function
