STEMI

Question 1

what causes STEMI?

Answer 1

Question 2

which leads indicate anterior STEMI?

Answer 2

ST elevation in V1,2,3,4

Question 3

which leads indicate lateral STEMI?

Answer 3

ST elevation in 1, aVL, V5 + V6

Question 4

which leads indicate inferior STEMI?

Answer 4

ST elevation in 2, 3, aVF

Question 5

explain the coronary artery territories ie area + artery supplying it

Answer 5

Question 6

what is RV infarction?

Answer 6

Question 7

what are the special complication of inferior MI?

Answer 7

RV infarction
sinus bradycardia + heart block

Question 8

what causes sinus bradycardia + heart block in inferior MI?

Answer 8

Question 9

what are the special STEMI subtypes?

Answer 9

left main + posterior

Question 10

how can you differentiate between left main + posterior STEMI?

Answer 10

Question 11

what is the immediate management of STEMI?

Answer 11

Pain relief: morphine 5-10mg
if breathless or low sats: give oxygen
transfer for PCI/coronary angiography
300-mg aspirin + 2nd antiplatelet drug (Prasugrel 60mg po OR clopidogrel 600mg po OR ticagralor 180mg)

Question 12

what is management post STEMI?

Answer 12

1. Dual antiplatelet therapy: aspirin 75mg po od (lifelong) and send anti-platelet (prasugrel 10mg po od, ticagralor 90mg bd OR clopidogrel 75mg po od)
2. Secondary prevention with Atorvastatin 80mg, Bisoprolol 1.25 – 2.5mg po od, Ramipril 2.5mg po od

Question 13

who should get coronary angiography?

Answer 13

if: presentation is within 12 hours of onset of symptoms AND primary PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given