STEMI

Question 1

What is a STEMI?

Answer 1

A STEMI (ST-Elevation Myocardial Infarction) is a type of acute coronary syndrome characterised by ST-segment elevation on ECG and myocardial necrosis.

Question 2

What causes a STEMI?

Answer 2

It is caused by a complete occlusion of a coronary artery due to a ruptured atherosclerotic plaque and subsequent thrombus formation.

Question 3

What are the common symptoms of a STEMI?

Answer 3

Severe chest pain (often crushing or squeezing), radiating to the left arm, neck, or jaw, dyspnoea, nausea, vomiting, and diaphoresis.

Question 4

What are the risk factors for STEMI?

Answer 4

Smoking, hypertension, diabetes, hyperlipidaemia, obesity, sedentary lifestyle, and a family history of cardiovascular disease.

Question 5

How is STEMI diagnosed?

Answer 5

Diagnosis is based on clinical presentation, ECG changes (ST elevation in two contiguous leads), and elevated cardiac biomarkers (e.g., troponin).

Question 6

What are the characteristic ECG findings in STEMI?

Answer 6

ST-segment elevation in contiguous leads, new left bundle branch block (LBBB), or pathological Q waves.

Question 7

What is the pathophysiology of STEMI?

Answer 7

Complete coronary artery occlusion leads to myocardial ischaemia and necrosis due to an imbalance between oxygen supply and demand.

Question 8

What are the immediate management steps for a suspected STEMI?

Answer 8

ABCDE assessment, oxygen if hypoxic, aspirin, P2Y12 inhibitor (e.g., clopidogrel), nitrates, and consideration of reperfusion therapy.

Question 9

What are the two main reperfusion therapies for STEMI?

Answer 9

Primary percutaneous coronary intervention (PCI) and thrombolysis.

Question 10

What is primary PCI, and why is it preferred in STEMI?

Answer 10

PCI involves mechanically opening the occluded artery with a stent and is preferred because it has better outcomes compared to thrombolysis.

Question 11

When is thrombolysis used in STEMI management?

Answer 11

Thrombolysis is used when PCI is not available within 120 minutes of first medical contact.

Question 12

What medications are used during primary PCI?

Answer 12

Antiplatelets (aspirin, P2Y12 inhibitors) and anticoagulants (e.g., heparin) to reduce clot formation.

Question 13

What is the role of beta-blockers in STEMI management?

Answer 13

Beta-blockers reduce myocardial oxygen demand by lowering heart rate and blood pressure, improving outcomes in certain patients.

Question 14

What complications can arise from a STEMI?

Answer 14

Heart failure, arrhythmias (e.g., ventricular fibrillation), cardiogenic shock, ventricular rupture, and recurrent ischaemia.

Question 15

What is the Killip classification in STEMI?

Answer 15

A system used to stratify the severity of heart failure in STEMI patients, ranging from no heart failure (Class I) to cardiogenic shock (Class IV).

Question 16

What is the role of troponin in STEMI diagnosis?

Answer 16

Elevated troponin levels confirm myocardial necrosis and help differentiate STEMI from other causes of chest pain.

Question 17

What lifestyle changes are recommended after a STEMI?

Answer 17

Smoking cessation, a heart-healthy diet, regular exercise, weight management, and adherence to prescribed medications.

Question 18

What medications are part of long-term secondary prevention after a STEMI?

Answer 18

Dual antiplatelet therapy (aspirin and a P2Y12 inhibitor), statins, beta-blockers, ACE inhibitors, and possibly anticoagulants.

Question 19

What is the role of statins in post-STEMI management?

Answer 19

Statins lower LDL cholesterol and stabilise atherosclerotic plaques, reducing the risk of recurrent events.

Question 20

How is STEMI managed in patients with cardiogenic shock?

Answer 20

Management includes inotropic support (e.g., dobutamine), mechanical ventilation, and urgent PCI or coronary artery bypass grafting (CABG).

Question 21

What are the ECG findings specific to an anterior STEMI?

Answer 21

ST elevation in leads V1-V4, often due to left anterior descending artery occlusion.

Question 22

What are the ECG findings specific to an inferior STEMI?

Answer 22

ST elevation in leads II, III, and aVF, typically caused by right coronary artery occlusion.

Question 23

Why is early recognition of a STEMI important?

Answer 23

Prompt diagnosis and reperfusion therapy minimise myocardial damage, reduce complications, and improve survival.

Question 24

What are the indications for implantable cardioverter-defibrillator (ICD) post-STEMI?

Answer 24

ICDs are indicated in patients with reduced ejection fraction and high risk of ventricular arrhythmias.

Question 25

What is the prognosis for STEMI patients?

Answer 25

Prognosis depends on the extent of myocardial damage, timeliness of reperfusion therapy, and adherence to secondary prevention strategies.