STEMI

Question 1

STEMI vs NSTEMI

Answer 1

Question 2

typically have ST elevation in two contiguous leads on a 12-lead ECG

Answer 2

• ST elevation in leads II, III and aVF
• Progressive development of Q waves in II, III and aVF
• Reciprocal ST depression in aVL (± lead I)
• This indicates myocardial infarction/necrosis

Question 3

STEMI is attributable to rupture of the

Answer 3

fibrous atherosclerotic plaque leading to platelet aggregation and thrombus formation at the site of rupture .

• The thrombus causes an abrupt 100% occlusion to the coronary artery, is a medical emergency, and requires immediate revascularization of the blocked coronary artery.

Question 4

Thrombolytic therapy

Answer 4

• using fibrinolytics dissolves thrombi in the coronary arteries and restores myocardial blood flow. Examples of these agents, which target the fibrin component of the coronary thrombosis, include:
• Tissue plasminogen activator (t-PA, alteplase [Activase]) (IV or intracoronary)
• Reteplase (Retavase) (IV or intracoronary)
• Tenecteplase (TNK) (IV push [IVP])

Question 5

Thrombolytic agents are most effective when

Answer 5

• Thrombolytic agents are most effective when administered within the first 6 hours of a coronary event. They are used in men and women, young and old.
• It is indicated for chest pain of longer than 30 minutes’ duration that is unrelieved by nitroglycerin, with indications of STEMI by the ECG.
• The goal is to start the infusion of fibrinolytics within 30 minutes of ED admission.

Question 6

For some patients having an ACS, primary percutaneous coronary intervention (PCI) may be used to reopen the clotted coronary artery and restore perfusion.

Answer 6

Percutaneous intervention has been associated with excellent return of blood flow through the coronary artery when it can be performed by an interventional cardiologist within 2 to 3 hours of the onset of symptoms.

Question 7

Monitor the patient for indications that the clot has been lysed (dissolved) and the artery reperfused. These indications include:

Answer 7

• Abrupt cessation of pain or discomfort
• Sudden onset of ventricular dysrhythmias
• Resolution of ST-segment depression/elevation or T-wave inversion
• A peak at 12 hours of markers of myocardial damage