STEMI

Question 1

Define STEMI.

Answer 1

ST-elevation myocardial infarction (STEMI) is suspected when a patient presents with persistent ST-segment elevation in 2 or more anatomically contiguous ECG leads in the context of a consistent clinical history.

Question 2

Explain the aetiology/risk factors of STEMI.

Answer 2

Smoking
Hypertension
Diabetes
Obesity
Metabolic syndrome
Physical inactivity
Dyslipidaemia
Renal insufficiency
Established coronary artery disease
Family history of premature coronary artery disease
Cocaine use
Male sex
Advanced age

Question 3

Summarise the epidemiology of STEMI.

Answer 3

The overall prevalence of MI in the US is around 2.8% in adults aged 20 years or over. The estimated incidence is 550,000 new and 200,000 recurrent MIs annually.

Question 4

Recognise the presenting symptoms of STEMI. Recognise the signs of STEMI on physical examination.

Answer 4

Chest pain
Dyspnoea
Pallor
Diaphoresis
Cardiogenic shock
Nausea and/or vomiting
Dizziness or light-headedness
Weakness
Tachycardia
Additional heart sounds

Question 5

Identify appropriate investigations for STEMI and interpret the results.

Answer 5

ECG
Troponin
Electrolytes, urea, and creatinine
Serum lipids
CXR
Coronary angiogram

Question 6

Generate a management plan for STEMI.

Answer 6

Aspirin

Adjunct:
GTN or morphine

Question 7

Identify the possible complications of STEMI and its management.

Answer 7

Sinus bradycardia
Heart block
Recurrent chest pain
Acute mitral regurgitation
Ventricular septal defects (VSD)
Acute pericardial tamponade
Post-infarction pericarditis (Dressler’s syndrome)
Congestive heart failure
Ventricular arrhythmias
Recurrent ischaemia and infarction

Question 8

Summarise the prognosis for patients with STEMI.

Answer 8

About 15% of people who have an acute MI in the US will die of it, half within the first hour of symptoms. Prognosis for patients with STEMI varies depending on time to presentation after onset of chest pain and time to treatment after presentation.