STEMI Flashcards
How should all patients with suspected ACS be managed?
All patients should be placed in an environment with continuous ECG monitoring and defibrillation capacity
Give aspirin and clopidogrel 300mg PO and do not give IM injections (causes CK rise and inc. risk bleeding)
If going straight to cathlab, consider loading dose of 600mg clopidogrel
What should your immediate assessment of a patient with ACS consist of?
Rapid assessment –> exclude hypotension and note prence of murmurs, and to identify and treat acute pulmonary oedema
IV access and bloods –> FBC, U&Es, glucose, troponin, lipid profile
12-lead ECG + reported within 10min
High-flow oxygen therapy (warning with COPD)
Prescribe –> diamorphine 2.5-150mg IV PRN, metoclopramide 10mg IV, GTN spray two puffs (unless hypotensive)
Portable CXR
General exam –> peripheral pulses, fundoscopy, abdominal examination for organomegaly, and aortic aneurysm
What are some non-ACS causes of raised troponin?
Troponin is a sensitive marker of myocyte damage, but is not specific to thrombotic coronary artery occlusion
Other causes of raised troponin –> sepsis, myocarditis, cardiac failure, renal failure, stroke, tachycardia
What are some differentials for ACS-related chest pain?
Cardiac –> pericarditis, dissecting aortic aneurysm
Resp –> pulmonary embolism
GI –> GORD, biliary disease, perf. peptic ulcer, pancreatitis
Misc –> MSK
What factors are associated with a poor prognosis?
Age > 70
Previous MI / chronic stable angina
Anterior MI / RV infarction
LV failure
Hypotension
T2DM
Acute mitral regurg
VSD
What are some conditions that may mimic the ECG changes of a STEMI?
LV / RV hypertrophy
LBBB
Wolff-Parkinson-White syndrome
Pericarditis / myocarditis
Hyperkalaemia
What are the ECG changes seen in a STEMI?
ST-segment elevation –> >/= 2mm in adjacent chest leads and >/= 1mm in adjacent limb leads needed to fulfil thrombolysis criteria
