STEMI Flashcards

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1
Q

What is involved in the management of a STEMI?

A
  1. ECG
  2. IV access and bloods
  3. Brief assessment
  4. Aspirin and ticagrelor
  5. Morphine
  6. Consider reperfusion therapy
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2
Q

What bloods should be done in STEMI?

A
  • FBC
  • U&Es
  • Glucose
  • Lipids
  • Troponin
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3
Q

What should be included in brief assessment in STEMI?

A
  • History of CVS disease
  • Risk factors for IHD
  • Pulse, BP, JVP, murmurs, signs of CCF, upper limb pulses
  • CXR if won’t delay management
  • Contraindications to PCI or fibrinolysis
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4
Q

What dose of aspirin should be given in STEMI?

A

300mg

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5
Q

What dose of ticagrelor should be given in STEMI?

A

180mg

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6
Q

If clopidogrel is used instead of ticagrelor, what dose should be used?

A

300mg

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7
Q

What dose of morphine should be given in STEMI?

A

5-10mg IV

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8
Q

What should be given with morphine in STEMI?

A

Metaclopramide 10mg IV

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9
Q

Should GTN be used in STEMI?

A

Routine use not recommended in acute setting unless patient is hypertensive or in acute LVF

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10
Q

When should oxygen be used in STEMI?

A
  • Sats <95%
  • Breathless
  • Acute LVF
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11
Q

What are the ECG criteria for reperfusion therapy?

A

One of;

  • ST elevation >1mm in 2+ adjacent leads, or >2mm in 2+ adjacent leads
  • LBBB
  • Posterior changes (deep ST depression and tall R waves in leads V1-3)
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12
Q

What are the options for reperfusion therapy in STEMI?

A
  • Primary PCI

- Thrombolysis

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13
Q

Who should be offered primary PCI in STEMI?

A

Patients presenting within 12 hours of symptom onset, who are either at or can be transferred to a primary PCI centre within 120 mins of first medical contact.

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14
Q

When should primary PCI be used beyond 12 hours of symptom onset?

A

Evidence of ongoing ischaemia or in stable patients presenting after 12-24 hours - seek specialist advice

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15
Q

What is the target time for thrombolysis?

A

Within 30 min from admission

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16
Q

When does the use of thrombolysis require specialist advice?

A

> 12 hours from symptom onset

17
Q

What agent is used for thrombolysis in STEMI?

A

Tenecteplase

18
Q

What are the contraindications to thrombolysis?

A
  • Previous intracranial haemorrhage
  • Ischaemic stroke <6 months
  • Cerebral malignancy or AVM
  • Recent major trauma/surgery/head injury (<3 weeks)
  • GI bleeding in last month
  • Known bleeding disorder
  • Aortic dissection
  • Non-compressible punctures <24hours, e.g. liver biopsy. LP
19
Q

What are the relative contraindications to thrombolysis?

A
  • TIA <6 months
  • Anticoagulant therapy
  • Pregnancy/ >1week post-partum
  • Refractory hypertension
  • Advanced liver disease
  • Infective endocarditis
  • Active peptic ulcer
  • Prolonged/traumatic resuscitation
20
Q

What should happen if thrombolysis?

A

Patients should be transferred to primary PCI centre for rescue PCI (if residual ST elevation) or angiography (if successful)

21
Q

What should be done in patients with STEMI who do not receive reperfusion therapy?

A

Treated with fondaparinux