Treatment of STEMI

Question 1

If onset of Infarct is <12 hours, then REPERFUSION

Percutaneous Coronary Intervention is door to ballon in how many minutes?

Answer 1

90

Question 2

How quickly do you start Fibrinolytic therapy?

Answer 2

Door to drug: 30 mins

Question 3

What is the eligibility criteria for STEMI treatment?

Answer 3

ST elevation in 2 or more leads OR new onset of LBBB

ONSET of chest pain < 12 hours

Chest pain of 30 mins in duration

Pain unresponsive to sublingual nitro

Question 4

Percutaneous Coronary Intervention: You want to monitor for vasovagal reactions during sheath removal. What are the symptoms and how do you treat?

Answer 4

Hypotension < 90 systolic with or without bradycardia; no compensatory tachy

Pallor, nausea, yawning, diaphoresis

Give fluids, Atropine

Question 5

What are GP IIb/IIIA inhibitors?

Answer 5

Glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors prevent platelet aggregation by blocking glycoprotein IIb/IIIa receptors on their platelet’s plasma membrane and inhibiting fibrinogen binding. The available GP IIb/IIIa inhibitors include tirofiban and eptifibatide

Question 6

What are the absolute contraindications for Fibrinolytic Therapy (breaking down of blood clots)?

Answer 6

Prior intracranial hemorrhage

Known structural cerebral vascular lesion (arteriovenous malformation)

Known malignant intracranial neoplasm

Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours

Suspected Aortic Disection

Active bleeding

Significant closed-head or facial trauma within 3 months

Question 7

What are some indications or evidence of successful reperfusion?

Answer 7

Chest pain relief: due to fibrinolysis of clot

Resolution of ST segment deviations: d/t return of blood flow

Marked elevation of proponin/CK-MB: d/t myocardial “stunning” when vessel opens

Reperfusion arrhythmias (VT, VF, accelerated idovientricular rhythm (AIVR): d/t myocardial stunning when vessel opens