STEMI resident survival guide: Difference between revisions

Jump to navigation Jump to search
Line 18: Line 18:
   
   
Shown below is an algorithm summarizing the diagnostic approach to [[STEMI]] based on the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction<ref name="O'GaraKushner2013">{{cite journal|last1=O'Gara|first1=Patrick T.|last2=Kushner|first2=Frederick G.|last3=Ascheim|first3=Deborah D.|last4=Casey|first4=Donald E.|last5=Chung|first5=Mina K.|last6=de Lemos|first6=James A.|last7=Ettinger|first7=Steven M.|last8=Fang|first8=James C.|last9=Fesmire|first9=Francis M.|last10=Franklin|first10=Barry A.|last11=Granger|first11=Christopher B.|last12=Krumholz|first12=Harlan M.|last13=Linderbaum|first13=Jane A.|last14=Morrow|first14=David A.|last15=Newby|first15=L. Kristin|last16=Ornato|first16=Joseph P.|last17=Ou|first17=Narith|last18=Radford|first18=Martha J.|last19=Tamis-Holland|first19=Jacqueline E.|last20=Tommaso|first20=Carl L.|last21=Tracy|first21=Cynthia M.|last22=Woo|first22=Y. Joseph|last23=Zhao|first23=David X.|title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction|journal=Journal of the American College of Cardiology|volume=61|issue=4|year=2013|pages=e78–e140|issn=07351097|doi=10.1016/j.jacc.2012.11.019}}</ref>
Shown below is an algorithm summarizing the diagnostic approach to [[STEMI]] based on the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction<ref name="O'GaraKushner2013">{{cite journal|last1=O'Gara|first1=Patrick T.|last2=Kushner|first2=Frederick G.|last3=Ascheim|first3=Deborah D.|last4=Casey|first4=Donald E.|last5=Chung|first5=Mina K.|last6=de Lemos|first6=James A.|last7=Ettinger|first7=Steven M.|last8=Fang|first8=James C.|last9=Fesmire|first9=Francis M.|last10=Franklin|first10=Barry A.|last11=Granger|first11=Christopher B.|last12=Krumholz|first12=Harlan M.|last13=Linderbaum|first13=Jane A.|last14=Morrow|first14=David A.|last15=Newby|first15=L. Kristin|last16=Ornato|first16=Joseph P.|last17=Ou|first17=Narith|last18=Radford|first18=Martha J.|last19=Tamis-Holland|first19=Jacqueline E.|last20=Tommaso|first20=Carl L.|last21=Tracy|first21=Cynthia M.|last22=Woo|first22=Y. Joseph|last23=Zhao|first23=David X.|title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction|journal=Journal of the American College of Cardiology|volume=61|issue=4|year=2013|pages=e78–e140|issn=07351097|doi=10.1016/j.jacc.2012.11.019}}</ref>




Line 24: Line 23:
{{familytree  | A01 | A01=<div style="float: left; text-align: left;"> '''Characterize the symptoms:''' <br>  
{{familytree  | A01 | A01=<div style="float: left; text-align: left;"> '''Characterize the symptoms:''' <br>  
❑ [[Chest pain]]<br>
❑ [[Chest pain]]<br>
:❑ Absence of physical exertion <br>
:❑ Sudden onset
:❑ Duration> 20 minutes <br>
:❑ Descried as a sensation of tightness, pressure, or squeezing
:❑ Radiation to the jaw or left arm
:❑ Radiation to the jaw or left arm
:❑ No relief with medications<br>
:❑ No relief with medications <br>
:❑ No relief with rest <br>
:❑ No relief with rest <br>
:❑ Worse with time <br>
:❑ Worse with time <br>
❑ [[Nausea]] <br>
Shortness of breath ([[Dyspnea]])
Vomiting <br>
❑ [[Diaphoresis]]
Sweating</div>}}
[[Light-headedness]]
[[nausea]] and/or [[vomiting]]
</div>}}
 
{{familytree  | |!| | }}
{{familytree  | |!| | }}
{{familytree  | B01 | B01= <div style="float: left; text-align: left;"> '''Obtain a detailed history:''' <br>
{{familytree  | B01 | B01= <div style="float: left; text-align: left;"> '''Obtain a detailed history:''' <br>

Revision as of 16:18, 3 March 2014


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Definition

ST elevation myocardial infarction (STEMI) is a syndrome defined by symptoms of myocardial ischemia (sudden chest pain and pressure, shortness of breath) associated with persistent ECG ST elevation and subsequent release of cardiac enzymes.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. STEMI is a life-threatening condition and must be treated as such irrespective of the causes.

Common Causes

Management

Diagnostic Approach

Shown below is an algorithm summarizing the diagnostic approach to STEMI based on the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction[1]


Characterize the symptoms:

Chest pain

❑ Sudden onset
❑ Descried as a sensation of tightness, pressure, or squeezing
❑ Radiation to the jaw or left arm
❑ No relief with medications
❑ No relief with rest
❑ Worse with time

❑ Shortness of breath (Dyspnea) ❑ DiaphoresisLight-headednessnausea and/or vomiting

 
 
 
 
 
Obtain a detailed history:

❑ Age
❑ Previous MI
❑ Previous PCI or CABG
❑ Cardiac risk factors:

Hypertension
Diabetes
Hypercholesterolemia
❑ Tobacco use
 
 
 
 
 
Examine the patient:

❑ Measure the blood pressure
❑ Measure the heart rate
❑ Auscultate the heart searching for murmurs
❑ Search for signs of CHF

❑ Decreased air entry in the lungs
❑ Edema in the extremities
 
 
 
 
 
Rule out life threatening alternative diagnoses:

Aortic dissection
Pulmonary embolism
Tension pneumothorax
Cardiac tamponade

Esophageal rupture
 
 
 
 
 
Order labs and tests:

EKG
❑ Biomarkers

❑ Troponin I
❑ CK-MB

Creatinine
Glucose

Hemoglobin

Therapeutic Apporach

Shown below is an algorithm summarizing the therapeutic approach to STEMI based on the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References

  1. O'Gara, Patrick T.; Kushner, Frederick G.; Ascheim, Deborah D.; Casey, Donald E.; Chung, Mina K.; de Lemos, James A.; Ettinger, Steven M.; Fang, James C.; Fesmire, Francis M.; Franklin, Barry A.; Granger, Christopher B.; Krumholz, Harlan M.; Linderbaum, Jane A.; Morrow, David A.; Newby, L. Kristin; Ornato, Joseph P.; Ou, Narith; Radford, Martha J.; Tamis-Holland, Jacqueline E.; Tommaso, Carl L.; Tracy, Cynthia M.; Woo, Y. Joseph; Zhao, David X. (2013). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction". Journal of the American College of Cardiology. 61 (4): e78–e140. doi:10.1016/j.jacc.2012.11.019. ISSN 0735-1097.


Template:WikiDoc Sources