STEMI resident survival guide: Difference between revisions

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❑ [[Chest pain]]<br>
❑ [[Chest pain]]<br>
:❑ Sudden onset
:❑ Sudden onset
:❑ Descried as a sensation of tightness, pressure, or squeezing
:❑ Described 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 or rest <br>
:❑ No relief with medications or rest <br>
Line 62: Line 62:
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{{familytree  | | F01 | | F02 | | F03 | | |F01=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''[[EKG]]'''<br> ❑ New ST elevation at the J point in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1
{{familytree  | | F01 | | F02 | | F03 | | |F01=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''[[EKG]]'''<br> ❑ New ST elevation at the J point in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1
mV) in other contiguous chest leads or the limb leads <br> ❑ For EKG Examples click [[ST elevation myocardial infarction electrocardiogram|here]]</div> | F02=<div style="float: left; text-align: left; width: 15em; padding:1em;"> '''[[Cardiac Enzymes]]''' <br>
mV) in other contiguous chest leads or the limb leads <br> ❑ For EKG Examples click [[ST elevation myocardial infarction electrocardiogram|here]]</div> | F02=<div style="float: left; text-align: left; width: 15em; padding:1em;"> '''Cardiac Enzymes''' <br>
:❑ Troponin I (preferred biomarker) <br>
:❑ [[Troponin I]] (preferred biomarker)<br>
:❑ CK-MB </div>
:❑ [[CK-MB]] </div>
|F03=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Other labs:''' <br>
|F03=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Other labs:''' <br>
❑ [[Creatinine]] <br>
❑ [[Creatinine]] <br>

Revision as of 17:40, 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
❑ Described as a sensation of tightness, pressure, or squeezing
❑ Radiation to the jaw or left arm
❑ No relief with medications or rest
❑ Worse with time
❑ Shortness of breath (Dyspnea)

❑ Diaphoresis
❑ Light-headedness

❑ Nausea and/or vomiting
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obtain a detailed history:

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

❑ Hypertension
❑ Diabetes
❑ Hypercholesterolemia
❑ Smoking
❑ Obesity
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
❑ Cardiac tamponade
❑ Tension pneumothorax

❑ Esophageal rupture
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order labs and tests:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EKG
❑ New ST elevation at the J point in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1 mV) in other contiguous chest leads or the limb leads
❑ For EKG Examples click here
 
Cardiac Enzymes
❑ Troponin I (preferred biomarker)
❑ CK-MB
 
Other labs:

❑ 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[1]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References

  1. ↑ 1.0 1.1 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.


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