1 Page Notes : Stemi

ST Elevation Myocardial Infarction. Risk f(x) 1. Previous Hx of vascular disease 2. Sedentary lifestyle 3. DM 4. HPT 5. Smoking & drinking 6. FH : M < 55, F < 60 7. Hyperlipidaemia 8. Male, Female after menopause

Signs & Symptoms 1. Chest pain – central, crushing >20 minutes, typical radiation to left arm. 2. SOB 3. Sweaty 4. Nausea & Vomiting 5. Anxiety 6. Grey Face

Early Mx : 1.

MONAC M orphine (diamorph 2.5mg IV) + M etachlorphromide O xygen N itrate (GTN IV - 6v) A spirin 300mg  75 mg C lopidogrel 300 mg

2. Do ECG 3. Blood test – Cardiac enzyme, DDx

To diagnose(a) Symptoms (b) ECG – STE/ new LBBB/ true posterior MI (c) Cardiac markers - Troponin T (<0.04), CKMB Subsequent Mx ( aim to reduce STE by 50% ) 1. Thrombolysis – Streptokinase given only for 1st time. Contraindicated in people with CVA, bleeding and surgery, TNK 2. Gold standard ( Angioplasty/ Stenting ) Prophylaxis - A spirin (for life) 75 mg - A CE - inhibitors - B eta-blockers - bisoprolol - C lopidogrel – 28 days/ 1 year - Statin – Atorvastatin/ Simvastatin •

Check for BM and give anti-diabetic medications

Complications 1. Arryhthmias 2. Valvular disease 3. VSD 4. Heart Failure Further Resources : 1. http://www.hammersmithmedicine.com/handouts/files/2b.pdf

© Minci 2007