STEMI resident survival guide: Difference between revisions
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===Diagnostic Approach=== | ===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 | 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> | ||
{{ | |||
{{Family tree/start}} | |||
{{familytree | A01 | A01=<div style="float: left; text-align: left;"> '''Characterize the symptoms:''' <br> | |||
{{familytree | ❑ [[Chest pain]]<br> | ||
{{familytree | | | :❑ Absence of physical exertion <br> | ||
{{familytree | | :❑ Duration> 20 minutes <br> | ||
{{familytree | |!| | :❑ Radiation to the jaw or left arm | ||
{{familytree | | :❑ No relief with medications<br> | ||
{{familytree | :❑ No relief with rest <br> | ||
{{familytree | | | :❑ Worse with time <br> | ||
{{ | ❑ [[Nausea]] <br> | ||
❑ Vomiting <br> | |||
❑ Sweating</div>}} | |||
{{familytree | |!| | }} | |||
{{familytree | B01 | B01= <div style="float: left; text-align: left;"> '''Obtain a detailed history:''' <br> | |||
❑ Age <br> | |||
❑ Previous [[MI]] <br> | |||
❑ Previous [[PCI]] or [[CABG]] <br> | |||
❑ Cardiac risk factors: <br> | |||
:❑ [[Hypertension]] <br> | |||
:❑ [[Diabetes]] <br> | |||
:❑ [[Hypercholesterolemia]] <br> | |||
:❑ Tobacco use </div>}} | |||
{{familytree | |!| | }} | |||
{{familytree | C01 | C01= <div style="float: left; text-align: left;">'''Examine the patient:''' <br> | |||
❑ Measure the [[blood pressure]] <br> | |||
❑ Measure the [[heart rate]] <br> | |||
❑ Auscultate the heart searching for murmurs <br> | |||
❑ Search for signs of [[CHF]] | |||
:❑ Decreased air entry in the lungs | |||
:❑ Edema in the extremities </div>}} | |||
{{familytree | |!| | }} | |||
{{familytree | D01 | D01= <div style="float: left; text-align: left;">'''Rule out life threatening alternative diagnoses:'''<br> | |||
❑ [[Aortic dissection]]<br> | |||
❑ [[Pulmonary embolism]]<br> | |||
❑ [[Tension pneumothorax]]<br> | |||
❑ [[Cardiac tamponade]]<br> | |||
❑ [[Esophageal rupture]] </div>}} | |||
{{familytree | |!| | }} | |||
{{familytree | E01 | E01= <div style="float: left; text-align: left;">'''Order labs and tests:''' <br> | |||
❑ [[EKG]] <br> | |||
❑ Biomarkers <br> | |||
:❑ Troponin I<br> | |||
:❑ CK-MB <br> | |||
❑ [[Creatinine]] <br> | |||
❑ [[Glucose]] <br> | |||
❑ [[Hemoglobin]] </div>}} | |||
{{Family tree/end}} | |||
===Therapeutic Apporach=== | ===Therapeutic Apporach=== |
Revision as of 16:01, 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:
❑ Nausea | |||||||
Obtain a detailed history: ❑ Age
| |||||||
Examine the patient: ❑ Measure the blood pressure
| |||||||
Rule out life threatening alternative diagnoses: ❑ Aortic dissection | |||||||
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
- ↑ 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.