STEMI resident survival guide: Difference between revisions

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

Rupture of high-risk plaque in the coronary arteries
Occlusive Thrombus

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) ❑ Diaphoresis ❑ Light-headedness ❑ nausea 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

↑ 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

[O'GaraKushner2013-1] 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.

[1]

@@ 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>
@@ Line 24: / Line 23: @@
 {{familytree  | A01 | A01=<div style="float: left; text-align: left;"> '''Characterize the symptoms:''' <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
-:❑ No relief with medications<br>
+:❑ No relief with medications <br>
 :❑ No relief with rest <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  | B01 | B01= <div style="float: left; text-align: left;"> '''Obtain a detailed history:''' <br>