STEMI resident survival guide: Difference between revisions
Line 21: | Line 21: | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{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> | ||
:❑ Sudden onset | :❑ Sudden onset | ||
Line 31: | Line 31: | ||
❑ [[Diaphoresis]] <br> | ❑ [[Diaphoresis]] <br> | ||
❑ [[Light-headedness]] <br> | ❑ [[Light-headedness]] <br> | ||
❑ [[Nausea]] and/or [[vomiting]] | ❑ [[Nausea]] and/or [[vomiting]]</div>}} | ||
</div>}} | |||
{{familytree | | | | | | |!| | | | | | | }} | {{familytree | | | | | | |!| | | | | | | }} | ||
Line 44: | Line 43: | ||
:❑ [[Hypercholesterolemia]] <br> | :❑ [[Hypercholesterolemia]] <br> | ||
:❑ [[Smoking]] <br> | :❑ [[Smoking]] <br> | ||
:❑ [[Obesity]] | :❑ [[Obesity]]</div>}} | ||
{{familytree | | | | | | |!| | | | | | | }} | |||
{{familytree | | | | | | |!| | | | | | | | {{familytree | | | | | | C01 | | | | | | C01=<div style="float: left; text-align: left;">'''Examine the patient:''' <br> | ||
{{familytree | | | | | | C01 | | | | | | | |||
❑ Measure the [[blood pressure]] <br> | ❑ Measure the [[blood pressure]] <br> | ||
❑ Measure the [[heart rate]] <br> | ❑ Measure the [[heart rate]] <br> | ||
Line 54: | Line 52: | ||
:❑ Decreased air entry in the lungs | :❑ Decreased air entry in the lungs | ||
:❑ Edema in the extremities </div>}} | :❑ Edema in the extremities </div>}} | ||
{{familytree | | | | | | |!| | | | | | | | {{familytree | | | | | | |!| | | | | | | }} | ||
{{familytree | | | | | | D01 | | | | | | | {{familytree | | | | | | D01 | | | | | | D01=<div style="float: left; text-align: left;">'''Rule out life threatening alternative diagnoses:'''<br> | ||
❑ [[Aortic dissection]]<br> | ❑ [[Aortic dissection]]<br> | ||
❑ [[Pulmonary embolism]]<br> | ❑ [[Pulmonary embolism]]<br> | ||
Line 62: | Line 60: | ||
❑ [[Esophageal rupture]] </div>}} | ❑ [[Esophageal rupture]] </div>}} | ||
{{familytree | | | | | | |!| | | | | | | }} | {{familytree | | | | | | |!| | | | | | | }} | ||
{{familytree | | | | | | E01 | | | | | | E01= <div style="float: left; text-align: | {{familytree | | | | | | E01 | | | | | | E01=<div style="float: left; text-align:center;">'''Order labs and tests:'''</div>}} | ||
{{familytree | | |,|-|-|-|+|-|-|-|.| | | }} | {{familytree | | |,|-|-|-|+|-|-|-|.| | | }} | ||
{{familytree | | F01 | | F02 | | F03 | | |F01= <div style="float: left; text-align: left;"> | {{familytree | | F01 | | F02 | | F03 | | |F01=<div style="float: left; text-align: left;"> '''[[EKG]]'''<br>$$$</div> | F02=<div style="float: left; text-align: left;"> '''[[Cardiac Enzymes]]''' <br> | ||
:❑ Troponin I<br> | :❑ Troponin I<br> | ||
:❑ CK-MB < | :❑ CK-MB </div> | ||
|F03='''Other labs:''' <br> | |F03=<div style="float: left; text-align: left;">'''Other labs:''' <br> | ||
❑ [[Creatinine]] <br> | ❑ [[Creatinine]] <br> | ||
❑ [[Glucose]] <br> | ❑ [[Glucose]] <br> | ||
❑ [[Hemoglobin]] </div>}} | ❑ [[Hemoglobin]] </div>}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
Revision as of 16:34, 3 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Definition
ST elevation myocardial infarction (STEMI) is a syndrome defined by symptoms of myocardial ischemia (sudden chest pain and pressure, shortness of breath) associated with persistent ECG ST elevation and subsequent release of cardiac enzymes.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. STEMI is a life-threatening condition and must be treated as such irrespective of the causes.
Common Causes
- Rupture of high-risk plaque in the coronary arteries
- Occlusive Thrombus
Management
Diagnostic Approach
Shown below is an algorithm summarizing the diagnostic approach to STEMI based on the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction[1]
Characterize the symptoms:
❑ Diaphoresis | |||||||||||||||||||||||||||||||
{{{ }}} | |||||||||||||||||||||||||||||||
Obtain a detailed history: ❑ Age
| |||||||||||||||||||||||||||||||
Examine the patient: ❑ Measure the blood pressure
| |||||||||||||||||||||||||||||||
Rule out life threatening alternative diagnoses: ❑ Aortic dissection | |||||||||||||||||||||||||||||||
Order labs and tests: | |||||||||||||||||||||||||||||||
EKG $$$ | |||||||||||||||||||||||||||||||
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.