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STEMI

Definition
  • Acute occlusion of coronary artery leading to muscle infarct
Risk Factors
  • Age
  • Male
  • FHx
  • Smoking
  • Hypertension
  • Overweight
  • Cholesterol
  • Diet
  • Inactivity
  • Alcohol
  • Type A personality
Differential diagnosis
  • Pneumothorax
  • Pneumonia
  • Pericarditis
  • NSTEMI
  • Pleural effusion
Epidemiology
  • Western lifestyle
  • Asian ++
Aetiology
  • Atherosclerosis
  • Plaque rupture
  • => thrombosis
Clinical features
  • Crushing central chest pain >20 mins
  • ST elevation on ECG
  • Dyspnoea
  • Diaphoresis
  • Pallor
  • Nausea
  • Additional heart signs
  • Levine's sign
Pathophysiology
  • Muscle death takes hours-days
Investigations
  • Cardiac enzymes
    • CK-MB
    • Troponin T
    • Troponin I
  • ECG
  • Angiogram
Management

a) conservative

b) medical
  • Immediate
    • 300 mg aspirin
      • Chewed
    • Beta blockers to reduce heart rate
      • Atenolol
    • Fluids??
    • O2
    • Morphine
      • Plus cyclizine
    • Thrombolytics?
    • GTN
    • ACE inhibitors?
  • Long term
    • AABCCDE
      • Aspirin
      • ACE inhibitors
      • Beta blocker
      • Cholesterol (statins)
      • Clopidogrel
      • Diabetes
      • Exercise 
c) surgical
  • PCI
Prognosis
  • 50% mortality
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