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