STEMI

ST Elevation MI ( STEMI )

ECG changes in myocardial infarction (STEMI) V2 – V5 Anterior

V1 – V3 Anteroseptal

V4 – V6, I, aVL Anterolateral

I, aVL Lateral

II, III, aVF Inferior

V1, V2(Reciprocal) Posterior

• Thrombolytic therapy is given in STEMI
• Thrombolytic therapy is NOT GIVEN IN UNSTABLE ANGINA AND NSTEMI

THROMBOLYTIC GIVE IN PERIPHERY HOSPITAL WHEN PCI NOT AVAILABLE!!!!!!!!!!!!!!!!!!!!!!!!!!

STEMI confirmed what is the next step !!! Immediately assess eligibility for coronary reperfusion therapy

Gold-standard treatment

Primary percutaneous coronary intervention (PCI) has emerged as the gold-standard treatment for STEMI but is not available in all centres. Thrombolysis should be performed in patients without access to primary PCI 18

Management options for STEMI

Immediate revascularization. Diagnosis of STEMI should not be excluded based on a single ECG.

STEMI

PCI
PCI is advised within 90 min, where facilities are available when patient presented to hospital in 6 hours(up to 12 hours) of pain.

THROMBOLYSIS

• If PCI not available ( small hospital ) Fibrinolysis (Thrombolysis) is done within 6 hours
• ( Up to 12 hrs ) of STEMI
• Drugs used for Thrombolysis are Alteplase (human tissue plasminogen activator or tPA) Streptokinase

Contraindications for fibrinolysis SDL

Severe hypertension unresponsive to emergency therapy Presence of intracranial conditions that increase the risk of bleeding (e.g. arteriovenous malformation) Intracranial malignancy Additionally for streptokinase: previous exposure within 6 months (highly antigenic)

Medical Treatment ACS

• O2
• Morphine and anti emetic (IV morphine: ! vomit)
• Antiplatelets agent: Aspirin + // (Clopidrogrel / prasugrel/ ticagrelor)
• Antithrombin drugs: Enoxaprin- low molecular heparin/Bivalirudin / Fondaparinux / Rivaroxaban
• Glycoprotein IIB/IIIA inhibitors: Abciximab
• Beta-blockers
• ACEIs
• Nitrates - nitrates & nitrites
• Statin eg lipitor

STEMI -COMPLICATIONS

Heart failure: Killip - Pericarditis Killip I – no crackles and no third heart sound • Killip II – crackles in <50% of the lung fields or a third heart sound • Killip III – crackles in >50% of the lung fields • Killip IV – cardiogenic shock.

STEMI – CARDIAC ARRHYTHMIAS

• Ventricular tachycardia
• Ventricular fibrillation ( C death )
• Cardiac arrest
• Atrial fibrillation
• Conduction defect - common with INFERIOR MI as Rt CA supplies SA & AV nodes

V fib is more dangerous than v tach

Post ACS Life-style modification

• Diet- Omega- 3 fatty acid from fish
• Daily walk 20- 30 min daily
• Stop smoking
• Maintain alcohol consumption in safe limits 21 units/ week
• If over-weight – reduce weight
• Control Hypertension less than 140/90 mmHg , DM: 130/ 90 mmHg
• Maintain Hb A1c less than 7% in Diabetic patient