ST-Elevation Myocardial Infarction (STEMI)<\/p>\n\n\n\n
STEMI is diagnosed when there is:
\uf0b7 ST elevation of \u22651 mm in 2 contiguous leads or
\uf0b7 New onset LBBB in the resting ECG
\uf0b7 Ischaemic type chest pains of > 30 minutes and
\uf0b7 Rise and fall in cardiac biomarkers
Echocardiography is recommended to evaluate regional and global LV function and to rule out differential diagnoses.<\/p>\n\n\n\n
Management of STEMI<\/p>\n\n\n\n
Oxygen<\/strong> Nitrates<\/strong> hypotension (SBP< 90 mmHg), RV infarction, history of PDE-5 inhibitors ingestion (within 24 hours of sildenafil or vardenafil, or within 48 hours of tadalafil-aha). After the first 48 hours, oral or topical nitrates may be continued in patients with persisting ischaemia and\/or HF.<\/p>\n\n\n\n Analgesics & tranquilizer<\/strong><\/p>\n\n\n\n ST-Elevation Myocardial Infarction (STEMI) STEMI is diagnosed when there is:\uf0b7 ST elevation of \u22651 mm in 2 contiguous leads or\uf0b7 New onset LBBB in the resting ECG\uf0b7 Ischaemic type chest pains of > 30 minutes and\uf0b7 Rise and fall in cardiac biomarkersEchocardiography is recommended to evaluate regional and global LV function and to rule out […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-621","post","type-post","status-publish","format-standard","hentry","category-med"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts\/621","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/comments?post=621"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts\/621\/revisions"}],"predecessor-version":[{"id":622,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/posts\/621\/revisions\/622"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/media?parent=621"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/categories?post=621"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/blog\/wp-json\/wp\/v2\/tags?post=621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Oxygen is administered in patients with hypoxaemia (SpO2 < 95% or PaO2 < 60 mmHg). Routine oxygen is not recommended in patients with SpO2 \u2265 95%.<\/p>\n\n\n\n
Patients with ongoing chest pain should receive S\/L GTN 0.5 mg every 5 minutes for a total of 3 doses. If symptoms still persist, intravenous GTN should be considered. During acute ACS, intravenous nitrates may be administered in the following situations:
\uf0b7 No symptom relief after 3 doses of sublingual GTN
\uf0b7 Presence of dynamic ECG changes
\uf0b7 Presence of left ventricular failure
\uf0b7 Concomitant high blood pressure.<\/p>\n\n\n\nContraindications to nitrate therapy: <\/h2>\n\n\n\n
Pain is associated with sympathetic activation, which causes vasoconstriction and increases the workload of the heart. IV opioids like morphine can be used when necessary. Watch for adverse events such as hypotension and respiratory depression. Antiemetic such as IV metoclopramide or IV promethazine can be given concurrently.NSAIDs (except aspirin) should not be initiated and should be discontinued during hospitalization for NSTE-ACS because of the associated risk of MACE A mild tranquillizer (usually a benzodiazepine) can be considered inanxious patients.<\/p>\n\n\n\nReperfusion therapy<\/h2>\n\n\n\n
In STEMI patients, reperfusion therapy is indicated in all patients with symptoms of ischaemia of \u226412 h duration and persistent ST-segment elevation. A primary PCI strategy is recommended over fibrinolysis within indicated timeframes. The DNT if fibrinolytic is to be administered should be within 30 minutes. Primary PCI is the preferred strategy in patients who have contraindications to fibrinolytic therapy and the high-risk patients.<\/p>\n\n\n\nHigh-risk patients<\/h2>\n\n\n\n
\uf0b7 Large infarcts
\uf0b7 Anterior infarcts
\uf0b7 Hypotension and cardiogenic shock.
\uf0b7 Significant arrhythmias
\uf0b7 Elderly patients
\uf0b7 Post-revascularization (post-CABG and post-PCI)<\/p>\n","protected":false},"excerpt":{"rendered":"