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    The document discusses ST-elevation myocardial infarction (STEMI). It defines STEMI as characteristic symptoms, electrocardiograph changes, and a rise and fall in cardiac markers. It notes that STEMI diagnosis involves an integrated assessment of history, ECG changes, cardiac markers, and imaging. It discusses the history, differential diagnosis, management, and specific measures for STEMI patients, including aspirin, beta-blockers, heparin, and reperfusion therapies like primary percutaneous coronary intervention (PCI) and thrombolytic therapy. It lists different types of thrombolytic drugs and their indications and contraindications. It also outlines the indications for primary PCI.

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    The document discusses ST-elevation myocardial infarction (STEMI). It defines STEMI as characteristic symptoms, electrocardiograph changes, and a rise and fall in cardiac markers. It notes that STEMI diagnosis involves an integrated assessment of history, ECG changes, cardiac markers, and imaging. It discusses the history, differential diagnosis, management, and specific measures for STEMI patients, including aspirin, beta-blockers, heparin, and reperfusion therapies like primary percutaneous coronary intervention (PCI) and thrombolytic therapy. It lists different types of thrombolytic drugs and their indications and contraindications. It also outlines the indications for primary PCI.

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    17 views2 pages

    Medicine: ST-Elevation Myocardial Infarction

    Uploaded by

    api-3829364
    The document discusses ST-elevation myocardial infarction (STEMI). It defines STEMI as characteristic symptoms, electrocardiograph changes, and a rise and fall in cardiac markers. It notes that STEMI diagnosis involves an integrated assessment of history, ECG changes, cardiac markers, and imaging. It discusses the history, differential diagnosis, management, and specific measures for STEMI patients, including aspirin, beta-blockers, heparin, and reperfusion therapies like primary percutaneous coronary intervention (PCI) and thrombolytic therapy. It lists different types of thrombolytic drugs and their indications and contraindications. It also outlines the indications for primary PCI.

    Copyright:

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    of 2

    Medicine

    Dr:Dara Lec: -4-


    8-Oct-06

    ST-Elevation Myocardial Infarction

    Definition

    WHO
    Definition: characteristic symptoms, electrocardiograph changes, & rise & fall cardiac
    markers.

    Integrated assessment of history plus indirect evidence of myocardial necrosis by


    ECG , cardiac markers & imaging modalities.

    History
    Pain : severity, duration, nature ,location & radiation & associated symptoms.

    Silent STEMI & Atypical presentation.

    Differential diagnosis:

    ECG & cardiac markers


    ST elevation , T inversion & Q wave ,LBBB.

    Differential diagnosis:
    Cardiac Biomarkers; CK –MB, Troponin & Myoglobin.

    Management

    Routine Measures:
    - Oxygen.
    - Nitroglycerin.
    - Analgesia.
    - Nitrate.

    1
    Specific Measures

    1. ASA given promptly & indefinitely.


    2. B- blockers given promptly & indefinitely ( unless contraindicated) Decrease the
    magnitude of infarction, Decrease the malignant arrhythmias & Decrease reinfarction.
    3. Heparin. HMWH or LMWH.

    Reperfusion Therapy

    A. Primary PCI.
    B. Thrombolytic (fibrinolytic) Therapy.

    Which one is better?

    Thrombolytic Therapy

    Types:
    - Streptokinase.
    - Anistreplase (Eminase).
    - Tissue plasminogen activator {Alteplase} ( Actilyse).
    - Reteplase.
    - Tenektoplase (Metalyse).

    Indication: STEMI or presumed new LBBB within 12 hours of the onset of chest
    pain.

    Contraindication : Absolute & Relative.

    Primary PCI

    - Indications:
    1) Contraindication to thrombolytic therapy.
    2) Failure of thrombolytic.
    3) Hemodynamic instability.
    4) Cardiogenic shock.

    Rescue PCI , Facilitated PCI ?.

    Written by:
    Rand Aras Najeeb

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