ST-Segment Elevation MI (STEMI)

ST-Segment Elevation MI (STEMI)

Pathology:                   Part of the acute coronarysyndrome spectrum of conditions that result from acute myocardial ischaemia


Aetiology:                    Atheromatous plaque ruptureand total luminal obstruction by thrombus, results in transmural (Q-wave) infarction


Symptoms:                   Central chest heaviness ortightness, heavy arms, nausea, and breathlessness.

Pain not relived by GTN.

Beware ‘atypical’ presentations (including back pain,syncope, shock, acute pulmonary oedema, especially in the elderly anddiabetics.


Signs:                              Levine’ssign, diaphoresis, and dyspnoea


Investigations:          Bloods:FBC, U&E, lipid profile, blood glucose, serial troponin

ECG: ST-segment elevation or new LBBB


Treatment:                   Diamorphine, antiemetic, oxygen, nitrates,aspirin and a thienopyridine

Priority of management is earlyreperfusion

Gold standard is primary percutaneouscoronary intervention

Text Box: Acute Myocardial Infarction Management Mnemonic
Oxygen (if appropriate)












Complications:          Arrhythmias, LV failure, sudden death,fever, RV failure, pericarditis, pulmonary embolism, tamponade, mitralregurgitation, ventricular septal defect, Dressler’s syndrome, depression andanxiety


Prognosis:                   Prognosis with STEMI is betterthan NSTEMI.

50% of patients who die from acute MIdo so in the first 2 hours.

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