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
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.
