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STEMI (Definition and Classification (Term (Primary PCI (Using (Balloon,…

- - - - Q-Wave MI (QWMI)
        
        Transmural lession
      - Non-Q Wave MI (NQMI)
        
        Non-Transmural MI
  - - - Emergent PCI
      - Using
        
        Balloon
        
        Stent
        
        Other approved device
      - Performed in culprit lession/Infarct related artery
      - Without previous thrombolysis
    - - Emergent PCI
      - Other same with PPCI
    - - Emergent PCI performed as soon as possible in the case of failed fibrinolytic
    - - Coro + PCI IRA if indicated
      - Between 2-24 h after successful fibrinolysis
    - - Fibrinolysis combined with rescue PCI or routine early PCI strategy
- - - - SaO2<90 %
      - OR PaO2 <60 mmHg
  - - - Slower uptake
      - Delayed onset of action
      - Diminished effect
  - - - Vasoconstriction
      - Increase heart workload
- - - - May associated with antiplatelet
        
        Slow uptake
        
        delayed onset
        
        diminished effect of oral antiplatelet agent
        
        Metabolic conversion of CPG in liver delayed
- - - - To neck
      - To lower jaw
      - To left arm
    - - Shortness of breath
      - Nausea/vomitting
      - Fatigue
      - Palpitations
      - Syncope
    - - NOT RECOMMENDED AS CLUE
        
        Decrease pain with NTG/ISDN
      - Complete normalization of ST elevation + Symptom
        
        CORONARY SPASM
        
        With MCI
        
        Without MCI
        
        Recommendation
        
        Early coro (24 h)
      - ECG criteria
        
        AT LEAST 2 contiguous leads with ST segment elevation (in the absence of
        
        men <40 years --> >= 2.5 mm
        
        Men >= 40 years, >= 2mm
        
        Women, >=1.5 mm in leads V2-V3 and/or >= 1 mm in other leads
        
        Inferior MI --> record right precordial leads
        
        RV infarct
        
        In LBBB
        
        Concordant ST Segmen elevation >= 1 mm in leads with positive qrs complex
        
        NEW LBBB -->does not predict MI
        
        Concordant ST segment depression >= 1 mm in V1-V3
        
        Discordant ST segmen elevation >= 5 mm in leads with negative qrs complex
        
        RBBB
        
        MI + RBBB have poor prognosis
        
        PRIMARY PCI Strategy --> persistent ischemic symptom occur
        
        Ventricular pacing
        
        Reprogram the pacemaker --> loweing the pace --> intrinsic pace rhythm --> in patients not dependent of ventricular pacing
        
        Non-diagnostic
        
        Hyperacute T waves
        
        No ST elevation
        
        Occluded circumflex coronary artery
        
        Acute occlusion of vein graft
        
        Left main disease
        
        Isolated posterior
        
        ST segment elevation >= 0.5 mm in V7-V9
        
        Left main coronary disease/severe triple VD
        
        ST depression >=1 mm in eight or more surface lead
        
        ST segment elevation in aVR and or V1
- - - - Receive DAPT
        
        Aspirin
        
        Orally - Chewing
        
        Dose: 150-300 mg
        
        Bioavailability 50%
        
        IV
        
        Dose 75-150 mg iv
        
        Lower dose range prevent Cox-2 dependent prostacyclin
        
        Inhibition of Cox-2 dependent prostacyclin
        
        2 more items...
        
        P2Y2 inhibitor
        
        Types
        
        Oral
        
        Clopidogrel
        
        Dose
        
        2 more items...
        
        Ticagrelor
        
        Dose
        
        2 more items...
        
        Side effect
        
        1 more item...
        
        Ticagrelor and Prasugrel better than clopidogrel
        
        Rapid onset
        
        Greater potency
        
        Intravenous
        
        Cangrellor
        
        Time given
        
        Ambulance for New ST Elevation Myocardial Infarction to Open Coronary Artery (ATLANTIC) Trial
        
        Ticagrelor
        
        30 minute early given in the ambulance
        
        Result
        
        No significant difference in
        
        2 more items...
        
        No difference in bleeding events
      - GPIIB/IIIA
        
        IN thrombus burden
        
        Not routinely used, no sig. benefit
    - - UFH
        
        Bolus 70-100U/kg
      - Bivalirudin
        
        Compared to UFH
        
        No advantage
        
        Major bleeding
        
        Mortality
        
        Stroke
        
        Disadvantage
        
        Increased risk of acute stent thrombosis
        
        Considered in
        
        Heparin induced thrombocytopenia
        
        High bleeding risk
      - Enoxaparin
        
        ATOLL trial
        
        Acute myocardial infarction Treated with primary angioplasty and inTravenous enOxaparin or unfractionated heparin to Lower ischaemic and bleeding events at short- and Long-term follow-up (ATOLL) trial
        
        Not significantly reduce
        
        30 day death
        
        MI
        
        Procedural failure
        
        Major bleeding
        
        Significantly reduce
        
        Death
        
        recurrent MI or ACS
        
        Revascularization
      - Potential harm in PPCI - Fondaparinux