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Nstemi and Stemi, The Ups and Downs: Juan I. Irizarry Medical Intern San Cristobal Hospital

The document discusses myocardial infarction, including STEMI and NSTEMI types, risk factors, diagnostic tests, and treatment approaches. It covers topics like medications, timing of procedures, and complications of myocardial infarction.

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Juanchi IN
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83 views27 pages

Nstemi and Stemi, The Ups and Downs: Juan I. Irizarry Medical Intern San Cristobal Hospital

The document discusses myocardial infarction, including STEMI and NSTEMI types, risk factors, diagnostic tests, and treatment approaches. It covers topics like medications, timing of procedures, and complications of myocardial infarction.

Uploaded by

Juanchi IN
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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NSTEMI AND

STEMI, THE UPS


AND DOWNS
Juan I. Irizarry
Medical Intern
San Cristobal Hospital
785,000 new MI every Heart disease is the
year, 470,000 re-infarcts leading cause of death

A 1 year mortality of +$200 billion dollars in


6%, 11% if re-infarct overall costs

WHY DOES IT MATTER?


WHAT IS A MYOCARDIAL INFARCT?
INFARCT SEVERITY
INFARCT SEVERITY
RISK FACTORS
STRATIFICATION
Framinham Risk Score ASCVD Risk Algorithm Killip Class
• Age • History of ASCVD • Class I
• Sex • LDL >190 • Class II
• Smoker • Age • Class III
• Total cholesterol • DM • Class IV
• HDL cholesterol • Sex
• Systolic BP • Race
• BP treated • HDL
• Systolic BP
• Smoker
• BP treated
CLINICAL PRESENTATION
DIAGNOSTIC TEST
 Baseline EKG STAT! then every 15-
30min
 CBC w/ differential
 BMP
 Fasting glucose
 Lipid profile
 Drug screening
 Cardiac biomarkers every 8 hours x 3
 Troponin T
 CK-MB
 Myoglobin
 Review home medications!
FIRST
CHANGE
ST ELEVATION OR
DEPRESSIONS

 ≥ 0.1mV in any 2 contiguous leads besides V2-V3


 ≥0.2 mV in men ≥ 40 years → V2-V3
 ≥0.25 mV in men <40 years → V2-V3
 ≥0.15 mV in women → V2-V3
 Without LVH or LBBB
EVOLUTION
NSTEMI CRITERIA
 New horizontal or down-sloping ST depression
≥0.05 mV in two anatomically contiguous leads
 T inversion ≥0.1 mV in two anatomically contiguous
leads with prominent R wave or R/S ratio >1
 New LBBB
CARDIAC BIOMARKERS
INITIAL TREATMENT
 ASA 325mg chewable
 Sublingual nitroglycerin 0.4mg q 5 minutes x3*
 Metoprolol tartrate 25mg*
 Morphine sulfate 2-4mg IV
 Atorvastatin 80mg

 Correct electrolyte abnormalities


 Stop NSAIDs
 Lorazepam 2-4mg IV q15 if cocaine related
TREATMENT
 STEMI  NSTEMI
 PCI → 120min of FMC, <12  PCI soon
hours  Ticagrelor 180mg
 Ticagrelor 180mg, prasugrel  UFH 60-70units/kg loading then
60mg or clopidogrel 600mg 12units/kg/hr IV infusion
 UFH 50-70units/kg  Noninvasive
 Fibrinolytic therapy → alteplase  Ticagrelor 180mg + eptifibatide if
15mg bolus then 0.75mg/kg x30min, very high risk
then 0.5mg/kg x60min  Enoxaparin 1mg/kg SQ q12hr
 Clopidogrel 300mg (q24 if CrCl <30)
 Enoxaparin 30mg IV bolus followed
by 1mg/kg SQ q 12hr
COMPLICATIONS
 DARTH VADER
 Death
 Arrhythmia
 Rupture
 Tamponade
 Heart failure
 Valve disease
 Aneurysm of ventricle
 Dressler’s syndrome
 Embolism
 Recurrence/Mitral Regurgitation
QUESTI
ONS?

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