ST-segment elevation myocardial infarction - Revision history

Danbot: Embed Sgarbossa Calculator on clinical page

2026-03-22T09:56:14Z

Embed Sgarbossa Calculator on clinical page

← Older revision		Revision as of 09:56, 22 March 2026
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	{{MedicationDose\|drug=Bivalirudin\|dose=0.75 mg/kg IV bolus, then 1.75 mg/kg/hr drip\|route=IV drip\|context=Anticoagulation (direct thrombin inhibitor)\|indication=ST-segment elevation myocardial infarction}}		{{MedicationDose\|drug=Bivalirudin\|dose=0.75 mg/kg IV bolus, then 1.75 mg/kg/hr drip\|route=IV drip\|context=Anticoagulation (direct thrombin inhibitor)\|indication=ST-segment elevation myocardial infarction}}
	</div>		</div>
			== Calculators ==
			{{Sgarbossa Calculator}}

	==See Also==		==See Also==
	*[[Acute Coronary Syndrome (Main)]]		*[[Acute Coronary Syndrome (Main)]]

Danbot: Add MedicationDose SMW annotations (8 entries: aspirin, clopidogrel, ticagrelor, nitroglycerin, atorvastatin, heparin, enoxaparin, bivalirudin); dosing verified per AHA/ACC STEMI guidelines

2026-03-20T16:25:22Z

Add MedicationDose SMW annotations (8 entries: aspirin, clopidogrel, ticagrelor, nitroglycerin, atorvastatin, heparin, enoxaparin, bivalirudin); dosing verified per AHA/ACC STEMI guidelines

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 *If not at tertiary care center consider tPA depending transfer time and transfer to cardiac cath lab center
 ==See Also==
 *[[Acute Coronary Syndrome (Main)]]

Rossdonaldson1: /* STEMI equivalents */

2022-03-12T12:07:32Z

STEMI equivalents

← Older revision		Revision as of 12:07, 12 March 2022
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	**Look for STE >1-1.5 mm in aVR		**Look for STE >1-1.5 mm in aVR
	**Can also bee seen in hemorrhage, type A [[Dissection]], [[PE\|massive PE]]		**Can also bee seen in hemorrhage, type A [[Dissection]], [[PE\|massive PE]]
			*Aslanger criteria<ref>Zhang CH, Xu Z. Where Is the Culprit Lesion in the New Electrocardiogram Pattern?. JAMA Internal Medicine. March 7, 2022</ref>
			**Aslanger pattern is a reliable sign of acute inferior MI, indicating occlusion of the RCA or left circumflex artery
			**Defined by a pattern consists of 3 criteria:
			**#ST elevation in leads III and aVRbut not in any other inferior lead
			**#ST depression in any of leads V4to V6but not in V2, AND
			**#ST in lead V1 higher than ST in lead V2.
			**Leads III and aVR are contiguous in anatomical position; therefore, they should be recognized as contiguous leads on ECG.

	==Management==		==Management==

Masoodrm: /* Adjunctive Therapies */

2021-03-25T17:00:35Z

Adjunctive Therapies

← Older revision		Revision as of 17:00, 25 March 2021
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	#*Defer to cardiologist for administration		#*Defer to cardiologist for administration
	#*Given right before PCI depending on specific institutional protocols		#*Given right before PCI depending on specific institutional protocols
			#Morphine
			#*Should be avoided if possible
			#**May interfere with the anti-platelet effect of P2Y12 receptor blockers (Aspirin)
			#*If pain is poorly controlled, consider 2-4mg IV with repeat dosing of 2-8mg ever 5-15 minutes
	#[[Beta blockers]]<ref>Campbell-Schere DL, Green LA. ACC/AHA guideline update for the management of ST-segment elevation myocardial infarction. Am Fam Physician.2009 Jun 15;79(12):1080-6.</ref>		#[[Beta blockers]]<ref>Campbell-Schere DL, Green LA. ACC/AHA guideline update for the management of ST-segment elevation myocardial infarction. Am Fam Physician.2009 Jun 15;79(12):1080-6.</ref>
	#*Per AHA guidelines, IV beta blockers should ''not'' be given to patients with STEMI routinely, but may be considered for hypertension treatment barring contraindications as below:		#*Per AHA guidelines, IV beta blockers should ''not'' be given to patients with STEMI routinely, but may be considered for hypertension treatment barring contraindications as below:

Masoodrm: /* Adjunctive Therapies */

2021-03-25T16:50:46Z

Adjunctive Therapies

← Older revision		Revision as of 16:50, 25 March 2021
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	===Adjunctive Therapies===		===Adjunctive Therapies===
	#[[Aspirin]] ~~162-~~325mg ~~chewable~~ or 600mg PR		#[[Aspirin]] 325mg PO or 600mg PR
	#[[Nitroglycerin]]		#[[Nitroglycerin]]
	#*~~Do not give~~ if RV MI		#*Should be avoided if concern for MI with RV extension or in patients with aortic stenosis
	#*Do not give ~~with~~ phosphodiesterase inhibitors		#*Do not give if patient has used phosphodiesterase inhibitors (Viagra) in the past 24 hours
	#[[O2]]		#[[O2]]
	#*For SpO2 <90%		#*For SpO2 <90%

Rossdonaldson1 at 16:15, 11 March 2021

2021-03-11T16:15:28Z

← Older revision		Revision as of 16:15, 11 March 2021
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	**Apply V7, V8, V9 leads and repeat ECG looking for ST elevation		**Apply V7, V8, V9 leads and repeat ECG looking for ST elevation
	**Usually will see changes in V6 OR II, III, aVF		**Usually will see changes in V6 OR II, III, aVF

			{{Clinical ACS Categories}}

	===Fourth Universal Definition of STEMI===		===Fourth Universal Definition of STEMI===

Lisayee25: /* Workup */ changed def of "J point"

2020-11-05T19:00:52Z

Workup: changed def of "J point"

← Older revision		Revision as of 19:00, 5 November 2020
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	*[[ECG]]		*[[ECG]]
	**Use the J-point for measurement in 2 contiguous leads<ref>ACCF/AHA 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Jan 29;61(4):e78-140. [http://www.sciencedirect.com/science/article/pii/S0735109712055623/pdfft?md5=1ab12406644b051890dfc4bb1634c2bf&pid=1-s2.0-S0735109712055623-main.pdf PDF]</ref>		**Use the J-point for measurement in 2 contiguous leads<ref>ACCF/AHA 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Jan 29;61(4):e78-140. [http://www.sciencedirect.com/science/article/pii/S0735109712055623/pdfft?md5=1ab12406644b051890dfc4bb1634c2bf&pid=1-s2.0-S0735109712055623-main.pdf PDF]</ref>
	***J point is ~~where there is a sudden change in direction~~		***J point is the junction between the end of the QRS complex and the beginning of the ST segment
	**When possible, compare to old ECGs		**When possible, compare to old ECGs
	**Repeating ECGs will increase sensitivity		**Repeating ECGs will increase sensitivity

Shihabali: /* Special Scenarios */

2019-11-23T00:18:28Z

Special Scenarios

← Older revision		Revision as of 00:18, 23 November 2019
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	*Even in those with successful reperfusion, its reasonable to do angiography within the index hospitalization, even within hours of thrombolytic therapy		*Even in those with successful reperfusion, its reasonable to do angiography within the index hospitalization, even within hours of thrombolytic therapy

			===Post-STEMI complications===
			*Cath site hematoma
			*Heart failure or cardiogenic shock
			**Hemodynamic support, consider norepinephrine or dobutamine
			**Mechanical support e.g. balloon pump or Impella, usually placed in cath lab
			*Ventricular tachycardia or ventricular fibrillation --> if sustained and > 48 hours after STEMI may need ICD
			*Pericarditis, < 1 week from STEMI --> treat with high dose aspirin, avoid NSAIDs
			*Bradycardia, if AV nodal involvement, rarely responds to atropine, likely will require pacing
			*Free wall or ventricular septal rupture
			*Dressler's syndrome, > 1 week post MI

	==Disposition==		==Disposition==

Rossdonaldson1: /* Background */

2019-10-29T20:39:09Z

Background

← Older revision		Revision as of 20:39, 29 October 2019
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	{{ACS anatomical correlation}}		{{ACS anatomical correlation}}
	[[File:EKG leads.png\|thumbnail\|ECG vectors]]		[[File:EKG leads.png\|thumbnail\|ECG vectors]]


	===Prehospital===		===Prehospital===

ClaireLewis: /* Management */

2019-09-26T16:40:41Z

Management

← Older revision		Revision as of 16:40, 26 September 2019
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	#**See drug link for specific age, indication related dosages		#**See drug link for specific age, indication related dosages
	#**Generally, loading dose of 600 mg if PCI anticipated (otherwise give 300 mg)		#**Generally, loading dose of 600 mg if PCI anticipated (otherwise give 300 mg)
	#*Ticagrelor		#*[[Ticagrelor]]
	#**May significantly reduce mortality as compared to clopidogrel<ref>Wallentin et Al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 2009; 361:1045-1057.</ref>		#**May significantly reduce mortality as compared to clopidogrel<ref>Wallentin et Al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 2009; 361:1045-1057.</ref>
	#**180mg loading dose, followed by 90mg BID		#**180mg loading dose, followed by 90mg BID
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	#*Defer to cardiologist for administration		#*Defer to cardiologist for administration
	#*Given right before PCI depending on specific institutional protocols		#*Given right before PCI depending on specific institutional protocols
	#Beta blockers<ref>Campbell-Schere DL, Green LA. ACC/AHA guideline update for the management of ST-segment elevation myocardial infarction. Am Fam Physician.2009 Jun 15;79(12):1080-6.</ref>		#[[Beta blockers]]<ref>Campbell-Schere DL, Green LA. ACC/AHA guideline update for the management of ST-segment elevation myocardial infarction. Am Fam Physician.2009 Jun 15;79(12):1080-6.</ref>
	#*Per AHA guidelines, IV beta blockers should not be given to patients with STEMI routinely, but may be considered for ~~HTN~~ treatment barring contraindications as below:		#*Per AHA guidelines, IV beta blockers should ''not'' be given to patients with STEMI routinely, but may be considered for hypertension treatment barring contraindications as below:
	#**Low output state, signs of HF		#**Low output state, signs of [[heart failure\|HF]]
	#**Increased risk of cardiogenic shock (age > 70, sinus tachycardia > 110 bpm or HR < 60 bpm, SBP < 120 mmHg)		#**Increased risk of [[cardiogenic shock]] (age > 70, sinus [[tachycardia]] > 110 bpm or HR < 60 bpm, SBP < 120 mmHg)
	#**Increased time since onset of STEMI		#**Increased time since onset of STEMI
	#**Relative contraindications -- [[asthma]], [[COPD]], PR interval > 0.24 sec, AV block		#**Relative contraindications -- [[asthma]], [[COPD]], PR interval > 0.24 sec, [[AV block]]
	#*PO beta blockers should be initiated within 24 hours of STEMI		#*PO beta blockers should be initiated within 24 hours of STEMI
	#ACE inhibitor or ARB<ref>ACE inhibitor use in patients with myocardial infarction. Summary of evidence from clinical trials. Latini R, Maggioni AP, Flather M, Sleight P, Tognoni G. Circulation. 1995;92(10):3132.</ref><ref>Antman EM, et al. American College of Cardiology, American Heart Association Task Force on Practice Guidelines, Canadian Cardiovascular Society. Circulation. 2004;110(9):e82.</ref>		#[[ACE inhibitor]] or [[ARB]]<ref>ACE inhibitor use in patients with myocardial infarction. Summary of evidence from clinical trials. Latini R, Maggioni AP, Flather M, Sleight P, Tognoni G. Circulation. 1995;92(10):3132.</ref><ref>Antman EM, et al. American College of Cardiology, American Heart Association Task Force on Practice Guidelines, Canadian Cardiovascular Society. Circulation. 2004;110(9):e82.</ref>
	#*Give within 24 hours in stable patients, '''typically not given in ED'''		#*Give within 24 hours in stable patients, '''typically not given in ED'''
	#*Careful initial dosing, starting at 2.5 mg/day of [[lisinopril]], increasing slowly up to 10 mg/day		#*Careful initial dosing, starting at 2.5 mg/day of [[lisinopril]], increasing slowly up to 10 mg/day