Anterior ST Elevation Myocardial Infarction

ECG: > 1-2 mm of ST elevation in two contiguous leads or new LBBB in patients with ischemic chest pain. Acute anterior MI involves ST elevation in some or all precordial chest leads (V1-V6).

SX: Chest pain/pressure radiating to the jaw, neck, shoulders, back, one or both arms.

Nausea/vomiting, dyspnea, diaphoresis, weakness, dizziness, loss of consciousness, or sudden cardiac arrest.

Elderly, diabetics, and female may present with no pain and rather experience dyspnea, weakness, lightheadedness, diaphoresis, nausea and vomiting.

TX: Acute management includes stabilizing the patient, Aspirin (162-325 mg), clopidogrel (300-600-mg), Nitroglycerin for 3 doses every 5 mins if no contraindications, if pain still not controlled to give Morphine, Oxygen only if O2 Sat is below 94%, B-blockers if no signs of heart failure, and high intensity statins before PCI.

Reperfusion therapy should be administered to all eligible patients with STEMI and symptom onset within 12 hours.

•PCI-capable hospital: First medical contact to device time should be less than 90 mins.

•Non-PCI capable facility: First medical contact to device time should be less than 120 mins.

17 Cardiology