Highlights on STEMI
Management
Based on 2017 ESC Guidelines (is there is a more recent guidelines?)
Types of STEMI
Lateral or high lateral STEMI → V1 and aVL
Extensive anterior STEMI → V1 - V6
Antero-septal STEMI → V1 - V4 ( V1 - V2 → septal, V3 - V4 → anterior wall)
Lateral STEMI → V5 - V6
Posterior STEMI → V7 - V9
Inferior STEMI (II, III, aVF)
Universal definition of MI
Myocardial injury: evidence of elevated cTn with at least one value >99th
percentile upper reference limit (URL). The myocardial injury is considered
acute if there is a rise and or fall of cTN values.
Acute myocardial injury: is injury with rise and/or fall of cTn values
(dynamic), if the values were static (no fall or rise) → chronic injury
Difference between acute myocardial infarction
and acute myocardial injury
Acute myocardial infarction is an acute myocardial injury with at least one of the
following:
Symptoms of myocardial ischemia
New ischemic ECG changes
Development of pathological Q-waves
Imaging of evidence of new loss of viable myocardium or new regional wall
motion abnormality in a pattern consistent with ischemic etiology
Highlights on STEMI Management 1
, Identification of a coronary thrombus by angiography or autopsy
⚡Both anterior and inferior STEMIs could result in LV dysfunction
Difference between stuttering and recurrent course STEMI
Recurrent: new episode of ischemia after a symptom-free interval, with the
following key features
Pain completely resolves, then returns later
There is a clear gap between episodes
Each episode is separate
⚡ Recurrent dynamic (more specific)
Recurrent symptoms + changing ECG each time
Example:
ST elevation → resolves
Then ST depression or T inversion
Stuttering: intermittent, repeated episodes of ischemia without full
resolution, with the following key features:
Pain comes and goes frequently
Incomplete relief between episodes
Often ongoing instability (plaque rupture with intermittent occlusion)
Reciprocal ST depression (ECG)
A ST segment depression seen in leads opposite to the area of ST elevation
during a myocardial infarction
ST-Elevation Myocardial Infarction:
Inferior STEMI (II, III, aVF)
→ Reciprocal depression in I and aVL
Highlights on STEMI Management 2
Management
Based on 2017 ESC Guidelines (is there is a more recent guidelines?)
Types of STEMI
Lateral or high lateral STEMI → V1 and aVL
Extensive anterior STEMI → V1 - V6
Antero-septal STEMI → V1 - V4 ( V1 - V2 → septal, V3 - V4 → anterior wall)
Lateral STEMI → V5 - V6
Posterior STEMI → V7 - V9
Inferior STEMI (II, III, aVF)
Universal definition of MI
Myocardial injury: evidence of elevated cTn with at least one value >99th
percentile upper reference limit (URL). The myocardial injury is considered
acute if there is a rise and or fall of cTN values.
Acute myocardial injury: is injury with rise and/or fall of cTn values
(dynamic), if the values were static (no fall or rise) → chronic injury
Difference between acute myocardial infarction
and acute myocardial injury
Acute myocardial infarction is an acute myocardial injury with at least one of the
following:
Symptoms of myocardial ischemia
New ischemic ECG changes
Development of pathological Q-waves
Imaging of evidence of new loss of viable myocardium or new regional wall
motion abnormality in a pattern consistent with ischemic etiology
Highlights on STEMI Management 1
, Identification of a coronary thrombus by angiography or autopsy
⚡Both anterior and inferior STEMIs could result in LV dysfunction
Difference between stuttering and recurrent course STEMI
Recurrent: new episode of ischemia after a symptom-free interval, with the
following key features
Pain completely resolves, then returns later
There is a clear gap between episodes
Each episode is separate
⚡ Recurrent dynamic (more specific)
Recurrent symptoms + changing ECG each time
Example:
ST elevation → resolves
Then ST depression or T inversion
Stuttering: intermittent, repeated episodes of ischemia without full
resolution, with the following key features:
Pain comes and goes frequently
Incomplete relief between episodes
Often ongoing instability (plaque rupture with intermittent occlusion)
Reciprocal ST depression (ECG)
A ST segment depression seen in leads opposite to the area of ST elevation
during a myocardial infarction
ST-Elevation Myocardial Infarction:
Inferior STEMI (II, III, aVF)
→ Reciprocal depression in I and aVL
Highlights on STEMI Management 2
