ST-ELEVATION MYOCARDIAL INFARCTION (STEMI) The Killip classification is a system used in individuals with an acute myocardial infarction (heart

attack), in order to risk stratify them. Individuals with a low Killip class are less likely to die within the first 30 days after their myocardial infarction than individuals with a high Killip class.

Killip class I includes individuals with no clinical signs of heart failure. Killip class II includes individuals with rales or crackles in the lungs, an S3, and elevated jugular venous pressure. Killip class III describes individuals with frank acute pulmonary edema. Killip class IV describes individuals in cardiogenic shock or hypotension (measured as systolic blood pressure lower than 90 mmHg), and evidence of peripheral vasoconstriction (oliguria, cyanosis or sweating

MEDICAL INTERVENTION: IMPORTANT INITIALACTIONS FOR ALL PATIENTS PRESENTING WITH ACUTE CORONARY SYNDROME Fast track to ECG within 10 minutes Give oxygen; maintain SpO2 > 98% Sublingual GTN if chest pain persisting (unless SBP < 90 mm Hg) Aspirin 300 mg chewed Focussed clinical examination IV access and bloods for biomarkers Continuous ECG monitoring Morphine IV 2 mg every 5 minutes until pain relieved. Clopidogrel 300 mg stat if diagnosis of STEMI made Please avoid: Arterial punctures Intra-muscular injection SURGICAL INTERVENTIONS: PERCUTANEOUS CORONARY INTERVENTIONS 1. Within 2 hours of onset of maximal chest pain 2. Extensive Anterior MI 3. Proximal (R) Coronary Block (RV + Post + Inferior) 4. Contraindications to Thrombolytic therapy 5. Killip Class III and IV

ECG Pattern Recognition for STEMI Evolution of ST changes in STEMI Hyperacute T waves (rst 30 mins) ST elevations followed by tombstone ST segment Q waves start developing; T begin inversions Normalizing of ST segment Acute Inferior Myocardial Infarction ST elevation in II, III, aVF Watch out for reciprocal ST depression in I, aVL Extensive Anterior Myocardial Infarction ST elevation in V1 - V6; I, aVL Reciprocal ST depression in II, III, aVF