STEMI

Definition
STEMI is an acronym meaning "ST segment elevation
myocardial infarction," which is a type of heart attack. This is
determined by an electrocardiogram (ECG) test.

Epidemiology
STEMI continues to be a significant public health problem in
industrialized countries and is becoming an increasingly
significant problem in developing countries.
There were 1 680 000 unique discharges for ACS in 2001.
Applying the conservative estimate of 30% of the ACS
patients who have STEMI from the National Registry of
Myocardial Infarction [NRMI-4] , we estimate 500000 STEMI
events per year in the U.S.
There has been a steady decline in the mortality rate from
STEMI over the last several decades.
This appears to be due to a combination of a fall in the
incidence of MI (replaced in part by an increase in the
incidence of unstable angina) and a reduction in the case
fatality rate once an MI has occurred. There has been a
progressive increase in the proportion of patients who present
with NSTEMI compared with STEMI.

Pathophysiology
A key concept in the pathophysiology of STEMI is ventricular
remodeling, a term that refers to changes in size, shape, and
thickness of the left ventricle involving both the infarct-ed and
noninfarcted segments of the ventricle.
Acute dilatation and thinning of the area of infarction that is
not due to additional myocardial necrosis is referred to as
infarct expansion.
An extra load is placed on the residual functioning
myocardium, which results in compensatory
hypertrophy.Inhibition of the renin-angiotensin-aldosterone
system is a key therapeutic maneuver in patients with STEMI .
Additional important pathophysiological concepts in patients
with STEMI include cardiac arrhythmias such as those that
result from electrical instability, pump failure/excessive
sympathetic stimulation, and conduction disturbances.

Diagnosis

Management