ST ELEVATED MI

Akshay kumar kumawat

Roll no.-5
Classification of Ischemic Heart Disease

Ischemic Heart Disease

Chronic coronary artery Acute coronary syndrome

disease

ST-elevation myocardial Non-ST-elevated Unstable angina

infarction (STEMI) myocardial
infarction (NSTEMI)
 STEMI
 STEMI represent the most lethal form acute coronary
syndrome ,in which a completely occlusive thrombus
typically results in total cessation of coronary blood flow ,
manifested electrically as elevation of the ST segment of
the ECG.
 Pathogenesis
 Acute coronary syndrome almost occurs in
patient who have atherosclerosis.
 The initial event is a sudden change in the
structure of an atheromatous plaque, i.e.
disruption as intraplaque hemorrhage,
ulceration, or rupture.
 This results in thrombus formation.
 Frequently within minutes, the thrombus
evolves to completely occlude the lumen of
the coronary artery.
Clinical features
 Prolonged cardiac pain
 Nausea and vomiting
 Breathlessness
 Syncope
 Hypotension , oliguria
 Raised jugular venous pressure
 Third heart sound
Complications
Early complication:-
 Disturbance of rate, rhythm, and
conduction
 Left ventricular failure
 Right ventricular failure
 Cerebrovascular accident
 Pricarditis
Late complications:-
 Heart failure
 Ventricular aneurysm
 Thromboembolism
 Sudden death
 Post MI syndrome
Management
Initial management for ACS
 Immediate clinical assessment , ECG,
Troponin
 Oxygen + cardiac rhythm monitoring
oral Aspirin 300 mg
oral Metoprolol 50-100 mg
If ST segment elevation MI
 Reperfusion therapy:- immediate
reperfusion therapy with percutaneous
coronary intervention(PCI).
 Thrombolytic therapy:- if primary PCI is
not possible (eg- tenecteplase , reteplase)
 Antithrombotic therapy:- aspirin 75-325mg
clopidogrel 300mg
 Anti-anginal therapy:-
-sublingual glyceryl trinitrate(300-500µg)
-β-blockers- Atenolol 5-10 mf
 Other-
-Renin-angiotensin blockade
-mineralocorticoid receptor antagonist
-Lipid lowering therapy
-Smoking cesstion
-Diet and exercise
Thank you