Acute Coronary Syndromes: STEMI

Melida A. Juarez, MD, Kassie Soefje Johnson, MD and Fozia Akhtar Ali, MD Reviewed 06/2017
 


BASICS

DESCRIPTION

Acute myocardial infarction (AMI) is the rapid development of myocardial necrosis resulting from a sustained and complete absence of blood flow to a portion of the myocardium. ST-seg...

DIAGNOSIS

HISTORY

  • Classically, sudden onset of chest heaviness/tightness, with or without exertion, lasting at least minutes

  • Pain/discomfort radiating to neck, jaw, interscapular area, upper extremities...

TREATMENT

GENERAL MEASURES

  • Admit to telemetry/coronary care unit (CCU) with continuous ECG monitoring and bed rest. Anxiolytics, if needed; stool softeners

  • Antiarrhythmics, as needed, for unstable dysrh...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Follow up in 3 to 6 weeks of discharge. Identify high-risk patients for implantable cardioverter defibrillator (ICD) placement (especially those with EF ≪30%). Co...

REFERENCES

O'Gara  PT, Kushner  FG, Ascheim  DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardio...

CODES

ICD10

  • I24.9 Acute ischemic heart disease, unspecified

  • I21.3 ST elevation (STEMI) myocardial infarction of unspecified site

  • I25.10 Athscl heart disease of native coronary artery w/o ang pctrs

ICD9

  • 411...

CLINICAL PEARLS

  • Discontinue clopidogrel at least 5 to 7 days before elective CABG.

  • For elective surgeries in patients on dual antiplatelet therapy (DAPT), it is recommended to wait until completion of ...

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