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Acute Coronary Syndromes: STEMI

Adedotun Anthony Ogunsua, MD, MPH, Kimberly Atianzar, MD and Yutthapong Temtanakitpaisan, MD Reviewed 06/2019
 


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

  • Symptoms:

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

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

TREATMENT

GENERAL MEASURES

  • See “Medication” for ED management.

  • Following emergent revascularization, admit the patient to the coronary care unit (CCU) or a telemetry unit with continuous ECG monitoring ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Emphasize medication adherence. Identify high-risk patients for implantable cardioverter defibrillator (ICD) placement (especially those with an EF <30%). Cons...

REFERENCES

1
O’Gara PT, Kushner FG, Ascheim DD, et al; for CF/AHA Task Force. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the Americ...

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

For elective surgeries in patients on DAPT, it is recommended to wait until completion of mandatory regimen and continue ASA perioperatively. 

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