ST-Elevation Myocardial Infarction
Elliott M. Antman
3
Recommendations for management of patients with
STEMI
Management before STEMI
A. Identifi cation of patients at risk of STEMI
B. Patient education for early recognition and
response to STEMI
Onset of STEMI
A. Out-of-hospital cardiac arrest
Prehospital issues
A. Emergency medical services systems
B. Prehospital chest pain evaluation and
treatment
C. Prehospital fi brinolysis
D. Prehospital destination protocols
Initial recognition and management in the Emergency
Department
A. Optimal strategies for Emergency Department
triage
B. Initial patient evaluation- History
- Physical examination
- Electrocardiogram
- Laboratory examinations
- Biomarkers of cardiac damage
- Imaging
C. Management - Routine measures
Hospital management
A. Location - Coronary care unit
- Stepdown unit
B. Early, general measures - Level of activity
- Diet
3. Patient education in the hospital setting
4. Analgesia/anxiolytics
C. Medication assessment- Beta-blockers
- Nitroglycerin
- Inhibition of the rennin–angiotensin–aldosterone
system - Antiplatelets
- Anticoagulents
- Oxygen
D. Estimation of infarct size - Electrocardiographic techniques
E. Hemodynamic disturbances - Hemodynamic assessment
- Hypotension
- Low-output state
- Pulmonary congestion
- Cardiogenic shock
- Right ventricular infarction
- Mechanical causes of heart failure/low-output
syndrome
F. Arrhythmias after STEMI - Ventricular arrhythmias
- Supraventricular arrhythmias/atrial fi brillation
- Bradyarrhythmias
G. Recurrent chest pain after STEMI - Pericarditis
- Recurrent ischemia/infarction
H. Other complications - Ischemic stroke
- DVT and pulmonary embolism
I. CABG surgery after STEMI - Timing of surgery
- Arterial grafting
- CABG for recurrent ischemia after STEMI
- Elective CABG surgery after STEMI in patients
with angina - CABG surgery after STEMI and antiplatelet
agents
The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978-1-405-18463-2