NSTE-ACS (Non ST Elevation Acute Coronary Syndrome) is defined by the absence of ST segment elevations on ECG.However, in clinical practice, STE-ACS and STEMI are equivalent because virtually all patients with chest pain and ST elevations on ECG will have elevated troponin levels. STEMI is only diagnosed when elevated troponin levels have been confirmed until then, the condition is classified as STE-ACS. If a patient with such ECG changes develops myocardial infarction (defined by elevated troponin levels in blood), the condition is classified as STEMI (ST Elevation Myocardial Infarction). STE-ACS (ST Elevation Acute Coronary Syndrome) is defined by the presence of significant ST segment elevations on ECG.There are two types of acute coronary syndromes: ST Elevation Myocardial Infarction (STEMI) is an acute coronary syndrome (ACS). Diagnosis and definition of acute STEMI (ST Elevation Myocardial Infarction) Anti-thrombotic medications, anticoagulants, and reperfusion reduce mortality by counteracting thrombus formation and restoring coronary blood flow. Reperfusion therapy is immediately needed because patients with acute STEMI have complete arterial occlusions which require reperfusion to restore patency. Virtually all patients with acute STEMI should be referred to the catheterization laboratory for angiography with the intention to perform PCI (percutaneous coronary intervention). STEMI is treated with anti-ischemic agents, anti-thrombotic agents, anticoagulants, and reperfusion (PCI or fibrinolysis). Nevertheless, cardiac troponins are always analyzed once the situation allows. Obviously, measurement of cardiac troponins is not necessary to establish a diagnosis of acute STEMI the diagnosis is based on clinical presentation (notably chest pain) and ST elevations on ECG. Moreover, patients who utilize the EMS may have better outcomes, since several evidence-based therapies (including reperfusion) may be given in the prehospital setting. Prehospital personnel has proven to be highly capable of recognizing STEMI using 12-lead ECG. The diagnosis is straightforward using the electrocardiogram (ECG). Most communities have therefore created a regional system of STEMI care which aim to rapidly identify and handle patients with STEMI. The dispatch center, ambulance, emergency department (ED), catheterization laboratory and cardiology ward must act in concert to provide optimal care. The entire chain of care, from prehospital assessment to hospital discharge will be covered in this chapter. Optimal STEMI care requires a sophisticated apparatus including the EMS (Emergency Medical Service) and the hospital. Death due to pumping failure ( cardiogenic shock) is much less common in the acute phase. ![]() Indeed, ventricular tachycardia and ventricular fibrillation cause the vast majority of all deaths in the acute phase of STEMI. Ventricular tachycardia (VT) and ventricular fibrillation (VF) may occur any time after occlusion of the coronary artery. For the same reason, patients with STEMI are at higher risk of life-threatening ventricular arrhythmias in the acute phase. The reason symptoms are more severe in patients with STEMI, as compared with NSTEMI and unstable angina (UA), is because the extent of the ischemia is greater in STEMI (i.e a larger portion of the myocardium is ischemic). A large body of evidence supports the concepts and recommendations presented in this chapter.Ĭhest pain (or discomfort) is the hallmark of myocardial ischemia and it is especially pronounced in patients with acute STEMI. Management of acute STEMI will be discussed in detail with emphasis on evidence-based therapies. The clinical definitions and recommendations presented in this chapter are in line with guidelines issued by the American Heart Association (AHA), American College of Cardiology (ACC) and the European Society for Cardiology (ESC). Although ECG changes in acute STEMI have been discussed previously (refer to ECG Changes in Acute Myocardial Infarction), a rehearsal is provided below. This chapter deals with the pathophysiology, definitions, criteria and management of patients with acute STEMI. STEMI (ST Elevation Acute Myocardial Infarction): Epidemiology, Diagnosis (ECG), Criteria & ManagementĪcute STEMI (ST Elevation Myocardial Infarction) is the most severe manifestation of coronary artery disease.
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