Stemi score11/22/2023 More likely to report fatigue, dyspnea, indigestion, nausea or vomiting, palpitations, or weakness, although some studies have found fewer differences in presentation. Less likely to receive timely reperfusion therapy.Less likely to undergo cardiac catheterization.Less likely to be treated with guideline-directed medical therapies.Chest pain associated with nausea/vomitingĬlinical factors that decrease likelihood of ACS/AMI:.Chest pain radiating to both arms > R arm > L arm.ST segment resolution occurs over 72hrs completely resolves within 2-3wksĬlinical factors that increase likelihood of ACS/AMI: Tall R waves in V1-V3 (Q waves on back of heart) w/ upright TWs STD in aVL (most common lead to see reciprocal change) LAD + circumflex = Left main or 2 critical lesions In men 40 and older: 2mm elevation in V2 and V3ĪCS Anatomical Correlation Chart Ischemic Changes. In men under 40: 2.5mm elevation in V2 and V3.The acceptable degree of ST elevation in V2 and V3 changes based on age and gender.1 mm of ST elevation in any two contiguous leads except V2 and V3.NSTEMI myocardium is damaged enough to increase biomarkers, UA is not.The new title, “Non-ST-Elevation Acute Coronary Syndromes,” emphasizes the continuum between UA and NSTEMI.Non-ST-elevation myocardial infarction (25%).ST-segment elevation myocardial infarction (30%).Usually will see changes in V6 OR II, III, aVF.Apply V7, V8, V9 leads and repeat ECG looking for ST elevation.Look for reciprocal changes, except in aVR and V1.Posterior (aka inferolateral) infarction is rarely isolated (~3-8% of all AMIs).Optimise preload (ensure volume replete).Do NOT reduce preload (caution with NTG).Hemodynamically significant only 10% of the time.RV infarction accompanies ~25% of inferior STEMIs.
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