stemi definition in the absence of lbbb or lvh new st elevation at the j point in at least 2...
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“STEMI Guidelines for the ED Physician and ECG
Review”
December 2, 2014
Gagan D. Singh M.D.
Division of Cardiovascular MedicineUC Davis Medical Center
Sacramento CA
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STEMI Definition
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STEMI Definition
In the absence of LBBB or LVH New ST elevation at the J point in at
least 2 contiguous leads of: 2 mm (0.2 mV) in men or 1.5 mm (0.15
mV) in women in leads V2–V3 and/or of 1 mm (0.1 mV) in other contiguous
chest leads or the limb leads ST depression in 2 precordial leads (V1–
V4) may indicate transmural posterior injury
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STEMI Definition
Caveats Most cases of LBBB at time of
presentation are “not known to be old” because of ECG is not available for comparison.
New or presumably new LBBB at presentation occurs infrequently Interfere with ST-elevation analysis, and Should not be considered diagnostic of
acute MI in isolation Baseline ECG abnormalities other than
LBBB (LVH, Brugadda, V paced) obscure STEMI assessment
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Jain et al. Am J Cardiol 2011;107: 1111–1116
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7
Hospitalizations in the U.S. Due to Acute Coronary Syndromes (ACS)
Acute Coronary Syndromes*
1.57 Million Hospital Admissions - ACS
UA/NSTEMI† STEMI
1.24 million Admissions per year
.33 million Admissions per year
Heart Disease and Stroke Statistics – 2007 Update. Circulation 2007; 115:69-171. *Primary and secondary diagnoses. †About 0.57 million
NSTEMI and 0.67 million UA.
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STEMI Epidemiology
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STEMI Facts
In hospital and 1 year mortality continue to decline Reperfusion therapy Earlier recognition “Time is myocardium”
Target Areas For Improvement Women, Non-whites, Diabetics, Elderly,
CKD/ESRD
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STEMI Timeline
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STEMI Guidelines – Cath Activation
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STEMI Guidelines
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Platelets Role in Thrombosis
Reproduced with permission from Cannon CP. Atherothrombosis slide compendium. Available at: www.theheart.org.
Aggregation31
Activation2
Adhesion
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Pathways to Clot Formation
White HD. AM J Cardiol 1997; 80:2B-10BSchafer A. J Clin Invest 1986; 78:73-79DeJong MJ, et al. Critical Care Nursing Clin of N Am 1999; 11:355-371
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STEMI Guidelines - Fibrinolytic
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STEMI Guidelines - Fibrinolytic
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STEMI Guidelines - Fibrinolytic
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STEMI Guidelines - Fibrinolytic
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STEMI Guidelines - Hypothermia
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STEMI Guidelines - Anticoagulation
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ECG Review
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An Electrical Beat
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Many faces of normal ST segments
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Pathologic ST segments
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ECG
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ECG
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ECG
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ECG
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ECG
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ECG
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ECG
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ECG
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THANK YOU
University of California Davis Medical Center