STEMI: The Daily PANCE Blueprint
A 44-year-old male with an unknown history presents to the ER via EMS due to chest pain, dizziness, and diaphoresis. He was given aspirin and nitroglycerin en route. Vitals demonstrate BP 110/70 mmHg, HR 100 bpm, SpO2 98%, RR 20, T 97.0F. A 12-lead EKG revealed ST elevations in the inferior leads with appropriate reciprocal changes. Troponin levels are pending at this time. Which of the following is the most appropriate, definitive management option?
A. Percutaneous coronary intervention
B. Systemic tPA
C. Cardiovascular surgery repair
D. Intravenous anticoagulation and anti-platelet
E. Place LV mechanical assist device
Answer and topic summary
The answer is A. Percutaneous coronary intervention
The patient is having an ST-elevation inferior myocardial infarction, which is defined by evidence of myocardial necrosis in a clinical setting with acute myocardial ischemia. In most patients, coronary plaque rupture is the initiating event of acute MI. Clinical features include sub-sternal chest pain, diaphoresis, dyspnea, fatigue, palpitations, indigestion, or N/V. GI symptoms are more common with inferior infarction. On physical exam, you may hear a new systolic murmur if the acute MI causes papillary muscle rupture with acute mitral regurgitation. Diagnostic workup includes EKG, cardiac enzymes, CXR, CBC, CMP, BNP, TTE, and lactic acid. Treatment includes beta-blocker (within first 24 hours), high-intensity statin, ASA 325 mg (uncoated, chewed), P2Y12 inhibitor (like clopidogrel or ticagrelor), anti-coagulation (heparin or bivalirudin drips), possibly nitroglycerin drip (avoid if interior MI or low BP). Definitive treatment is percutaneous coronary intervention (ideally door to balloon time is 90 minutes).
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also found in the Emergency Medicine, Internal Medicine, and Family Medicine EOR content blueprint
