vital; report of a patient with a stemi

What is the role of the Ems in the treatment of STEMI?

Importantly, the EMS can obtain a 12-lead ECG, which can be transmitted electronically to the hospital for further evaluation. In some instances, the EMS may even administer reperfusion therapy (fibrinolysis) en route to the hospital. Studies have demonstrated the importance of prehospital delay in patients with acute STEMI.

What are the guidelines for transportation to the hospital for STEMI?

Hence, American and European guidelines recommend that patients with chest pain should use the EMS (Emergency Medical Service) for transportation to the hospital. EMS personnel should be trained in advanced cardiac life support and the early management of acute STEMI. The prehospital chain of care is initiated at the emergency dispatch center.

What is the mortality and morbidity associated with STEMI?

In-hospital mortality is now 5% and 1-year mortality is 7–18%. Roughly 70% of patients with STEMI are men. Women, on the other hand, have a longer delay from symptom onset to first medical contact and women are also less likely to receive evidence-based interventions, such as PCI and fibrinolysis.

What does STEMI stand for in cardiac?

ST Elevation Myocardial Infarction (STEMI) is an acute coronary syndrome (ACS). There are two types of acute coronary syndromes: STE-ACS (ST Elevation Acute Coronary Syndrome) is defined by the presence of significant ST segment elevations on ECG.

What happens to vital signs during myocardial infarction?

The patient's vital signs may demonstrate the following in MI: The patient's heart rate is often increased (tachycardic) secondary to a high sympathoadrenal discharge.

Do vital signs change with heart attack?

During a heart attack, the blood flow to a portion of your heart is blocked. Sometimes, this can lead to your blood pressure decreasing. In some people, there may be little change to your blood pressure at all. In other cases, there may be an increase in blood pressure.

What are the abnormal vital signs?

We used two a priori definitions for vital signs: abnormal (heart rate (HR) ≤ 60 or ≥ 100 min−1, respiratory rate (RR) ≤ 10 or > 20 min−1 and systolic blood pressure (SBP) ≤ 90 mm Hg) and severely abnormal (HR ≤ 50 or ≥ 130 min−1, RR ≤ 8 or ≥ 30 min−1 and SBP ≤80 mm Hg).

What are the signs and symptoms of STEMI?

STEMI Myocardial Infarction Signs and SymptomsShortness of breath.Fatigue.Dizziness or lightheadedness.A cold sweat.Nausea and vomiting.

How do vitals change during a heart attack?

Increase in blood pressure Blood pressure might rise during a heart attack because hormones, such as adrenaline, are released. These hormones are released when the “fight or flight” response is triggered at times of intense stress or danger.

What are normal vital signs?

Normal vital sign ranges for the average healthy adult while resting are:Blood pressure: 90/60 mm Hg to 120/80 mm Hg.Breathing: 12 to 18 breaths per minute.Pulse: 60 to 100 beats per minute.Temperature: 97.8°F to 99.1°F (36.5°C to 37.3°C); average 98.6°F (37°C)

What are the 5 vital signs?

Emergency medical technicians (EMTs), in particular, are taught to measure the vital signs of respiration, pulse, skin, pupils, and blood pressure as "the 5 vital signs" in a non-hospital setting.

What are the 7 vital signs?

What are vital signs?Body temperature.Pulse rate.Respiration rate (rate of breathing)Blood pressure (Blood pressure is not considered a vital sign, but is often measured along with the vital signs.)

How do you document vital signs?

Temperature, pulse, respira- tion, and blood pressure are usually taken in this order. For proper charting of vital signs in the medical record, it is helpful to remember the T, P, R, BP sequence and record the results in that order.

What is STEMI alert?

A STEMI heart attack, like a Widow Maker, is taken very seriously and is a medical emergency that needs immediate attention. For this reason its often called a “CODE STEMI” or a “STEMI alert.” STEMI stands for ST elevation myocardial infarction.

What is a STEMI ECG?

A STEMI is a myocardial infarction that causes a distinct pattern on an electrocardiogram (abbreviated either as ECG or EKG). This is a medical test that uses several sensors (usually 10) attached to your skin that can detect your heart's electrical activity.

What happens during a STEMI?

ST-segment elevation myocardial infarction (STEMI) describes the most deadly type of heart attack. With a STEMI heart attack, the artery , or tube that carries blood from your heart to the rest of the body, is completely blocked. Parts of the heart that are supplied by this artery will then begin to die.

How much mortality is there in STEMI?

Mortality in STEMI has also declined dramatically in the past decades. In-hospital mortality is now 5% and 1-year mortality is 7–18%. Roughly 70% of patients with STEMI are men. Women, on the other hand, have longer delay from symptom onset to first medical contact and women are also less likely to receive evidence based interventions, such as PCI and fibrinolysis. Women also tend to present with atypical symptoms more frequently than men.

What is the ECG for STEMI?

The ECG is the key to diagnose STEMI . ECG criteria for STEMI are not used in the presence of left bundle branch block (LBBB) or left ventricular hypertrophy (LVH) because these conditions cause secondary ST-T changes which may mask or simulate ischemic ST-T changes. ST segment elevation is measured in the J-point and the elevation must be significant in at least 2 contiguous ECG leads. Contiguous leads refers to leads that direct neighbors and reflect the same anatomical area; such as anterior leads (V1–V6), inferior leads (II, aVF, III) and lateral leads (I, aVL). For example, leads V3 and V4 are contiguous; V1 and V2 are also contiguous; aVL and I are also contiguous; V3 and V5 are not contiguous, because lead V4 is placed between these leads.

What is the treatment for STEMI?

General principles of treatment. STEMI is treated with anti-ischemic agents, anti-thrombotic agents, anticoagulants, and reperfusion (PCI or fibrinolysis). Reperfusion therapy is immediately needed because patients with acute STEMI have complete arterial occlusions which require reperfusion to restore patency.

What is ST elevation myocardial infarction?

Acute STEMI (ST Elevation Myocardial Infarction) is the most severe manifestation of coronary artery disease. This chapter deals with the pathophysiology, definitions, criteria and management of patients with acute STEMI. Although ECG changes in acute STEMI have been discussed previously (refer to ECG Changes in Acute Myocardial Infarction ), a rehearsal is provided below. 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). A large body of evidence supports the concepts and recommendations presented in this chapter.

What are the best risk models for STEMI?

These models typically include information regarding medical history, ECG findings, presenting features (notably hemodynamic status) and cardiac troponins. The best validated risk models are TIMI and GRACE. These vary with respect to the type of risk estimated (short-term, long-term, myocardial infarction, death). TIMI score is easiest to use but GRACE score has proven to be the most accurate. Links to GRACE and TIMI calculators:

Can thrombus be resolved?

On rare occasions the thrombus may resolve (either spontaneously or by means of reperfusion therapy) before the infarction process begins. In this case the troponin levels are not elevated and the condition is classified as unstable angina pectoris or aborted myocardial infarction. This is, however, rare because virtually all cases of STE-ACS progress to STEMI.

Can nitroglycerin be given to patients with STEMI?

Nitrates are administered to the vast majority of patients with STEMI. It does not affect the prognosis but relieves symptoms. Sublingual nitroglycerin (0.3 to 0.4 mg; may repeat two times with 5 minute intervals) may therefore be given for relief of ischemic discomfort. Intravenous nitroglycerin is considered if ischemic discomfort is not relieved. Nitroglycerin is also considered in patients with congestive heart failure as well as patients with uncontrolled hypertension.

What is a STEMI?

A STEMI is an ST-Segment Elevation Myocardial Infarction – the worst type of heart attack. This type of heart attack shows up on the 12-lead EKG. An NSTEMI (or Non-STEMI) does not have any ST elevation on the ECG, but may have ST/T wave changes in contiguous leads. Patients with STEMI usually present with acute chest pain and need to be sent to ...

What is the ACUTE MANAGEMENT OF STEMI?

STEMIs are true medical emergencies. The patient is at a high risk of significant conduction disturbances and arrhythmias including cardiac arrest. The longer you wait – the more heart cells will die, leading to worse cardiac outcomes as well as increasing the possibility of patient death.

What happens if you have ischemia for a long time?

Prolonged ischemia can lead to infarction – which is cell death of the heart tissue. This cell death causes the release of troponin into the bloodstream, an enzyme that is not usually found in the systemic circulation. Cardiac ischemia is usually secondary to atherosclerosis which is a buildup of plaque within the coronary arteries.

How long does a STEMI last?

Hyperacute T waves are first seen, which are tall, peaked, and symmetric in at least 2 contiguous leads. These usually last only minutes to an hour max.

What is non ST segment elevation?

A Non-ST segment elevation myocardial infarction (NSTEMI) refers to a complete occlusion of a coronary artery that does not cause ST-segment elevation on the ECG. While some heart tissue dies, this is usually less extensive than a STEMI. The infarction is usually limited to the inner layer of the myocardial wall.

Is NSTEMI a heart attack?

As the name suggests, an NSTEMI does not have ST elevation seen on the ECG, but it is still a heart attack. An elevated and rising troponin leve l is associated with an NSTEMI. The ECG can be completely normal, or it can have nonspecific T wave changes or even ST depression in contiguous leads. Management of an NSTEMI is similar to ...

Can a diabetic have a silent MI?

Women, older adults, and diabetics may have atypical presentations including a “silent” MI, where they don’t even have chest pain. There are many actions that need to be taken in a short amount of time, and many medications that will need to be administered before the cath team gets there.

What are the concerns with STEMI?

The first area of concern is related to the delay in patient access to medical care. Many patients wait a significant amount of time after the onset of symptoms before seeking care (1). The initial management of patients with STEMI is the most crucial part of treatment and delays in treatment can result in worsening outcomes.

What is the most important part of STEMI treatment?

The initial management of patients with STEMI is the most crucial part of treatment. With implementation of quality protocols and team management, the healthcare team can evolve and implement strategies to improve patient outcomes and reduce morbidity and mortality. It is essential for healthcare providers working in the environments of Emergency Departments, Cath Labs, ICU’s, and step-down units to understand the importance of timely intervention among the patients that they are caring for.

How long does it take to get myocardial infarction treated?

Studies show that if a patient with acute myocardial infarction is treated within 70 minutes, the damage to the left ventricle can be minimized.

What is the best treatment for STEMI?

Pain management is a crucial element in the initial management of patients with STEMI. The control of cardiac pain is usually accomplished with a combination of nitrates, opiate analgesics, oxygen, and beta-adrenergic blockers.

Is heart disease time sensitive?

Recent advances in the treatment of acute myocardial infarction have significantly reduced rates of morbidity and mortality. However, these treatments are time-sensitive and necessitate rapid initiation for desirable outcomes.

Should troponins be used in STEMI?

Cardiac-specific troponins should be used as the ideal biomarker for the evaluation of patients with STEMI who have a coexistent skeletal muscle injury.

Abstract

ST-elevation myocardial infarction (STEMI) requires timely coronary reperfusion but localizing ST-segment elevation (STE) can develop in clinical settings other than STEMI.

Introduction

ST-elevation myocardial infarction (STEMI) is diagnosed in the setting of characteristic symptoms of myocardial ischaemia in association with persistent ST-segment elevation (STE) on electrocardiogram (ECG) and subsequent release of biomarkers of myocardial necrosis.

Case presentation

A 66-year-old male with a history of type 2 diabetes mellitus and osteoarthritis, on no prescribed medications, presented with haemoptysis and chest pain. On examination, the temperature was 36.7°C, the blood pressure 84/69 mmHg, the heart rate 130 b.p.m., the respiratory rate 18 breaths per minute, and the oxygen saturation 100% on room air.

Discussion

We present a case of a patient presenting with haemoptysis and chest pain with marked STE triggering an STEMI code but the emergent cardiac catheterization showed no coronary obstruction. The patient was found to have metastatic squamous cell lung cancer and malignant myocardial infiltration.

Lead author biography

Ruihai Zhou, MSc, MD, FACC, RPVI, is a cardiologist on the faculty of Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, USA. He is board certified by American Board of Internal Medicine (ABIM) in internal medicine, cardiovascular disease, and interventional cardiology.

Supplementary material

Supplementary material is available at European Heart Journal - Case Reports online.