DDx

• ST Elevation (diffused) + PR depression = Pericarditis
• Other causes of STE

Other Presentations

"STEMI-equivalents"

1. Global ST Depression and Elevation in aVR
   • can indicate severe left main or multi-vessel coronary artery disease.
2. Global ST Depression + hyperacute T wave (de Winter’s sign)
3. Dynamic T wave inversions/flattening (OMI)

Posterior MI

• may be shown as ST Depression on V1-V3 (+/- STE in inferior) → ask for 15 lead ECG

  

  

T-wave Changes

Treatment

Pain management

• Rest
• Morphine
• Give some O2

Anti-platelet and anti-coagulant

• 1 Anti-Coagulant (Heparin (-parin) )
• 2 Anti-Platelet (DAPT)

Reperfusion (KEY for ****STEMI) → restore blood flow

1. directly go for Angioplasty (PCI)
   • Used when time-to-balloon time WITHIN 90 min
   • Often Toronto
2. TNK-tPA (tenecteplase) (< 12 hr) → Angioplasty (PCI)
   • Works 60% of the time
   • Used when time-to-balloon time BEYOND 90 min + within 3 hours the start of the symptom onset (usually when they entered the ER)
   • Completely ineffective after 12 hours
   • Observe for 1 hour
     • if didn’t work (the 40%) → rescue Angioplasty (PCI) immediately
     • if worked (the 60%) : Can send for PIC a few days later
   • Often Rural

Angiography + Revascularization (Dx + Tm) → permenantly restore blood flow → Do it for almost all MI Pt (reduce refractory sym., improve prognosis)

• Coronary Angiogram / Cath Lab
• 1 or 2 vessel: Angioplasty (PCI)
• Multi-vessel, calcification: CABG

Complications

Immediate

90% necrosis within 3 hours