STEMI Management

Question 1

STEMI criteria on an ECG

Answer 1

• ST-segment elevation in at least 2 adjacent leads
• 2mm in men over 40 and 1.5mm in women in leads V2 and V3

Question 2

why do we put pads on the patient

Answer 2

risk of cardiac arrest from VF is highest in the first few hours from symptom onset. VF can occur without warning

Question 3

GTN indications

Answer 3

cardiac chest pain, systolic BP must be above 90mmHg

Question 4

GTN dosage

Answer 4

400mcg spray sublingual, up to 2 sprays

Question 5

GTN action

Answer 5

• nitric oxide produces chemical changes which reduce calcium influx, relaxing smooth muscles
• dilates coronary arteries (relieving coronary spasm), increasing blood flow to compromised heart tissue in MI and unstable angina
• vasodilation results in lower preload, BP and reduced pulmonary oedema

Question 6

aspirin indications

Answer 6

ECG suggestive of MI or ischaemia

Question 7

aspirin dosage

Answer 7

300mg chewable tablet

Question 8

aspirin action

Answer 8

• antiplatelet so reduces the clotting of platelets, prevents them from sticking together and forming clots
• which ensures the blood flow to the heart is maintained
• therefore reducing risk of cardiac arrest and death to heart muscle

Question 9

morphine indication

Answer 9

pain, pain in MI

Question 10

morphine dosage

Answer 10

10mg in 10ml, IV preferred

Question 11

morphine action

Answer 11

• morphine has haemodynamic side effects such as reducing heart rate, blood pressure and venous return and preload
• blocks pain signals by binding to opioid receptors in the CNS
• causes the release of histamine which leads to vasodilation

Question 12

12 lead ECG placement

Answer 12

• V1- 4th intercostal space, right sternal border
• V2- 4th intercostal space, left sternal border
• V3- in between V2 and V4
• V4- 5th intercostal space, mid-clavicular
• V5- 5th intercostal space, in between V4 and V6
• V6- 5th intercostal space, mid-axilla

Question 13

CV exam indications

Answer 13

• chest pain
• collapse with unknown cause
• shortness of breath
• ECG changes
• hypo/hypertension
• dizzy/lightheaded

Question 14

CV ausculatory landmarks

Answer 14

• aortic valve- 2nd intercostal space, right sternal border
• pulmonary valve- 2nd intercostal space, left sternal border
• Erb’s point- 3rd intercostal space, left sternal border
• tricuspid valve- 4th intercostal space, left sternal border
• mitral valve- 5th intercostal space, mid-clavicular line

listening for normal “lub dub” sound

Question 15

STEMI and PE similarities and differences

Answer 15

• both can have chest pain, shortness of breath, lower leg oedema
• PE may have calf pain

Question 16

inspection of chest in a CV exam

Answer 16

looking for any surgery scars, pulsating masses, lumps or dips