STEMI vs NSTEMI

Question 1

Describe the etiology of an MI:

Answer 1

Part of pre-existing coronary plaque dislodges from vessel wall. Plaque contents are exposed to blood, which favors clot formation on disrupted plaque.

Question 2

Differences in clot between STEMI and NSTEMI:

Answer 2

STEMI: RBC, TOTAL occlusion / NSTEMI: platelet, partial occlusion.

Question 3

What is the main treatment difference between treatment for a STEMI vs NSTEMI?

Answer 3

NSTEMI - do NOT use Thrombolytics; STEMI - reperfuse immediately with Thrombolytics

Question 4

Signs and Symptoms of MI:

Answer 4

Often occur at rest & in a.m., substernal chest pain that builds rapidly –> jaw, L shoulder or arm, Kussmaul’s Sign (JVP increases w/inspiration), pt becomes sweaty, syncopal, weak, dyspnic, orthopnic, has cough, wheezes, N/V, soft heart sounds

Question 5

Presentation of chest pain unique to STEMI:

Answer 5

Sudden and prolonged anterior chest pain (may be confused with gas), crushing pressure on chest not relieved by nitro - “Crushing substernal pain”, heavy squeezing - “worst pain of my life”

Question 6

Treatment for NSTEMI:

Answer 6

Anticoagulants: Aspirin, Platelet Inhibitor, Heparin. Give Beta Blockers, Nitro, CCB. High Risk = Cardiac Cath

Question 7

Treatment for STEMI:

Answer 7

Thrombolytics in under 12 hours, best within 3; Balloon angioplasty

Question 8

What % of STEMI patients die before arriving at the hospital?

Answer 8

50%

Question 9

_____% of MIs are silent MIs / What type of MI is a silent MI / What does it masquerade as? / patient demographic most likely to have this

Answer 9

20% / Painless STEMI / HF, syncope, stroke, shock / older, male w/ diabetes