Myocardial infarction definition

• Rise/fall in cardiac biomarkers
• AND evidence of ischemia
• ST/T wave changes, new LBBB, new Q waves, imaging showing new infarct (TTE, myocardial perfusion scan (MPI))

• EKG, CXR, CBC, CMP, troponin, T&S, coags, hCG
• Other causes of troponin elevation: dissection, CHF, PE, myocarditis, ESRD, HTN emergency, trauma, cocaine, chemo, sepsis...etc.

EKG basics

STEMI

• ST elevations ≥ 1 mm in ≥ 2 contiguous leads (with reciprocal ST depression in contralateral leads)
• New LBBB + symptoms c/w new MI
• In absence of old EKG or baseline LBBB, use Sgarbossa criteria (link)

UA/NSTEMI

• UA sx + elevated troponin = NSTEMI

EKG - anatomic sites of infarct

• Inferior (RCA; posterior descending) OR CFX
•  III > II (points to right) = RCA
• II > III (points to left) = CFX
• Anterolateral (LCX)
• Anteroseptal (LAD)
• Anteroapical (LAD)

MONA

• Morphine - 2-4 g (small vasodilatory effects; may or may not be recommended due to masking chest pain and preventing medical therapy)
• Oxygen
• Nitrates (unless R heart involvement)
• Aspirin 325 mg chewable
• Plavix/clopidogrel load 600 mg x 1
• Heparin/lovenox/bivalirudin
• Reperfusion - STEMI pager, cath lab
• PCI < 90 minutes (ask about contrast allergy)
• If PCI unavailable witihn window, fibrinolytic therapy within 30 min

BLS/ACLS