ST-Elevation Myocardial Infarction

Episode overview

ST-elevation myocardial infarction, or STEMI, is an acute coronary emergency caused by coronary plaque rupture and thrombotic occlusion leading to transmural myocardial ischemia. The key is rapid recognition and immediate reperfusion. In this episode, Chris and Mars review classic STEMI presentation and important atypical symptoms, how to localize infarction using the ECG, why treatment should not wait for troponin or echocardiography, emergency reperfusion with percutaneous coronary intervention, when fibrinolytic therapy may be considered, antiplatelet therapy, anticoagulation, statins, and nitroglycerin, recognition and management of right ventricular infarction, why nitrates can be dangerous in preload-dependent right ventricular infarction, and major post-MI complications including ventricular arrhythmias, papillary muscle rupture, interventricular septal rupture, and left ventricular free wall rupture. Episode pearl: In a clear STEMI, do not let additional testing delay reperfusion. Opening the occluded coronary artery is the priority.