800 likes | 1.3k Views
OUTLINE. Definition of MIRisk stratificationMedical management. REVISED DEFINITION MI. (Myocardial infarction redefined?a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction:. J. Am. Coll. Car
E N D
1. Risk stratification and Medical management of STEMI Dr . Ranjith MP 14-11-2011
2. OUTLINE Definition of MI
Risk stratification
Medical management
3. REVISED DEFINITION MI (Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction:. J. Am. Coll. Cardiol. 2000;36;959-969)
Criteria for Acute, Evolving, or Recent MI
Either of the following criteria satisfies
Typical rise &/or fall of biochemical markers of myocardial necrosis with at least one of the following:
Ischemic symptoms
ECG changes indicative of new ischemia (new ST elevation or new/presumed to be new LBBB)
Development of pathological Q waves in the ECG
Imaging e/o new loss of viable myocardium or new RWMA
Pathologic findings of an acute MI
4. REVISED DEFINITION MI (Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction:. J. Am. Coll. Cardiol. 2000;36;959-969)
PCI periprocedural MI:
increases of biomarkers >3 x 99th percentile URL
CABG-related MI
Increases of biomarkers >5 x 99th percentile URL plus either new pathological Q waves or new LBBB, or angiographically documented new graft or native coronary artery occlusion, or imaging evidence of new loss of viable myocardium.
5. REVISED DEFINITION MI (Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction:. J. Am. Coll. Cardiol. 2000;36;959-969)
Criteria for established MI.
Either of the following criteria satisfies
Development of new pathologic Q waves on serial ECGs. The patient may or may not remember previous symptoms. Biochemical markers of myocardial necrosis may have normalized, depending on the length of time that has passed since the infarct developed.
Pathologic findings of a healed or healing MI.
6. Risk stratification of STEMI
7. Risk stratification of STEMI There is risk stratification within STEMI, but in general, STEMI is high-risk
Important to select greater-risk patients who warrant more aggressive strategies for prevention of future serious events such as reinfarction or sudden death
8. Risk Stratification Occurs in several stages
Initial presentation
In-hospital course (CCU, intermediate CU)
At the time of hospital discharge
9. Acute Phase Risk Stratification: Prior angina pectoris
Prior MI
Female gender
Hypertension
History of CHF
Hyperlipidemia
Diabetes ECG Criteria
Markedly elevated cardiac enzymes
Elevated BUN
Complications
VSR/PMD-rupture
Myocardial rupture
10. Acute Phase Risk Stratification:Electrocardiographic features Anterior MI/ Persisting ST elevation
Q waves in multiple leads
RVMI + IWMI
High sum of ST elevation
Reciprocal ( anterior ) ST depression
Persisting ST depression
Prolonged QT
Conduction defects/ heart block
Sinus tachycardia/atrial fibrillation
11. Acute Phase Risk Stratification:Importance of LV dysfunction