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Card 1 of 19
DiseaseCardiovascular

Acute Coronary Syndrome (STEMI)

Recall: Pathophysiology ยท S/Sx ยท Gold Standard Dx ยท First-line Tx ยท Pearl

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DiseaseCardiovascular

Acute Coronary Syndrome (STEMI)

Pathophysiology
Plaque rupture โ†’ thrombus โ†’ complete coronary occlusion โ†’ transmural ischemia/infarction.
S/Sx
Crushing substernal chest pain >20 min, radiates to L arm/jaw, diaphoresis, dyspnea, N/V.
Gold Standard Dx
ECG: ST elevation โ‰ฅ1 mm in โ‰ฅ2 contiguous leads (higher cutoffs in V2โ€“V3) + troponin (hs-cTn preferred). Angiography defines the culprit lesion.
First-line Tx
ASA + P2Y12, anticoagulation, beta-blocker, high-intensity statin; PCI <90 min (120 if transfer), else fibrinolytics. Oโ‚‚ only if hypoxic.

Time is muscle โ€” door-to-balloon (FMC-to-device) <90 min, 120 if transferred. Do NOT give nitrates if RV infarct or recent PDE-5 inhibitor.