Acute Coronary Syndrome (STEMI)
Cardiovascular · ~11% of blueprint- Pathophysiology
- Plaque rupture → thrombus → complete coronary occlusion → transmural ischemia/infarction.
- Signs & Symptoms
- Crushing substernal chest pain >20 min, radiates to L arm/jaw, diaphoresis, dyspnea, N/V.
- Gold Standard Diagnosis
- ECG: ST elevation ≥1 mm in ≥2 contiguous leads (higher cutoffs in V2–V3) + troponin (hs-cTn preferred). Angiography defines the culprit lesion.
- First-line Treatment
- ASA + P2Y12, anticoagulation, beta-blocker, high-intensity statin; PCI <90 min (120 if transfer), else fibrinolytics. O₂ only if hypoxic.
High-Yield Pearl
Time is muscle — door-to-balloon (FMC-to-device) <90 min, 120 if transferred. Do NOT give nitrates if RV infarct or recent PDE-5 inhibitor.
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Sources
Reviewed September 2026- 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes — ACC/AHA/ACEP/NAEMSP/SCAI, 2025
- StatPearls: Acute ST-Segment Elevation Myocardial Infarction (STEMI) — NCBI Bookshelf / StatPearls, 2025
- StatPearls: Acute Coronary Syndrome — NCBI Bookshelf / StatPearls, 2025
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