ST Elevation

Sinus Rhythm with ST Elevation (STEMI)

ST elevations signifies an occlusion of a coronary artery most commonly caused by a thrombus or an embolus. STEMI can be described as mild, moderate, or severe deviations from the baseline or isolectric line. The higher the elevation, the more symptoms are present, greater injury and the greater the risk for cardiac arrest. Various underlying rhythms can occur.

INTERVENTIONS: based on AHA 2011 Guidelines
Oxygen - 4 L via NC titrate to effect to maintin SaO2 94% or greater
Aspirin - 160-325 mg chewable or suppository
Nitroglycerin -0.3-0.4 mg spray/sublingual every 3-5 mins. x3
Morphine Sulphate - 2-4 mg IV titrate to effect; may be repeated 2-8 mg every 5-15 minute intervals

Follow AHA STEMI guidelines and assess for contraindications before medication administration.

Category:

Education

Tags:

• SR with STEMI
• MI
• AMI
• RVI
• Infarction
• myocardial injury
• mona
• aspirin
• nitroglycerin
• morphine
• oxygen
• 12 lead
• heart attack
• chest pain
• cardiac arrest

[GWeis314]

ECG's are significant only if you have access to a history. Treatment won't change, but the determining factor (diagnosis) will happen with cardiac markers. CPK's and Traponin levels. Give ASA, give nitro, paste if needed, and morphine.

[Nirvana87]

Could someone tell me what's the difference between unstable angina and NSTEMI considering the ST segment (and other segments)?

[rostifer28]

@celticcare With an MI, won't the ST segment usually depress before it elevates?

[kokeneox]

Hay que realizar trombolisis.

[celticcare]

As the posters said, this is just a lead 2 view of ST elevation, early sign of this in monitoring should alert the assessing staff to order a 12 lead or to assess their patient for any signs of MI. And remember, there are such things as silent MI's that can present with no outward chest pain, so don't always assume that a patient will have pain with this rhythm. This is posted not as a diagnosis of ACS, but then remember the ECG is only part of the diagnosis of ACS, not the only tool.

[czkss143]

@leviathan85

hi to all...i agree with you..its not diagnostic of ACS, its just shows the picture of NSR wyth ST elevation

[leviathan85]

Calm down. This is NSR with ST elevation in lead II, which could be an inferior MI if in conjunction with leads III and aVF. They did not say this was a diagnosis of any type of acute coronary syndrome; it is simply a demonstration of what ST elevation looks like.

[swarzenegera]

That is just an example stupid, yeah that is NSR with ST elevation!

[mrsmastakilla]

so meaningful..