stemi case reviews - american heart associationwcm/@mwa/...stemi case reviews sw region st. alexius...

St. Alexius Medical Center

STEMI Case Reviews

SW Region


60 year old male

Presented after 20-30 minutes of chest pain

Pain is anterior midsternal with radiation

Diaphorectic, short of breath

No history of cardiovascular disease

Past smoking hx

Denied any medications


VSS on arrival 110/70 HR 65

EKG completed, ASA and 2 NTG given

IV inserted, NTG drip prepared

BP dropped in the 80’s sys, NS bolus given

Pt. admitted to taking Viagra 5 hours ago

EKG ST elevation in Inferior leads


TNK given, heparin bolus and drip

started

Pain improved

Pt. loaded for transport. BP 110-120/70


Chest pain returned

NTG drip started

ST elevation returned

BP 80/40

Arrived St. A’s – NTG drip DC’d

Taken to Cath Lab


Mid RCA totally occluded

Aspiration thrombectomy with resolution

of EKG changes

Remaining 80% occlusion – stent

placed

Integrillin started and Plavix given.

Echo showed EF of 45-50%

Troponin peak 43.81


Second case

60 y/o male

Developed severe chest pain while doing yard

work

Found on the ground, pale, diaphoretic and

moaning with pain

12 lead revealed ST elevation in the anterior

leads

Vitals taken, IV started, ASA, NTG and

dilaudid given


PMH: Had neg Heart cath in 2006. Hx of

asthma, sleep apnea, HTN,

hyperlipidemia, gastritis and remote GI

bleed.

TNK given with IV dose of lovenox followed by

heparin bolus and drip

Helicopter activated and CP easing slightly.

Chest pain remained 4/10 throughout flight

On arrival went directly to the cath lab


Heart cath revealed 80% occlusion with

a thrombus and a 70% ostial lesion

of the diagonal.

Stent placed, Integrillin started, Brilinta

given

Peak troponin 19.69


69 y/o male who developed chest pain while doing errands.

Presented to ER after 20-30 minutes of pain.

Pain was central anterior with radiation to back.

EKG confirmed ST elevation in V1-V5

PMH included DM type II, HTN, hyperlipidemia and rheumatoid arthritis.

ASA, morphine and a heparin bolus given

Taken to the cath lab

Third Case


Cath revealed multivessel disease but

primarily 100% of his proximal LAD

and 80% of the diagonal.

Stents were placed

Pt. developing signs of cardiogenic

shock, a balloon pump was placed

and pt. started on pressors


Improved quickly post stent

Echo showed a 35-40% EF

Troponin peaked at >73

Slight problem with CHF easily

controlled with Lasix


DOCUMENTATION

REMINDERSUpon transfer fax the following:

12 lead EKG

ED record both MD and nursing

Lab results

Medication record

STEMI Rush documentation

EMS report if pt. arrived to your facility by

ambulance

stemi case reviews - american heart associationwcm/@mwa/...stemi case reviews sw region st. alexius...

Documents