Myocardial Ischaemia

Illness Script

Myocardial Ischaemia

When the tissue in the heart becomes ischaemic due to lack of oxygen

Timeline

Can be a sudden or gradual onset over hours/days

Clinical Signs for STEMI

More than or equal to 2mm of ST elevation in two or more leads from V1-V3, or more than 1mm in leads V4-6, I, II, III, aVl or aVf, or V7-9. Or a new known left bundle branch block.

Clinical signs for NSTEMI

ST depression of 0.05mm in 2 adjacent leads. ST depression of 0.1-0.2mV in single lead. Other signs may include T-wave inversions.

Symptoms of MI

Chest pain, could radiate down left arm, up to jaw or in both arms can even radiate to the back or epigastric region. SOB, diaphoresis, nausea, pain associated with exertion, palpitations, dizzy.

What went wrong

blockage due to thrombosis, global ischaemia. Either causes lack of oxygen in heart muscle causing pain and cell death.

Treatment at EMT level

for a STEMI - DO NOT WALK THEM. 300mg Aspirin PO, 0.4mg of GTN with caution, withhold if signs of poor perfusion. For NSTEMI 300mg Aspirin PO, 0.4mg of GTN repeat every 5 minutes if needed. Call for Paramedic backup.

Differentials

PE - also causes chest pain and SOB, but it is pinpoint chest pain and doesnt show ECG changes. Non-cardiac pain (usually sharp, positional, not associated with exertion, and not associated with ECG changes