What are the quality measures for acute STEMI in adults?
Quality measures. Structure. a) Evidence of local arrangements to ensure that adults with acute STEMI who present within 12 hours of onset of symptoms have primary PCI, as the preferred coronary reperfusion strategy, within 120 minutes of the time when fibrinolysis could have been given.
What is the preferred PCI strategy for acute STEMI?
a) Evidence of local arrangements to ensure that adults with acute STEMI who present within 12 hours of onset of symptoms have primary PCI, as the preferred coronary reperfusion strategy, within 120 minutes of the time when fibrinolysis could have been given.
What are the drug regimens for post STEMI?
Drug therapy The following drug regime is recommended for all patients post NSTEMI and STEMI to reduce the risk of future ACS (secondary prevention) and improve myocardial function: ACE inhibitor or ARB: continued indefinitely Dual antiplatelet therapy (aspirin plus a second agent): for up to 12 months
What advice should be given to patients with an NSTEMI?
Advice should include: Cardiac rehabilitation should be offered to all patients with an NSTEMI, ideally before hospital discharge. Mechanical complications such as papillary muscle rupture, ventricular aneurysm and free wall rupture are rare post-NSTEMI. 8
What is the gold standard for STEMI?
Direct percutaneous recanalization of the infarct-related artery represents the gold standard in treating STEMI, specifically when performed within two hours after first medical contact.
What is the best treatment for STEMI?
Primary percutaneous coronary intervention (PCI) is the term for emergency treatment of an STEMI. It's a procedure to widen the coronary artery (coronary angioplasty). Coronary angiography is done first, to assess your suitability for PCI.
What is the golden treatment for myocardial infarction?
Recently the reperfusion therapy in the form of Primary Percutaneous Coronary intervention (PPCI) has become the gold standard for the treatment of Acute Myocardial Infarction.
What is the preferred treatment for acute MI?
The pain of myocardial infarction is usually severe and requires potent opiate analgesia. Intravenous diamorphine 2.5–5 mg (repeated as necessary) is the drug of choice and is not only a powerful analgesic but also has a useful anxiolytic effect.
What is STEMI protocol?
Code STEMI is a program designed to help medical professionals recognize heart attacks and immediately activate a protocol that ensures patients receive lifesaving care as quickly as possible. At NHRMC, we focus on reducing heart attack treatment times to give the best chance for a full recovery.
Is Mona used for STEMI?
MONA. Immediate treatment typically includes morphine, oxygen, nitroglycerin and aspirin (MONA). Morphine Sulfate: Morphine sulfate is the analgesic of choice for the management of chest pain associated with STEMI. Administer administered in 2 – 4 mg IV repeated at 5- to 15-minute intervals until pain is relieved.
Why are ACE inhibitors used after MI?
A meta-analysis concluded that administration of an ACE inhibitor within 3 to 16 days of infarction can slow the progression of cardiovascular disease and improve the survival rate (figure 1) [1].
When should fibrinolytic therapy be administered in STEMI?
For optimal results, fibrinolytic therapy should be administered as early as possible, preferably within the first 3 to 6 hours and potentially up to 12 hours after the onset of symptoms (Figure I in the Data Supplement). After 3 hours of symptom onset the clinical benefit of fibrinolysis markedly decreases.
What treatment is indicated in the first 12 hours of myocardial infarction?
Alteplase, reteplase and streptokinase need to be given within 12 hours of symptom onset, ideally within one hour. Tenecteplase should be given as early as possible and usually within six hours of symptom onset. Bleeding complications are the main risks associated with thrombolysis.
Why is metoprolol given in MI?
The METOCARD-CNIC trial (Metoprolol in Cardioprotection During an Acute Myocardial Infarction) demonstrated that the intravenous administration of metoprolol during ongoing anterior STEMI reduces the size of infarction,10 reduces the presence of microvascular obstruction and reperfusion injury,11 and improves long-term ...
Which beta blocker is used for myocardial infarction?
Use of sustained-release metoprolol succinate, carvedilol, or bisoprolol is recommended for beta-blocker therapy with concomitant ACS without ST-segment elevation, stabilized HF, and reduced systolic function.
When should you not give Nitro for STEMI?
2013 AHA/ACC STEMI Guidelines: "Nitrates should not be given to patients with hypotension, marked bradycardia or tachycardia, RV infarction, or 5'phosphodiesterase inhibitor use within the previous 24 to 48 hours."
Why is it important to perform additional diagnostic tests in these patients?
It is important to perform additional diagnostic tests in these patients to identify the etiology and tailor appropriate therapy, which may be different from typical STEMI . In some cases, there is a gap between optimal guideline-based treatment and actual care of STEMI patients.
What is the 2017 ESC guidelines?
2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation: The Task Force for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2017;Aug 26: [Epub ahead of print].
What is the best treatment for monomorphic ventricular tachycardia?
If monomorphic ventricular tachycardia is not accompanied by chest pain, pulmonary congestion, or hypotension, it should be treated with intravenous lidocaine, procainamide, or amiodarone. The patient with acute MI and symptomatic sinus bradycardia or atrioventricular block should receive atropine.
How long does it take to take a syringe for MI?
1. For the first 24 to 48 hours in all patients with acute MI who do not have hypotension, bradycardia, or tachycardia. 2. Continued use (beyond 48 hours)* in patients with a large or complicated infarction.
What is MI in medical terms?
1. When MI is suspected to have occurred by a mechanism other than thrombotic occlusion at an atherosclerotic plaque. This would include coronary embolism, certain metabolic or hematological diseases, or coronary artery spasm.
How long should a patient be monitored for electrical shock?
The patient should be monitored closely for adverse electrical or mechanical events because reinfarction and death occur most frequently within the first 24 hours. The patient's physical activities should be limited for at least 12 hours, and pain and/or anxiety should be minimized with appropriate analgesics.
How long does diltiazem last?
It may be added to standard therapy after the first 24 hours and continued for 1 year.
What is a spontaneous episode of myocardial ischemia?
1. Patients with spontaneous episodes of myocardial ischemia or episodes of myocardial ischemia provoked by minimal exertion during recovery from infarction. 2. Before definitive therapy of a mechanical complication of infarction such as acute mitral regurgitation, VSD, pseudoaneurysm, or LV aneurysm.
Who endorses echocardiography guidelines?
These guidelines have been officially endorsed by the American Society of Echocardiography, the American College of Emergency Physicians, and the American Association of Critical-Care Nurses. This executive summary and listing of recommendations appears in the November 1, 1996, issue of Circulation.
Quality statement
Adults with acute ST-segment-elevation myocardial infarction (STEMI) who present within 12 hours of onset of symptoms have primary percutaneous coronary intervention (PCI), as the preferred coronary reperfusion strategy, as soon as possible but within 120 minutes of the time when fibrinolysis could have been given.
Rationale
Primary PCI is a form of reperfusion therapy which should be done as soon as possible. This is because heart muscle starts to be lost once a coronary artery is blocked and the sooner reperfusion therapy is delivered the better the outcome for the patient. If too much time elapses the benefits of primary PCI may be lost.
Quality measures
a) Evidence of local arrangements to ensure that adults with acute STEMI who present within 12 hours of onset of symptoms have primary PCI, as the preferred coronary reperfusion strategy, within 120 minutes of the time when fibrinolysis could have been given.
What the quality statement means for different audiences
Service providers (ambulance services, accident and emergency service provider and cardiac service providers) ensure that local pathways and transfer protocols are in place for adults with acute STEMI who present within 12 hours of the onset of symptoms to be offered primary PCI, as the preferred coronary reperfusion strategy, as soon as possible but within 120 minutes of when fibrinolysis could have been given..
Definitions of terms used in this quality statement
Local areas should collaborate with healthcare professionals to determine the appropriate timeframes for patients. [Expert opinion]
How long does a NSTEMI last?
Typical symptoms of ACS/NSTEMI include: Sudden onset central crushing chest pain radiating to the left arm and/or jaw lasting longer than 20 minutes (if pain-free, identify when their last episode of pain occurred) Diaphoresis. Nausea. Shortness of breath. Other important areas to cover in the history include:
How long after a patient presents with ACS can they have a second troponin?
A second troponin 30 minutes to three hours after initial presentation is typically required to exclude an NSTEMI in patients at high risk of ACS.
Why is a 12-lead ECG important?
Serial 12-lead ECGs are important for assessing and monitoring patients with suspected ACS. A record of the patient’s baseline ECG may be helpful in determining the presence of acute changes.
What are the clinical findings of ACS?
Typical clinical findings of ACS/NSTEMI include: Signs of respiratory distress, pallor, diaphoresis, or fluid overload. Tachycardia.
Is troponin a good indicator of myocardial damage?
Troponin is a good indicator for myocardial damage but is not always due to myocardial ischaemia. Several other pathologies may cause myocardial damage in the absence of coronary artery pathology and thus present with raised serum troponin and ECG changes. These include: Myocarditis. Pericarditis.
Is ACS the same as NSTEMI?
Long term management. Long term management of ACS is essentially the same for STEMI and NSTEMIs. All patients with a diagnosis of NSTEMI, regardless of their risk stratification, require long term management and prevention strategies.