Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department -
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Publication Date: January 2021 (Volume 23, Number 01)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 01/01/2024.
Authors
Marshall Frank, DO, MPH, FACEP
Assistant Professor of Emergency Medicine, Florida State University College of Medicine; Medical Director, Sarasota County Fire Department, Sarasota, FL
Carson Sanders, BS, NRP, CCEMT-P
Assistant Chief-EMS, Sarasota County Fire Department, Sarasota, FL
Bryan P. Berry, MD, BCEM, FACEP
Associate Clinical Faculty of Emergency Medicine, Florida State University College of Medicine; Emergency Medicine Physician, Sarasota Memorial Hospital, Sarasota, FL
Peer Reviewers
James Morris, MD, MPH
Program Director, Emergency Medicine Residency, Texas Tech University Health Sciences Center, Lubbock, TX
Douglas L. Robinson, DO, MS
Medical and Aeromedical Director, Military Intelligence Battalion, 75th Ranger Regiment, FBGA; Emergency Medicine Physician, Piedmont Regional Medical Center, Columbus, GA
Andrew Schmidt, DO, MPH
Assistant Professor, Department of Emergency Medicine, University of Florida-Jacksonville, Jacksonville, FL
Abstract
ST-segment myocardial infarction (STEMI) is a time-sensitive emergency that requires swift and seamless integration of prehospital and emergency department resources in order to achieve early diagnosis and reperfusion therapy. This issue reviews the current literature on emergency department management of STEMI, including recognition of more subtle diagnoses on electrocardiogram, identification of STEMI mimics, an update on treatment therapies, and strategies to achieve more effective management of STEMI across gender and age groups.
Excerpt From This Issue
CASE 1
A 74-year-old woman with chest pain is delivered to your ED by EMS…
You greet the paramedics, and they inform you that the patient called 911 from home because she was having chest pain. They have given her 324 mg of aspirin orally and 3 doses of 0.4 mg of nitroglycerin sublingually. The patient’s pain improved, but is still present.
Her vital signs are normal. The paramedic hands you an ECG that he obtained and states that there is anterior ST-segment depression concerning for ischemia, but no ST elevation.
You look at the tracing and note ST depression in leads V2 and V3. You wonder whether this could actually be a STEMI, and what would be the best way to confirm your suspicion…
CASE 2
A 60-year-old man presents with retrosternal chest pain…
The patient reports that he’s had pain for 2 days that has been constant and never goes away.
He has no dyspnea, diaphoresis, or radiation of the pain. Additionally, there is no increase in the pain with exertion.
You obtain an ECG and note ST-segment elevation in the inferior and lateral leads.
Given the patient’s history of present illness, you are not convinced that he has STEMI and wonder what the best next step is…
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A 74-year-old woman with chest pain is delivered to your ED by EMS…
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