HELPFUL TO UNDERGRADUATES

1. PRE TEST QUESTIONS
• State true or false
1. In an Elderly diabetic male coming with short history of retrosternal crushing
chest pain acute gastritis is your first differential diagnosis
2. A detailed and elaborate cardiovascular examination is a must in acute MI ?

2. • State true or false
3. The earliest cardiac enzyme to elevate and decrease is troponin I
4. Oxygen should be provided for all MI patients
5. All patients with MI should receive antiplatelets as a early as possible if no
contraindications
6. Thrombolysis is the preferred treatment in all patients of MI?

3. CASE
Doc is it gastritis ????????

4. • 56 year old male
• c/o acute onset chest pain since 1 hour with minimal dyspnea
• Past history : HTN since 10 years , DM since 5 years
• Family : nothing contributory
• Personal : smoking 10 pack years per day

5. EXAMINATION
• PR : 108 / min
• BP : 120 /80
• RR: 20/min
• SPO2 : 96 % on RA

6. •Pale
•Diaphoretic
•JVP: Not elevated

7. CVS

8. AUSCULTATION OF LUNGS
• Normal vesicular breath sounds heard

9. ECG

10. LABS
• Normal Troponin and CKMB levels

11. DIAGNOSIS

12. Acute ST Elevation Myocardial
Infarction

13. ACUTE CORONARY
SYNDROME
DR SOURAB HIREMATH
MD INTERNAL MEDICINE
EMERGENCY MEDICINE

15. ACUTE STEMI
Acute Myocardial infarction characterised by ST
segment elevation of more than 1 mm In two
contiguous leads

16. ETIOLOGY / RISK FACTORS

17. PATHOPHYSIOLOGY

18. CLINICAL FEATURES
CHEST PAIN
Retrosternal
Radiation
Severe crushing type

19. CLINICAL FEATURES

20. • Dyspnea
• Diaphoresis
• Palpitation
• Lightheadedness
• Nausea
• Vomiting

21. CLINICAL FEATURES
• Examination should be quick assessment as acute presentation usually has no
CVS findings
• Mechanical complications will produce CVS findings

22. ECG
• ST segment elevation of more than 1 mm in 2 contiguous leads
• Or new onset LBBB

25. LABORATORY
• CBC : mild leucocytosis
• Lipid profile : LDL elevation

26. CARDIAC ENZYMES

27. 2D ECHO

29. TREATMENT
TIME is MUSCLE

30. GOLDEN RULE OF EMERGENCY MEDICINE
ABC
In cardiac arrest
CAB

31. PRIOR TO MEDICATIONS

32. PRIOR TO REPERFUSION TREATMENT
ASPIRIN 325 mg tablet

33. LOADING DOSE of oral P2Y12 antagonists
Eg. Clopidogrel 75 mg 4 tablets

34. High dose Statins 40-80 mg stat

35. OXYGEN
?????
<94%

36. NITROGLYCERIN
• Oral : GTN 2.6 mg every 5- 10 mins
• Intravenous infusion 5-10 mcg

37. REDUCING MYOCARDIAL OXYGEN DEMAND
Beta blockers

38. PAIN RELIEF
MORPHINE

39. REPERFUSION THERAPY
FIBRINOLYTICS VS PERCUTANEOUS CORONARY INTERVENTION
DOOR TO Drug time 30 mins Door to balloon time 90 mins
Time period <12 hours

40. THROMBOLYTICS

43. PERCUTANEOUS CORONARY INTERVENTION

44. THANK YOU