STEMI part 1: focus on reperfusion- Elias Hanna

freecme000
Published on Dec 24, 2024
**Ideas of this talk are from chapter 2 of my book, Practical Cardiovascular Medicine, Wiley 2022
0:00 Timelines: physiology and streamlined management (inspired by guidelines)
12:21 Brief on management beyond 24 hours and OAT trial, and ECG features of late STEMI
22:33 Brief on ECG features and on new LBBB
26:50 When to give fibrinolytics in transfer patients: equipoise door-to-balloon time, importance of ischemic time (more or less than 3 hrs), risk profile, age over 75. Trials and efficacy curve of PCI vs fibrinolysis (31:57)
39:16 When to do PCI after fibrinolysis: rescue PCI, pharmacoinvasive PCI. Definition of response to fibrinolytics (40:20)
44:35 and 34:20 Bottom line approach for transfer patients
47:10 Fibrinolytics pharmacology (47:10), efficacy (06:42), adjunct therapy (50:37), contraindications (36:32), how to define response (40:20), and doses (59:12)
59:12 r-tpa dose: 15-50-35 (not 30): 15 mg bolus-then 50 mg over 30 min-then 35 mg over 60 min (total 100 mg). Weight adjust the dose in patients less than 67 kg
52:01 Case illustrations/ECGs/management
1:00:25 Case of transient ST elevation
1:03:40 Case of a responder to fibrinolytics, how to manage over 24 hrs later
1:08:12 Multivessel CAD and non-culprit PCI. Define what is significant non-culprit stenosis. Cases of shock and STEMI, shock and NSTEMI
1:14:06 CABG for multivessel CAD after STEMI