2. Objectives Review chest pain Define ACS
Review acute MI Alert vs Activation

3. 64 yo Male with history of diabetes, hypertension and hyperlipidemia presents to the ED with chest pain and sweating for 1 hour since onset.
Chest pain characterized as burning, pressure like and radiating to arm and neck.
At 3pm was performing manual labor and noted burning in his chest that radiated to his left arm associated with diaphoresis and palpations

4. Vitals:
175/131 BP bpm RR F % on RA
PE:
Diaphoretic, uncomfortable
Lungs – clear auscultation without evidence of distress
Cardiac – regular rhythm, tachy

5. PTA Medications:
Simvastatin
Amlodipine
Losartan/HCTZ
Metformin
Glimepiride

12. Whats a STEMI?
ST Elevation (no LBBB/LVH) is > 2mm in men or > 1.5mm in women in V2-V3 and/or > 1mm in 2 contiguous chest or limb leads
Posterior MI: ST Depression > 2mm Precordial Leads (V1 – V4)
LM/pLAD MI: Multilead ST Depression w ST Elevation in aVR.

14. LBBB
Sgarbossa criteria demonstrated that a score or ≥3 had a specificity of 98% for acute myocardial infarction
1. ST-elevation ≥1 mm and concordant with QRS complex
OR 25.2 Score 5
2. ST-segment depression ≥1 mm in lead V1, V2, or V3
OR 6.0 Score 3
3. ST-elevation ≥5 mm and discordant with QRS complex
OR 4.3 Score 2

16. 55 yo female presenting to the ED with complaints of chest pain.
Has been progressive over the month.
PMH: hypertension, diabetes, active tobacco use and osteoarthritis

17. PTA medications:
Clonidine
Metformin
Nifedipine

23. Activation vs MI Alert Dial 156 Activation (STEMI only)
Operator will ask you for the patient’s name and location
Page goes to:
CCU Fellow/Resident/Intern
Interventional attending on call
Cath lab tech/RN on call
MI Alert

24. When to Active? STEMI unstable angina with high risk features
hemodynamically unstable NSTEMI
Remember this alerts the cardiac cath team

26. After you active? 16 gauge IV access EKG and CXR
Labs! BMP, INR and CBC
Medications:
STEMI or nstemi: DAPT (aspirin and Ticagrelor), statin, (heparin bolus 5000 units)

27. When to use Acute MI
this alerts the cardiology fellow covering the CCU service
It does not active the cardiac cath lab
For patients that require a cardiologist, but not urgent revascularization

28. Use the Acute MI Activation
dial 156 to activate the cath lab
don’t forget about right sided EKG or posterior EKGs

33. “Thats all folks.”
Thanks for Listening