Abstract
Immediate diagnosis and management of ST-elevation myocardial infarction (STEMI), a condition resulting from the complete occlusion of a coronary artery, is critical to achieving optimal patient outcomes. This report outlines an acute inferior STEMI simulation which can be used for teaching different levels of learner including novice, intermediate and advanced. It focuses on the presentation, diagnosis, and management of inferior myocardial infarctions. Additionally, it incorporates the advanced cardiovascular life support (ACLS) protocol for more advanced learners and uses the CanMEDS collaborator/communicator role as an adjunct objective for all learners.
Highlights
Chest pain is a common presentation of a life-threatening condition known as acute ST-elevation myocardial infarction (STEMI)
STEMI typically presents with a history of substernal or leftsided chest discomfort that may radiate into the arm, neck, jaw, back, abdomen, or shoulder [4]
Fibrinolysis is only recommended if percutaneous coronary intervention (PCI) cannot occur within 120 minutes, or PCI is not available
Summary
Chest pain is a common presentation of a life-threatening condition known as acute ST-elevation myocardial infarction (STEMI). Accurate recognition and assessment of this condition is essential as the 30day mortality of myocardial infarctions and unstable anginas (collectively acute coronary syndrome) may reach 10% [1]. Death of myocardial tissue can result in devastating complications such as heart failure, cardiogenic shock, cardiac arrest, and patient mortality [3]. In the context of emergency medicine, acute chest pain of cardiac origin is described by a broader term known as acute coronary syndrome (ACS) [4]. ST-segment elevation of greater than 1 mm (greater than 2 mm in leads V1/V2 in males) in two anatomically contiguous leads on an electrocardiogram (ECG) in the patient with fitting history and physical exam findings are adequate for diagnosis in an acute setting [3]. Later elevation of cardiac biomarkers such as Troponin T or Troponin I correlates with the diagnosis of a STEMI [5]
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