courtesy cg from an old thread - amith

[ArchivalUser]

Whenever patient has transmural MI serial changes occur in involved leads:

1. increase in R wave voltage-------------------------within minutes
2. elevation of ST segment----------------------------minutes to hours
3. St segment falls towards baseline and T wave flattens along with appearance of Q waves.-------------Hours to days
4. St seg comes back to baseline , fully appeared Q waves and T inversion------ days to weeks

Thrombolysis or PTCA done at before appearance of q waves can halt the process and even if small Q waves are there, areas surrounding infarct in that is also in jeopardy is spared.

[ArchivalUser]

ajeet I am still not grasping the concept. Can we make this more simple and 1st define what the differences are btw

NSTMI and STEM and Unstable on EKG and then do a stepwise approach on Mx.

Really aprrecaite it and hopefully it will make it more clear for me and evrynone else that are struggling with this.

[ArchivalUser]

yup sure im lil confused as well one kind request either ben or ajeet pls concise in the end..in a single post ..rather in dribs and drabs for everyone

[ArchivalUser]

diagnosis..... EKG.........................cardiac enzy................treatment

USA........normal/T inv/ST dep.......not raised......Aspirin, NTG, beta, heparin, o2, morphine

Nstemi....normal/T inv/ST dep........raised...........same as above

STEMI....ST elevation/new LBBB.....raised...... ...same + STK/tPA/PTCA if in window period

[ArchivalUser]

hey i think the clinical picture for both NSTEMI and USA are same except tht there would be raised enzymes in NSTEMI signifying tht MI has occured

there are no raised enzymes in USA... there is no ST elevation in both of them

treatment for NSTEMI and USA =
asprin , nitroglycerine , beta blockers , morphine , oxygen and heparin
IIb/IIIa inhibitors in pts goin to undergo stenting

For USA we observe enzymes and EKG to see tht they are not goin into NSTEMI or STEMI

[ArchivalUser]

thx.........