STEMI (ST – Elevation Myocardial Infarction)

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1

Which of the following is the most appropriate initial treatment for this patient?

A 58-year-old male presents to the ER with chest pain lasting 45 minutes. His ECG shows ST-segment elevation in leads II, III, and aVF. He is hypotensive and bradycardic.

Hint: Exclude two medications that are contraindicated in hypotensive and bradycardic patients.
2

What artery is most likely occluded in this patient?

A 72-year-old female presents with acute onset of chest pain radiating to the jaw. Her ECG shows ST-segment elevation in leads V1-V4.

Hint: Leads II, III, and AVF demonstrate an occlusion of the RCA.
3

What is the most likely cause of his deterioration?

A 70-year-old male is undergoing treatment for STEMI. After thrombolytic therapy, he develops a sudden loss of consciousness and a pulseless electrical activity (PEA) arrest.

Hint: Think about complications of thrombolytic therapy.
4

Which part of the heart is most likely affected?

A 65-year-old male with a history of hypertension presents with chest pain. His ECG shows ST-segment elevation in leads I, aVL, V5, and V6.

Hint: ST segment elevation of the Anterior/Septal territory of the heart is found in Leads V 1-4 on an ECG.
5

Which complication should be suspected in this patient?

A 60-year-old female is undergoing treatment for STEMI. During Percutaneous Coronary Intervention (PCI), she suddenly develops severe hypotension. The ECG shows abnormal Q waves in the inferior leads.

Hint: Myocardial Infarction is commonly associated with heightened or peaked T waves on an EKG.
6

What is the best next step in management?

A 54-year-old male presents with chest pain and is diagnosed with an anterior STEMI. His initial troponin level is normal, and his ECG shows persistent ST-elevation after 2 hours. 

Hint: Persistent ST-elevation in an acute setting warrants immediate intervention.
7

What complication should be suspected?

A 68-year-old female presents with an acute STEMI and undergoes primary PCI, after which a stent was placed. Post-procedure, she has persistent ST-elevation and worsening heart failure symptoms.

Hint: Pneumonia and Cardiogenic Shock may be suspected as an underlying and ongoing disease process unrelated to the STEMI and PCI with coronary stent placement.
8

Which type of myocardial infarction is most likely?

A 45-year-old male smoker presents with chest pain. His ECG shows ST-elevation in lead III greater than in lead II, and hypotension.

Hint: Anterior MI is typically suspected with ST elevation in Leads V3 and V4.
9

Which of the following are interventions part of STEMI management?

A 58 year old female patient with crushing chest pain and an ECG showing ST elevation in V7-V9 presents to the ER. 

Hint: Reviewing a patient's medical record and medications is an integral part of STEMI management to ensure medications are not administered that are either allergic or contraindicated for the patient.
10

What artery is most likely occluded?

 

A 55-year-old male presents with chest pain and an ECG showing ST-elevation in leads I and aVL with reciprocal ST-depression in leads II, III, and aVF.

Hint: Reciprocal changes are key in determining the artery involved.

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