Lectures

STEMI and NSTEMI

by Carlo Raj, MD
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    We have arrived at acute myocardial infarction. If you remember, we had discussed the two different types of myocardial infarctions and I need to make sure that we are clear about where we are heading next. There were the transmural type and you tell me if it is transmural, entire wall has been affected and so, therefore, you would find your obstruction where exactly? Is it an artery or arteriole? If you remember that functional anatomical picture that I showed you of the left ventricular wall and that is what we called it then the coronary artery was on the superficial aspect of the wall, on the surface by the pericardium. Thus, if the coronary artery was to be affected, then entire wall underneath was, so, therefore, you then refer to this as being a transmural infarct. So, as you move forward here and when you see NSTEMI this refers to what the actual patient is suffering from? A non-ST elevation myocardial infarction and by that we are referring to an ST depression. Or if it is an ST elevation myocardial infarction and if it is transmural of any type and I walked you through the three major blood vessels in our earlier discussion with left anterior descending, with left circumflex, and also right coronary artery, those will then result in an ST-elevation myocardial infarction. Now we are at a point where you need to make sure that you put all of this together, please. As we had discussed earlier, if the atherosclerotic plaque becomes large enough and as you see in the illustration here, there will be rupture. And if there is rupture, then understand that the central necrotic material including LDL and such escapes into and embolizes distally into the coronary artery, resulting in complete occlusion, and may...

    About the Lecture

    The lecture STEMI and NSTEMI by Carlo Raj, MD is from the course Ischemic Heart Disease. It contains the following chapters:

    • Pathogenesis
    • Signs & Symptoms
    • Localizing AMI by EKG
    • Special Inferior Wall MI's

    Included Quiz Questions

    1. Lateral aspect of the heart - leads V5, V6, aVL and Lead I
    2. Apex of the heart - V5, V6, aVL and I
    3. Interventricular septum - V1, V2, V3, V4
    4. Lateral aspect of the heart - V1, V2, V3, V4
    5. Inferior wall of the heart - II, II, aVR
    1. Coagulant necrosis with preserved architecture.
    2. Liquefactive necrosis with macrophage lined border.
    3. Gangrenous necrosis which is a type of coagulant necrosis.
    4. Fibrinoid necrosis which is not visible grossly.
    5. Caseous necrosis with a granuloma like appearance.
    1. S2 indicating closure of the aortic and pulmonic valves.
    2. S1 indicating closure of the mitral and tricuspid valves.
    3. S3 indicating closure of the aortic and pulmonic valves.
    4. S2 indicating closure of the mitral and tricuspid valves.
    5. S1 indicating closure of the aortic and pulmonic valves.
    1. S3
    2. S1
    3. S2
    4. S4
    5. systolic murmur
    1. ...backup up of blood into the PULMONARY VEINS from the LEFT ATRIUM resulting from a weakened LEFT VENTRICLE..
    2. ...backup of blood into the PULMONARY ARTERIES from the RIGHT ATRIUM resulting from a weakened LEFT VENTRICLE.
    3. ...backup of blood into the PULMONARY ARTERIES from the LEFT ATRIUM resulting from a weakened LEFT VENTRICLE.
    4. ...backup of blood into the PULMONARY VEINS from the RIGHT ATRIUM resulting from a weakened RIGHT VENTRICLE.
    5. ...backup of blood into the PULMONARY VEINS from the RIGHT ATRIUM resulting from a weakened LEFT VENTRICLE.
    1. Paradoxical split of S2, with closure of the pulmonic valve earlier than the aortic valve.
    2. Paradoxical split of S2, with closure of the pulmonic and aortic valve occurring simultaneously.
    3. Fixed splitting of S2, splitting of S2 that doesn't vary with inspiration.
    4. Splitting of S2 during inspiration.
    5. Wide splitting of S2, due to delayed right ventricular emptying.
    1. At least 1 mm (or 1 box) elevation in at least 2 contiguous leads.
    2. At least 1 mm (or 1 box) elevation on at least 1 lead.
    3. At least 2 mm (or 2 boxes) elevation on at least 1 lead.
    4. At least 2 mm (or 2 boxes) elevation on at least 2 contiguous leads.
    5. At least 1 mm (or 1 box) elevation on at least 2 leads in any order.
    1. V5, V6, I, aVL
    2. V1, V2, V3, V4
    3. II, III, aVR, V4
    4. V3, V4, II, III
    5. V1, V2, II, aVR
    1. A previous myocardial infarction occurred and has healed.
    2. An early indication of a myocardial infarction that is occurring.
    3. A right bundle branch block.
    4. A left bundle branch block.
    5. An accessory pathway exists in the conducting system of the heart.
    1. V1 also shows ST elevation
    2. V4 also shows ST elevation.
    3. V2 also shows ST elevation.
    4. V3 also shows ST elevation.
    5. V5 also shows ST elevation.
    1. Preload must be increased to improve hypotension.
    2. Preload must be reduced to improve hypotension.
    3. Afterload must be increased to improve hypotension.
    4. Afterload must be reduced to improve hypertension.
    5. Preload must be increased to improve hypertension.
    1. 3-7 days ago.
    2. 1-3 days ago.
    3. More than 7 days ago.
    4. It is occurring currently.
    5. Over a month ago.

    Author of lecture STEMI and NSTEMI

     Carlo Raj, MD

    Carlo Raj, MD


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    Excellent !
    By Linda T. on 27. February 2017 for STEMI and NSTEMI

    Love his lectures, really good explanation and I love his attitude. He more motivated and want to learn more. Thank you !