Case presentation Optimal management of STEMI Cardiology Update - - PowerPoint PPT Presentation

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Feb 20, 2024 158 likes •372 views

Case presentation Optimal management of STEMI Cardiology Update 2013 Davos 14.2.2013 Daniel Srder, MD Fondazione Cardiocentro Ticino Crucial factors in management of STEMI (among others ) 1. Time o What counts: FMC to reperfusion 2.

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Case presentation Optimal management of STEMI

Daniel Sürder, MD Fondazione Cardiocentro Ticino

Cardiology Update 2013 Davos 14.2.2013

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Crucial factors in management of STEMI (among others…)

1. Time
What counts: FMC to reperfusion
2. Antiplatelet regimen
What counts: Early administration (FMC !)
3. Thrombus removal
Do it whenever possible and until proximal

thrombus is removed

4. PCI/Stenting
5. Cardiac rehabilitation / secondary prevention

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Case

42 years old lady
absence of a significant medical history
typical anginbal chest pain since 30 min
alerts the ambulance

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Ticino

Roveredo (GR)

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Direct transmission

f the ECG to the

invasive cardiologist on duty

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Ticino

Roveredo (GR) Regional Hospital Bellinzona A Stop takes between 30 and 60 min of time !!!

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Arrival in the Cath-lab

asymptomatic
complete normalization of the ECG
hemodinamically stable

What to do ?  Perform coronary angiogram ?  Wait and see (CCU) ?  CT scan ?  Other ?

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How would you treat this (spontaneous) coronary dissection in a young women ?  Perform PCI ?  Wait and see (+/- GPIIb/IIIa inhibitors) ?  CABG ?  Other ?

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Our option:  Wait and see (+ 36 h GPIIb/IIIa inhibitors) spontaneous healing ?

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2 hours after interution of GPIIb/IIIa inhibitor: Chest pain and ST elevation

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