A 65 year old elderly male has history of sweating and chest pain for last 24 hrs with the following ECG. Which of the following is not given in managing the patient?
Ans. C. Thrombolytic therapyFirst let us diagnose the ECG; we need to know the following points:E.C.G changes in acute infarctionEarly acute phase (with - in hours)Fully evolved phaseOld infarction (resolution phase)Elevation of ST segmentPathological Q warePathogical Q waveTall wide (peaked) T waveElevated ST segment being to resolveT wave inverts.ST segment and T wave may be normalST segment elevation, unlike depression, will localize to the ECG lead of the affected myocardium. Note that 1mm of ST elevation in 2 contiguous leads is required to diagnose STEMI, however there are two major exceptions.a. Anterior STEMI requires 2mm of ST elevation in V2 and V3 in men > 40 years old or 1.5mm in women according to the ACC/AHA definition.b. Posterior STEMI frequently has ST depression in V1-V3 instead of elevation since the vectors are completely reversed. Hence, this is an ECG of anterior STEMI.In STEMI, thrombolysis or PCI (primary PCI) are effective methods to restore coronary blood flow and salvage myocardium within the first 12 h after onset of chest pain.ST elevation MI (STEMI) Immediate management:a. Nitratesb. Morphinec. Oxygend. AspirinStart adjunctive treatmenta. Beta blockers (IV)b. Nitroglycerine (IV)c. Heparin (IV)Reperfusion therapy is the definitive treatment of choice if patient present < 12 hours.a. Thrombolysis (Streptokinase)b. Early primary PCI
Aspirin
Statin
Thrombolytic therapy
Morphine
C.V.S.