11. ECG criteria for thrombolysis
• Characteristic Pain
• Gradual onset of pain (>30 mins < 12 hours)
• Pain not relieved by nitrates
• ECG changes
• 1mm or > ST elevation in 2 limb leads
• 2 mm or > ST elevation in 2 or more adjacent chest
leads
• New left bundle branch block
12.
13. Case study
• 64 year old man with 1 hour of chest pain.
Wife dialled 999. Friday 6pm.
• Recent bout of Flu.
• Severe, heavy, central pain with radiation to
jaws and arms.
• Pale and sweaty.
• Lives 5 minutes from Raigmore Hospital.
17. What would you do?
Thrombolysis if no
contraindications
‘Scoop and Run’
18. In the early stages of STEMI each 1 minute delay
to thrombolysis reduces life expectancy by:
1 day
11 days
19. The 12-lead ECG in a patient with
Unstable Angina may appear
normal?
True
False
20. STEMI or not STEMI?
• 45 year old man with 3 days of chest pain.
• First aware of it while playing 5-a-side
football.
• Varying intensity over last 3 days but there
pretty much all of the time.
• Feels like a pulled muscle.
• No radiation.
• A bit pale but otherwise looks well.
23. Pericarditis
ECG changes:
• ST elevation
• Upward concavity
• Widespread
• Notching at end of QRS
• Not evolving
• No Q wave
• Pain often pleuritic in nature,
worse on inspiration.
28. Case study
• 32 year old man.
• No significant PMH. Smoker.
• Chest pain for about 8 hours.
• Dull central ache. No radiation.
• ECG #1 recorded - not transmitted to CCU.
36. Case study
• 59 year old lady.
• Hypertension and smoker.
• Ischaemic chest pain for 2 hours.
• Lives in isolated croft 2 hours from
Raigmore.
• Call made in January 2010.
• When Paramedics arrived 2 feet of snow
outside her house!
46. Case study
• 50 year old man from Aviemore
complaining of central chest pain.
• Feels like trapped wind.
• Diagnostic ECG machine querying
anterior MI.
47.
48. Anterior STEMI – advise
Thrombolysis.
Normal ECG – advise he
has a fart.
