What is the diagnosis and management for a patient with acute inferior STEMI (ST-elevation myocardial infarction) presenting with chest pain and diaphoresis (profuse sweating)?

From the Guidelines

The diagnosis for a patient with acute inferior STEMI presenting with chest pain and diaphoresis is confirmed by an electrocardiogram (ECG) showing ST-elevation in the inferior leads, and the management involves immediate reperfusion therapy, preferably primary percutaneous coronary intervention (PCI), if available within 90 minutes of first medical contact (FMC) 1.

Key Management Points

• Reperfusion therapy should be administered to all eligible patients with STEMI within 12 hours of symptom onset, with primary PCI being the preferred method when it can be performed in a timely fashion by experienced operators 1.
• Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration, and also in those with contraindications to fibrinolytic therapy, cardiogenic shock, or acute severe heart failure, irrespective of the time delay from FMC 1.
• If primary PCI cannot be performed within 120 minutes of FMC, fibrinolytic therapy should be administered to patients with STEMI, in the absence of contraindications, with an anticipated FMC-to-device time exceeding 120 minutes 1.
• Adenosine diphosphate receptor antagonists and unfractionated heparin (UFH) can be given either prehospital or in-hospital for suspected STEMI patients with a planned primary PCI approach 1.

Important Considerations

• The choice between primary PCI and fibrinolytic therapy should be individualized based on time from symptom onset, anticipated time to PCI, relative contraindications to fibrinolysis, and other patient factors 1.
• Prehospital activation of the catheterization laboratory can reduce treatment delays and improve patient mortality in STEMI patients 1.

From the Research

Diagnosis of Acute Inferior STEMI

• The diagnosis of acute inferior STEMI is typically made using a 12-lead electrocardiogram (ECG) which shows ST-segment elevation in the inferior leads [(2,3,4)].
• A thorough evaluation of the patient's history, physical examination, and cardiac biomarkers is also necessary for accurate diagnosis 5.
• It is essential to consider other potential diagnoses, such as type A aortic dissection, which can present with similar symptoms and ECG findings 3.

Management of Acute Inferior STEMI

• Primary percutaneous coronary intervention (PPCI) is the preferred treatment for patients with STEMI, and should be performed within 120 minutes of first medical contact [(2,6)].
• Thrombolysis is also a treatment option, although PPCI is generally preferred if available [(6,5)].
• The management of patients with STEMI requires a timely and coordinated approach, involving emergency medical services, emergency department staff, and cardiologists [(2,6,5)].
• It is crucial to recognize atypical ECG patterns, known as "STEMI equivalents," which may require urgent primary percutaneous coronary intervention 4.

Considerations for Patients with Acute Inferior STEMI

• Patients with acute inferior STEMI may present with chest pain and diaphoresis, and require prompt evaluation and treatment 3.
• The presence of other symptoms, such as shortness of breath or palpitations, should be evaluated and considered in the diagnosis and management of the patient 5.
• The use of prehospital biomarker measurement and other diagnostic methods may help to rapidly diagnose and manage patients with STEMI 2.
• A detailed history taking and focused physical examination are essential to avoid misdiagnosis and ensure timely treatment 3.