An anterior STEMI is a heart attack in which the left anterior descending artery is fully blocked, so a large part of the front wall of the left ventricle starts to die. Every minute counts: the goal is to open the artery with PCI within 90 minutes of first medical contact.
Key symptoms
- Pressure or squeezing chest pain lasting more than 20 minutes
- Pain spreading to the left arm, neck or jaw
- Sweating, nausea and shortness of breath
- Lightheadedness or fainting
- Vague or no chest pain in some older adults, women and people with diabetes
What you find on exam
- Pale, sweaty, anxious patient
- Blood pressure in both arms and heart rate
- Signs of heart failure or shock: crackles, cold skin, low pressure
- New murmur that may mean a mechanical complication
- Third heart sound or raised jugular venous pressure
Tests
- 12-lead ECG within 10 minutes: ST elevation in V1 to V4
- Troponin, but do not wait for it to treat
- Blood count, electrolytes, kidney function, clotting tests
- Bedside echocardiogram for wall motion and complications
- Continuous cardiac monitoring for arrhythmias
Treatment basics
- Aspirin 162 to 325 mg chewed
- Primary PCI with a stent, or fibrinolysis if PCI cannot happen within 120 minutes
- Second antiplatelet (ticagrelor or clopidogrel) plus heparin
- Nitroglycerin for pain if blood pressure allows; oxygen only if saturation is below 90%
- Before discharge: high-intensity statin, beta blocker, ACE inhibitor and cardiac rehab
Red flags
- Ventricular tachycardia or fibrillation
- Low blood pressure, cold skin or confusion (cardiogenic shock)
- New loud murmur or sudden breathlessness after the attack
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Related guides
Sources: NCCPA PANCE Content Blueprint; NASEMSO National Model EMS Clinical Guidelines; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.