156. Time is Tissue - An Approach to STEMI

ST elevation myocardial infarction (STEMI) represents a critical clinical emergency requiring rapid recognition and intervention to minimize permanent tissue damage. The pathophysiology involves the rupture of an unstable lipid plaque, triggering a coagulation cascade that results in transmural ischemia. Diagnosis relies on identifying characteristic ECG changes, such as ST elevation in contiguous leads, alongside cardiac biomarker analysis. Management prioritizes immediate reperfusion via percutaneous coronary intervention (PCI) or fibrinolytic therapy, ideally within 90 to 120 minutes of first medical contact. Clinical assessment must account for potential complications like cardiogenic shock or right ventricular infarction, the latter of which contraindicates standard nitroglycerin use. Secondary prevention, including dual anti-platelet therapy, beta-blockers, and lifestyle modifications, remains essential for long-term recovery and reducing mortality risk following the acute event.