Cardiology · USMLE Step 1 and Step 2

STEMI song

STEMI - ECG Criteria & Post-MI Complications, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

STEMI

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Key points in this song10

STEMI is diagnosed by ≥1 mm ST elevation in ≥2 contiguous limb leads or ≥2 mm in ≥2 contiguous precordial leads, representing transmural myocardial infarction due to complete coronary artery occlusion.
The left anterior descending artery (LAD) supplies the anterior wall and septum; occlusion causes ST elevation in V1–V4 and is the most lethal STEMI, nicknamed "the widowmaker."
Right coronary artery (RCA) occlusion causes inferior STEMI with ST elevation in leads II, III, and aVF; always obtain right-sided leads (V4R) to rule out right ventricular infarction.
Right ventricular infarction complicating inferior STEMI presents with hypotension, elevated JVP, and clear lungs — treat with IV fluids and avoid nitrates and diuretics, which worsen preload-dependent state.
First-line reperfusion is primary PCI within 90 minutes of first medical contact (door-to-balloon time); fibrinolysis is used if PCI is unavailable within 120 minutes.
Fibrinolytics (e.g., tPA, tenecteplase) are contraindicated with prior intracranial hemorrhage, ischemic stroke within 3 months, active internal bleeding, or suspected aortic dissection.
Early STEMI complications include ventricular fibrillation (first 24 hours), free wall rupture (3–5 days), papillary muscle rupture causing acute mitral regurgitation (3–5 days), and VSD (3–5 days).
Ventricular free wall rupture presents with sudden cardiac tamponade (Beck's triad: hypotension, JVD, muffled heart sounds) and is diagnosed by echocardiography requiring emergent surgery.
Post-STEMI medical therapy includes dual antiplatelet therapy (aspirin + P2Y12 inhibitor), high-intensity statin, beta-blocker, ACE inhibitor, and aldosterone antagonist if EF ≤40% with heart failure or diabetes.
Dressler syndrome is an autoimmune pericarditis occurring 2–10 weeks post-MI, presenting with fever, pleuritic chest pain, and pericardial friction rub; treated with aspirin and NSAIDs.