Clinical Scenario
STEMI pathway & door-to-balloon
VIGNETTE
- A 62-year-old smoker presents with crushing central chest pain for 40 minutes.
- ECG shows 3 mm ST elevation V2–V4 with reciprocal change.
IMMEDIATE
- A–E, IV access ×2, continuous monitoring, defibrillator at bedside.
- Aspirin 300 mg PO, ticagrelor 180 mg PO (or prasugrel/clopidogrel per local pathway), morphine 5 mg IV + antiemetic, oxygen only if SpO2 <94%.
- GTN if SBP >100 and no inferior STEMI.
PATHWAY
- Activate PPCI immediately. Target door-to-balloon <90 minutes
- FMC-to-balloon <120 minutes. If PPCI not deliverable within 120 minutes, thrombolyse (tenecteplase) and transfer for rescue PCI.
POST-PCI
- Dual antiplatelet 12 months, high-intensity statin, beta-blocker, ACEi, aldosterone antagonist if EF <40% with HF/diabetes.
- Echo 24–48 h.
- Cardiac rehab referral, smoking cessation, secondary prevention.
- DVLA notify (private 1 wk, HGV 6 wk).
COMPLICATIONS
- Arrhythmia, cardiogenic shock, mechanical (VSD, papillary muscle rupture, free-wall rupture, mural thrombus), pericarditis (Dressler's).
- Have a low threshold for re-imaging on deterioration.