ST-Elevation Myocardial Infarction

Myocardial infarction is a relatively common clinical scenario where timely treatment is of great importance.  There are well established protocols and therapeutic systems in place.  Your team should be drilled in this scenario.

(Print off  the following PDF checklists to optimise timely clinical management.)

DIAGNOSTIC CRITERIA ST-Elevation Myocardial Infarction

  1. Symptoms of AMI: chest pain +/- diaphoresis, dyspnea, syncope, pallor
    • at least 15 minutes duration
    • less than 12 hours duration (greater benefit in first 6 hours)
    • after 12 hours – discuss with Cardiologist for further risk assessment
  2. ST-segment elevation in 2 or more contiguous leads
    • > 1 mm elevation in adjacent leads
    • consider posterior infarction or right-sided leads
  3. OR  a LEFT Bundle branch block that is not known to be pre-existing 



  1. Cerebrovascular disease
    1. Any previous haemorrhagic CVA
    2. Ischemic / thrombotic CVA within the past 1 year
    3. Known intracranial aneurysm or AV malformation
  2. Intracranial neoplasm
  3. Intracranial or spinal surgery
  4. Active bleeding: trauma, GI bleeding.  (NOT menses)
  5. Suspected aortic dissection


  1. Uncontrolled hypertension  of > 180/110
  2. Use of anticoagulants with INR > 2
  3. Known bleeding diathesis
  4. Recent (previous 2 -4 weeks)
    1. trauma
    2. major surgery
    3. prolonged CPR > 10 minutes
  5. Pregnancy – including 6 weeks post-partum
  6. Recent internal bleeding
  7. Non-compressible vascular puncture sites


Thrombolysis Administration Protocol

We currently use tenecteplase as our thrombolytic agent.  The treatment algorithm is relatively straightforward.  Print off the  following document as a checklist to guide the team through the process.

Tenecteplase checklist (Printable PDF)

The rate limiting steps are:

  • Contacting the on-call Cardiologist for review of the ECGs
  • the preparation of the tenecteplase (& other medications) and
  • moving the patient to an appropriate Resus area.

** These tasks should be prioritized and delegated by the team leader as soon as an STEMI is identified in order to minimise the “door-needle time”.



A BEGINNER’S  GUIDE TO STEMI THROMBOLYSIS:  A nice case discussion and run through the practicalities of thrombolysis from Dr Chris Creswell ( )  this post includes images and a 10 minute audio podcast discussing the use of tenecteplase for STEMI.

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