Patient handout

STEMI in sickle cell disease (vaso-occlusive / microvascular)

PRODUCTION

1. Your condition

This handout is for stemi in sickle cell disease (vaso-occlusive / microvascular). Your care team identified this based on: known scd (hbss, hbsc, hbs-β-thal) presenting with chest pain → stemi/nstemi workup with voc + acs overlap consideration.

Other reasons your team may use this plan: st-elevation pattern on ecg in scd patient — emergent cath; expect microvascular pattern more often than obstructive plaque; vaso-occlusive crisis + chest pain + troponin elevation — overlaps with acs, acute chest syndrome, microvascular mi.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162-325 mg chewed	PO	load + 81 mg daily	AHA 2025 Class I; same as parent — proceed unless active bleed/hyperhemolysis
ticagrelor	180 mg load → 90 mg BID	PO	BID × 12 mo default DAPT	PLATO PMID 19717846; cautious if rhabdomyolysis from VOC + bleed risk elevated
heparin	70-100 U/kg IV bolus — REDUCE if hyperhemolysis or rhabdomyolysis	IV	bolus + infusion	AHA 2025 Class I; titrate cautiously given elevated bleed risk in active VOC
automated_red_cell_exchange_transfusion	target HbS <30% post-exchange	IV apheresis	single procedure ± repeat per HbS%	NHLBI 2014 + ASH 2020 — automated red cell exchange (not simple transfusion) for severe SCD complications including ACS/MI overlap; reverses microvascular occlusive substrate
morphine	0.1-0.15 mg/kg IV q3-4h or PCA	IV/PCA	q3-4h or continuous PCA	NHLBI 2014 + ASH 2020 — opioid pain control essential; PCA preferred; switch to hydromorphone if morphine intolerance
hydromorphone	0.015 mg/kg IV q3-4h or PCA	IV/PCA	q3-4h or continuous PCA	Alternative opioid; preferred in renal impairment vs morphine
atorvastatin	80 mg PO daily	PO	daily	PROVE-IT extrapolation; SCD endothelial dysfunction may benefit from statin pleiotropic effects
carvedilol	3.125 mg BID titrate	PO	BID	CAPRICORN PMID 11356436
hydroxyurea	15 mg/kg PO daily, titrate to MTD	PO	daily	NHLBI 2014 Class I — hydroxyurea for HbSS adults + recurrent VOC; MSH trial Charache PMID 7531569

Plan: SCD STEMI / vaso-occlusion phenotype — adds to parent cardio.stemi.core.v1 reperfusion regimen with SCD-specific exchange + hydration + pain control

3. When to call your provider

Contact your care team if any of the following happen:

Recurrent VOC despite triple-therapy → consider transplant evaluation
New cardiac symptoms → return for eval

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Vaso-occlusive crisis + troponin elevation — requires differentiation between true ACS, microvascular MI, demand ischemia, and acute chest syndrome
Need for full-dose anticoagulation post-PCI in patient with concurrent VOC + rhabdomyolysis (elevated bleed risk)
New CXR infiltrate + chest pain + hypoxia + fever in SCD patient with concurrent STEMI presentation — acute chest syndrome may be primary or co-morbid driver(life-threatening)
SCD patient with new neurologic symptoms during ACS workup — stroke risk elevated in SCD baseline + acute illness(life-threatening)

5. Follow-up

Cardiology + hematology dual follow-up; initiate or up-titrate hydroxyurea (NHLBI Class I); consider L-glutamine, voxelotor, crizanlizumab; transcranial Doppler stroke screen (children + repeat in adults); SCD specialty clinic enrollment

6. Sources

Guideline: 2025 ACC/AHA ACS Guideline + NHLBI 2014 SCD Expert Panel + ASH 2020 SCD Acute Complications Guideline