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Cardiovascular Week 5 2016/17 > 1: Acute myocardial infarction > Flashcards

1: Acute myocardial infarction Flashcards

1
Q

A myocardial infarction is colloquially known as a…

A

heart attack.

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2
Q

Normal coronary arteries have ___ walls and a large ___ for blood to travel through.

A

smooth , lumen

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3
Q

Name some modifiable risk factors which accelerate the degenerative process in coronary arteries.

A

Smoking

Obesity (–> diabetes mellitus)

Hypertension

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4
Q

In atherosclerosis, the lumen of blood vessels is narrowed by ___.

A

plaque

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5
Q

The process underlying the narrowing of lumen is…

A

atherosclerosis.

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6
Q

Chronic stable angina is characterised by:

___ stenosis

___-led ischaemia

It is (predictable / unpredictable)and relatively(safe / unsafe).

A

fixed stenosis

demand-led ischaemia

predictable

safe

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7
Q

What should patients with chronic stable angina do when they suffer pain?

A

Stop and sit down (reduces oxygen requirement of heart muscle)

Use GTN spray (reduces blood pressure, vasodilates and improves coronary perfusion)

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8
Q

What are some characteristics of cardiac chest pain?

A

Heavy feeling

Weight on the chest

Pressure, tightness

Affects left breastbone and radiates down left arm from neck & shoulder

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9
Q

Why do people suffer cardiac chest pain after having a meal?

A

Coronary blood flow decreases as intestines require more blood flow to help absorb food

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10
Q

Inferior infarctions may present as pain in the ___ and ___.

A

epigastrium , back

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11
Q

What is acute coronary syndrome?

A

An acute presentation of coronary artery disease

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12
Q

What are some diseases contained within acute coronary syndrome?

A

Unstable angina

Myocardial infarction (ST elevated and NSTEMI)

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13
Q

What do STEMI and NSTEMI stand for?

A

ST elevated myocardial infarction

Non-ST elevated ““

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14
Q

Which event in the arteries usually associates with acute coronary syndromes (unstable angina, MI, sudden death)?

A

Plaque rupture

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15
Q

Acute coronary syndrome is characterised by:

___ stenosis

___-led ischaemia

It is (predictable/unpredictable) and (safe/dangeous).

A

Dynamic stenosis

Supply-led ischaemia

Unpredictable

Dangerous

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16
Q

What are some factors affecting plaque rupture / fissure?

A

Lipid content of plaque

THICKNESS of the fibrous cap

Changes in blood pressure

Mechanical injury

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17
Q

An example of a percutaneous coronary intervention which may cause plaque rupture is __ fitting.

A

stent

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18
Q

Endothelial damage reveals __ and __ on the surface of blood vessels.

A

collagen , vWF

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19
Q

Which component of the blood activates and seals endothelial damage?

A

Platelets

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20
Q

Activated platelets tend to clump and ___ together.

A

stick

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21
Q

Which chemicals, released by activated platelets, bind to surface receptors on other platelets to encourage clumping and the platelet cascade?

A

ADP
Thromboxane A2

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22
Q

Activated platelets also trigger the process ___.

A

inflammation

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23
Q

Thrombi are rich in a protein called ___.

A

fibrin

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24
Q

Platelet clumps (increase / reduce) the lumenal radius of blood vessels and thus (increase / reduce) blood flow downstream.

A

reduce

reduce

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25
Q

Platelet aggregation can cause complete ___ of a coronary / cartoid artery, resulting in ___/___.

A

occlusion

MI / stroke

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26
Q

Platelet aggregation causes which type of myocardial infarction?

A

ST-elevated myocardial infarction

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27
Q

Tissue downstream from an infarcted artery will __.

A

die

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28
Q

What happens in tissue which is infarcted?

A

Death, fibrosis

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29
Q

Infarction of myocardium reduces its ___ potential and the amount of blood it can pump. In time, this results in ___ failure, particularly ___ ventricular failure.

A

contractile

cardiac

left

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30
Q

Which kind of breathlessness occurs in people who have suffered MIs?

A

Orthopnea

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31
Q

What symptoms of an STEMI may a patient present with?

A

Severe crushing central chest pain

Radiating to jaw and arms (left)

Worse than angina, not relieved by GTN

Sweating, nausea and vomiting

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32
Q

Patients may use characteristic ___ to describe their severe, crushing central chest pain.

A

gestures

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33
Q

Not all chest pain can be attributed to ___ problems.

A

cardiac

34
Q

What tool can be used to diagnose myocardial infarction?

A

Electrocardiogram (ECG)

35
Q

What ECG changes may you see in an STEMI?

A

ST elevation (early infarct)

T wave inversion and Q waves

36
Q

What does a cardiologist mean when they refer to the “ST elevation” of an ECG?

A

>1mm ST elevation in 2 adjacent limb leads

or

>2mm ST elevation in contiguous precordial leads (e.g V1 to V2)

New onset left bundle branch block

37
Q

How can you tell, from an ECG, that someone is having an MI?

A

ST elevation

38
Q

What are the inferior leads on an ECG?

A

II, III and aVF

39
Q

What are the anterior leads of an ECG?

A

V2, V3, V4

40
Q

What are the septal leads of an ECG?

A

V1 - V3

41
Q

What are the lateral leads of an ECG?

A

V1, V5 , V6 and aVL

42
Q

What else can be tentatively used to diagnose STEMI?

A

Cardiac enzymes and protein markers

43
Q

Which protein is used as a marker in STEMI?

A

Troponin

44
Q

What drugs are used to treat STEMI? Why?

A

Asprin and clopidogrel (block platelet receptors)

45
Q

According to the SIGN guidelines, what should patients be treated with for acute coronary syndrome?

A

300mg aspirin

46
Q

According to the SIGN guidelines, if a patient is definitely having a STEMI (elevated ST, elevation of markers) what should they be prescribed with?

A

300mg aspirin

AND

300mg clopidogrel

47
Q

The longer a coronary artery is occluded, the more __ that will be lost.

A

muscle

48
Q

Which class of drug is used to break up thrombus and restore patency to occluded arteries?

A

Thrombolytic drugs

49
Q

In which case should reperfusion therapy (thrombolysis or PCI) be attempted?

A

Chest pain suggestion of AMI for more than 20 mins

ECG changes - ST elevation / NEW left branch block

50
Q

Thrombolysis may be administered by ___ pre-hospital admission.

A

paramedics

51
Q

What are the risks of thrombolytic therapy?

A

HAEMORRHAGE (worse cause, intracranial i.e stroke)

52
Q

What is the probability of reopening a vessel using thrombolysis?

A

50%

53
Q

___ is probably a quicker and safer way of reopening occluded blood vessels, compared to thrombolysis.

A

Angioplasty

54
Q

The longer a STEMI patient is left before receiving PCI, the ___ their prognosis is.

A

poorer

55
Q

What is used in the early treatment of STEMI?

A

Analgesia e.g morphine IV - also reduces BP and heart rate

Anti-emetics - for nausea

Aspirin 300mg and clopidogrel 300mg

GTN is BP > 90mmHg

Oxygen if hypoxic

Primary angioplasty OR Thrombolysis depending on journey time

56
Q

What are some important complications of acute myocardial infarction?

A

Death

Arrhythmia

Structural complications

57
Q

Name a arrythmic complication of acute MI.

A

Ventricular fibrillation

causes loss of cardiac output and death.

58
Q

___ ___ causes cardiac output to fall to zero, the patient to lose consciousness and eventually, death.

A

Ventricular fibrillation

59
Q

What, in the context of an MI, causes ventricular fibrillation?

A

Infarction of cardiac muscle

60
Q

What intervention is used to correct ventricular fibrillation and restore normal sinus rhythm?

A

Defibrillation

61
Q

Give some examples of structural complications of an MI.

A

Cardiac rupture

Ventricular septal defects

Mitral valve regurgitation

62
Q

Mitral regurgitation often presents alongside acute ___ ___.

A

pulmonary oedema

63
Q

What is a rare autoimmune condition causing long-term pain after an MI?

A

Dressler’s syndrome

64
Q

What are two functional complications of an MI?

A

Cardiac failure

Cardiogenic shock

65
Q

What is monitored in MI patients after the event itself?

A

Rhythm

Pulse and blood pressure

Heart sounds (v.s defects & mitral regurgitation)

Murmurs, crepitations - signs of cardiac failure

66
Q

A NSTEMI is still dangerous compared to __ angina.

A

stable

67
Q

In an NSTEMI, platelet activation still occurs but acute ___ of the vessel does not occur.

A

occlusion

68
Q

In an NSTEMI, ___ thrombolysis breaks up the clot before it occludes the blood vessel.

A

intravascular

69
Q

What ECG changes are seen in an NSTEMI?

A

ST segment depression

T wave inversion

THE ECG MAY BE NORMAL

70
Q

What is important to remember about ECG changes in the context of an NSTEMI?

A

The ECG may be normal

71
Q

Troponins are a good way of predicting MIs. Why do they appear in the blood?

A

Embolisation of plaques and myonecrosis downstream

72
Q

What are troponins used to identify?

A

Myocyte damage

73
Q

It is important to treat troponins with caution as they are present in many other ___ diseases.

A

cardiac

74
Q

The inhibition of which factor is important in preventing coagulation of blood, preventing NSTEMI –> STEMI?

A

Factor X

75
Q

Which drugs prevent the activation of Factor X?

A

LMWH, fondaparinux

76
Q

What are some other anti-platelet drugs stemming from clopidogrel?

A

Ticagrelor

Prasugrel

77
Q

Glycoproteins II & IIIa facilitate binding of ___ which leads to platelet aggregation.

A

vWF

78
Q

Drugs inhibiting which proteins, found on the surface of platelets, can be used to prevent platelet aggregation and clotting?

A

Glycoproteins II & IIIa

79
Q

On an angiogram, a coronary of an NSTEMI patient would not be totally occluded, rather highly ___.

A

stenosed

80
Q

What can be fitted to improve the patency and blood flow of a vessel in a patient with NSTEMI?

A

Stent

81
Q

If anti-platelet drugs aren’t used for a period of time in patients with a stent, what can form?

A

In-stent thrombosis - really bad

82
Q

Giving the patient important ___ is essential before they are discharged.

A

information

Cardiovascular Week 5 2016/17 (5 decks)

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