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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
Platelet aggregation can cause complete ___ of a coronary / cartoid artery, resulting in \_\_\_/\_\_\_.
**occlusion** **MI / stroke**
26
Platelet aggregation causes which type of myocardial infarction?
**ST-elevated myocardial infarction**
27
Tissue downstream from an infarcted artery will \_\_.
**die**
28
What happens in tissue which is infarcted?
**Death, fibrosis**
29
Infarction of myocardium reduces its ___ potential and the amount of blood it can pump. In time, this results in ___ failure, particularly ___ ventricular failure.
**contractile** **cardiac** **left**
30
Which kind of breathlessness occurs in people who have suffered MIs?
**Orthopnea**
31
What symptoms of an STEMI may a patient present with?
**Severe crushing central chest pain** **Radiating to jaw and arms (left)** **Worse than angina, not relieved by GTN** **Sweating, nausea and vomiting**
32
Patients may use characteristic ___ to describe their severe, crushing central chest pain.
**gestures**
33
Not all chest pain can be attributed to ___ problems.
**cardiac**
34
What tool can be used to diagnose myocardial infarction?
**Electrocardiogram (ECG)**
35
What ECG changes may you see in an STEMI?
**ST elevation** (early infarct) **T wave inversion** and **Q waves**
36
What does a cardiologist mean when they refer to the "ST elevation" of an ECG?
**\>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
How can you tell, from an ECG, that someone is having an MI?
ST elevation
38
What are the **inferior** leads on an ECG?
II, III and aVF
39
What are the **anterior** leads of an ECG?
**V2, V3, V4**
40
What are the **septal** leads of an ECG?
**V1 - V3**
41
What are the **lateral** leads of an ECG?
**V1, V5** , **V6 **and **aVL**
42
What else can be tentatively used to diagnose STEMI?
**Cardiac enzymes** and **protein markers**
43
Which protein is used as a marker in STEMI?
**Troponin**
44
What drugs are used to treat STEMI? Why?
**Asprin** and **clopidogrel** (block platelet receptors)
45
According to the SIGN guidelines, what should patients be treated with for **acute coronary syndrome**?
**300mg aspirin**
46
According to the SIGN guidelines, if a patient is definitely having a STEMI (elevated ST, elevation of markers) what should they be prescribed with?
**300mg aspirin** **AND** **300mg clopidogrel**
47
The longer a coronary artery is occluded, the more __ that will be lost.
**muscle**
48
Which class of drug is used to break up thrombus and restore patency to occluded arteries?
**Thrombolytic drugs**
49
In which case should **reperfusion therapy** (thrombolysis or PCI) be attempted?
**Chest pain** suggestion of AMI for more than 20 mins ECG changes **- ST elevation** / NEW **left branch block**
50
Thrombolysis may be administered by ___ pre-hospital admission.
**paramedics**
51
What are the risks of **thrombolytic therapy?**
**HAEMORRHAGE** (worse cause, intracranial i.e stroke)
52
What is the probability of reopening a vessel using thrombolysis?
**50%**
53
\_\_\_ is probably a quicker and safer way of reopening occluded blood vessels, compared to thrombolysis.
**Angioplasty**
54
The longer a STEMI patient is left before receiving PCI, the ___ their prognosis is.
**poorer**
55
What is used in the early treatment of STEMI?
**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
What are some important **complications** of acute myocardial infarction?
**Death** **Arrhythmia** **Structural complications**
57
Name a **arrythmic complication** of acute MI.
**Ventricular fibrillation** causes loss of cardiac output and death.
58
\_\_\_ ___ causes cardiac output to fall to zero, the patient to lose consciousness and eventually, death.
**Ventricular fibrillation**
59
What, in the context of an MI, causes ventricular fibrillation?
**Infarction of cardiac muscle**
60
What intervention is used to correct ventricular fibrillation and restore normal sinus rhythm?
**Defibrillation**
61
Give some examples of **structural complications** of an MI.
**Cardiac rupture** **Ventricular septal defects** **Mitral valve regurgitation**
62
Mitral regurgitation often presents alongside **acute ___ \_\_\_.**
**pulmonary oedema**
63
What is a rare autoimmune condition causing long-term pain after an MI?
**Dressler's syndrome**
64
What are two **functional complications** of an MI?
**Cardiac failure** **Cardiogenic shock**
65
What is monitored in MI patients after the event itself?
**Rhythm** **Pulse and blood pressure** **Heart sounds** (v.s defects & mitral regurgitation) **Murmurs, crepitations** - signs of cardiac failure
66
A NSTEMI is still dangerous compared to __ angina.
**stable**
67
In an NSTEMI, platelet activation still occurs but acute ___ of the vessel does not occur.
**occlusion**
68
In an NSTEMI, ___ thrombolysis breaks up the clot before it occludes the blood vessel.
**intravascular**
69
What ECG changes are seen in an **NSTEMI?**
ST segment depression T wave inversion **THE ECG MAY BE NORMAL**
70
What is important to remember about ECG changes in the context of an NSTEMI?
The ECG may be **normal**
71
Troponins are a good way of predicting MIs. Why do they appear in the blood?
**Embolisation of plaques and myonecrosis downstream**
72
What are troponins used to identify?
**Myocyte damage**
73
It is important to treat troponins with caution as they are present in many other ___ diseases.
**cardiac**
74
The inhibition of which factor is important in preventing coagulation of blood, preventing NSTEMI --\> STEMI?
**Factor X**
75
Which drugs prevent the activation of Factor X?
**LMWH,** fondaparinux
76
What are some other anti-platelet drugs stemming from clopidogrel?
**Ticagrelor** **Prasugrel**
77
Glycoproteins II & IIIa facilitate binding of ___ which leads to platelet aggregation.
**vWF**
78
Drugs inhibiting which proteins, found on the surface of platelets, can be used to prevent platelet aggregation and clotting?
**Glycoproteins II** & **IIIa**
79
On an angiogram, a coronary of an NSTEMI patient would not be totally occluded, rather highly \_\_\_.
**stenosed**
80
What can be fitted to improve the patency and blood flow of a vessel in a patient with **NSTEMI?**
Stent
81
If anti-platelet drugs aren't used for a period of time in patients with a stent, what can form?
**In-stent thrombosis** - really bad
82
Giving the patient important ___ is essential before they are discharged.
**information**

Cardiovascular Week 5 2016/17 (5 decks)

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