19 - Acute Myocardial Infarction

Question 1

Diagnostic criteria for MI

Answer 1

1) Rise and or fall of troponin
2) Ischaemia symptoms - chest pain
3) New ST segment or T wave change or new L BBB
4) Pathological Q waves on ECG
5) New loss of viable myocardium
6) Intracoronary thrombus by angiography

Question 2

What causes Troponin release

Answer 2

Leaked when cardiac myocytes die

Question 3

NSTEMI

Answer 3

• Ruptured coronary plaque with sub occlusive thrombus

- ECG non diagnostic

Question 4

STEMI

Answer 4

Ruptured coronary plaque with occlusive thrombus

- ECG is diagnostic

Question 5

Clinical manifestations of myocardial injury (

Answer 5

Chest pain
4th heart sound
Low grade fever
Troponin leak
Inflammatory markers

Question 6

Autonomic disturbances during AMI

Answer 6

Tachycardia
Sweating
Vomiting

Question 7

What percentage of MI patients die after 1 year

Answer 7

40%

Question 8

What do patients in hospital die of

Answer 8

LV damage
Pulmonary Oedema
Cardiogenic shock

Question 9

Treatment for STEMI

Answer 9

Reperfusion therapy = Primary PCI
Aspirin + ticagrelor
Heparin
PPCI

Question 10

Treatment for NSTEMI

Answer 10

Aspirin and ticagrelor, GP IIb/IIIa inhibitor
Fondaparinux (Xa inhibitor)
Anti-ischaemic drugs (BB, nitrates)
Angiography and/minus PCI within 24-96 hours

Question 11

Prevention lifestyle

Answer 11

Smoking
Diet
Exercise

Question 12

Prevention drugs

Answer 12

Aspiring, tricagrelor, statin,BB, ACEI

Question 13

Prevention devices

Answer 13

ICD (Implantable Cardioverter Defibrillator)

Question 14

What percentage of patients with AMI are smokers

Answer 14

20%

Question 15

The 4 steps when someone comes in with a MI

Answer 15

1) Relieve pain w/morphine
2) Defibrillator
3) Reperfusion therapy
4) Implantable defibrillator