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Lucy Knox - Year 2 > 206 - MI > Flashcards

206 - MI Flashcards

1
Q

What part of the heart do leads II, III, aVF show?

A

Inferior surface

Mainly L ventrical

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2
Q

What part of the heart do leads I and aVL show?

A

Lateral wall

  • L Ventrical
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3
Q

What part of the heart do leads V1- V6 show?

A

Anteroseptal - lateral surface

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4
Q

What part of the heart do V1 and V2 show?

A

Anteroseptal

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5
Q

What part of the heart do V3 and V4 show?

A

Apex / anterior inferior surface

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6
Q

What part of the heart do V5 and V6 show?

A

Lateral wall

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7
Q

What does this ECG show?

A

Inferior STEMI (II, III, aVF)

with reciprical changes

eg. R coronary artery occlusion

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8
Q

What does this ECG show?

A

STEMI - V1, V2, V3, V4

Inverted T wave -> hours post MI

eg. L anterior decending artery

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9
Q

What does this ECG show?

A

STEMI II, III, aVF

Inferior leads

? V2 in mirror -> ? posterior infarct too

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10
Q

What does this ECG show?

A

Atrial Fibrillation

+ Tenting of T waves V2, V3

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11
Q

What does this ECG show?

A

STEMI - V2, V3, V4

+ Pathological Q waves in V2, V3, shows heart attack days ago, so if not in pain no intervention, he has had and survived MI.

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12
Q

What does this ECG show?

A

Tombstoning - STEMI V2, V3

Large anterior MI

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13
Q

What does this ECG show?

A

nSTEMI

ST depression in V2, V3, V4, V5, V6

Medical mamagement

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14
Q

This ECG is of a young, fit person with a fever. What could it show?

A

ST elevation V2-V6

Acute pericarditis

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15
Q

What is the difference between ischaemia and infarction?

A

Ischaemia - Reversible, no harm done

Infarction - irreversible, cell death, troponin release

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16
Q

What 3 things are used to diagnose an MI?

A

Myocardial pain

ECG alteration

Troponin T levels

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17
Q

What signs can be seen in an MI?

A

Sweating, anxiety, pale, high HR, high BP

or sometimes excessive parasympathetic tone - bradycardia, low BP, nausea, belching

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18
Q

What signs could suggest a severe MI?

A

Impaired LV function - crackles in lung, murmur - 3rd heart sound

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19
Q

There are many differentials for chest pain, what are some?

A

Resp - PE, pneumothorax, plurisy

MSK - chostochondritis, fracture, nerve compression

GI - Oseophagitis, spasm , rupture

Vascular - Aortic dissection

Cardiac - Angina, Pericarditis

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20
Q

What may you see on an ECG of a suspected MI?

A

Dynamic ST segment change

Evidence of previous MI (Q wave, ST depression)

Arrythmias

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21
Q

Describe the dynamic ST changes you may see in an MI

A

1st - loss of clear ST segment

2nd - ST elevation

3rd - development of Q waves

4th - ST depression - later stage/incomplete occlusion

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22
Q

Why are troponin levels used?

A

A marker for myocardial damage

  • higher trop = bigger infarct
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23
Q

What are the limiting factors of using troponin?

A

Might not elevate until 4-6hrs after MI

Highest levels 1 day later - so retrospective diagnosis?

Not cardiac specific:

renal dysfunction

PE

Arrythmias

Hypertensive crisis

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24
Q

What is the immediate management of an MI?

A

MONAC

Morphine

O2

Nitrates

Aspirin

Clopidogrel

25
How can coronary blood flow be restored post MI?
STEMI - reperfusion therapy - PCI (primary angioplasty) or Throbolytic therapy Nitrates Elective angioplasty/CABG
26
What are the MI5 drugs given post MI?
Aspirin Clopidogrel Beta Blocker - metoprolol ACE inhibitor - ramipril Statin - atorvostatin
27
Platelet activation involves many pathways - name 5 things/molecules that initiate platelet activation
ADP Thrombin Collagen Adrenaline Thomboxane
28
How does Aspirin work as an antiplatelet?
Permenant acylation of COX in platelets which stops thromboxane A2 synthesis - reduced activation
29
How does clopidogrel work as an antiplatelet?
Irreversible blocks ADP receptor - inhibits ADP dependant activation
30
Why does clopidogrel not work in all people?
It is a prodrug, needs cytrochrome P-450 to work Genetic deficiencies exist
31
How does presugrel work as a antiplatelet?
Similar to clopidogrel - blocks ADP receptor Stronger effect - more prolonged Higher risk of bleeding needs hepatic activation
32
How does ticagrelor work as an antiplatelet?
Similar to clopidogrel Reversibly blocks ADP receptor Not a prodrug No higher bleeding risk - good
33
How does dipyridomole work as an antiplatelet?
Reversibly binds to platelet phosphodiesterase - so increases cAMP concentration - reduced activity
34
What 3 antiplatelets act directly on the fibrinogen/CPIIbIIIa receptor?
Abciximab (Reo-pro) Eptitibratide Tirofiban
35
What is an atheroma?
Degredation of walls of the arteries due to formation of fatty plaques and scar tissue - predisposes the artery to thrombosis
36
Where do atheromas usually form?
Elastic arteries - large and medium sized - not in veins (too low presure)
37
Describe the structure of a atheromatous plaque
Cap - connective tissue, lots of collagen and preoteoglycans, fibronectin and elastic fibres Core - made up of extracellular lipid and macrophages, smooth muscle cells, T lymphocytes and dendritic cells
38
What thrombogenic substances are found in an atheromatous plaque?
Fibrin and platelets
39
The hallmark of atheromatous disease is .........?
Endothelial dysfunction
40
What do the endothelial cells of a plaque produce?
Nitric oxide - has anti-atherogenic actions - inhibits WBC adhesion - promotes macrophage apoptosis - inhibits lipid oxidation
41
What do the inflammatory cells in a plaque produce?
Cytokines Growth factors Metalloprotienases
42
What do vascular smooth muscle cells in a plaque produce?
Proteinases growth factors collagen elastin - their role becomes reparative rather than contractile
43
What occurs when an atheromatous plaque ruptures?
The subendothelial collahen is exposed This activates a coagulation cascade via intrinsic and extrinic pathways Cross linking of platelets by fibrin Plaque englarges, can cause thrombosis...
44
As what do lipids and cholesterol travel in the blood as?
Lipoprotein
45
What influences a lipoproeitns role in metabolism?
The density of lipid and proetin making it up
46
What are chylomicrons?
How FA and cholesterol are carried from the SI and absorbed into the lymphatics
47
Where are FAs aborbed into as they enter the blood stream from the lymphatics
Muscles fat cells Liver
48
In the liver, unburnt food metabolites (FA + cholesterol) are converted into what substances?
VLDL - IDL + LDL HDL
49
What are VLDLs and what happens to them?
Very Low density lipoproteins Secreted into plasma Then converted into IDL - intermediate density and LDL + fatty acids - Low density These are then absorbed into body tissues
50
What are HDLs and what happens to them?
High density lipoproteins Transport cholesterol back to the liver for excretion
51
Which type of lipoprotein is seen as good?
HDL In health - high levels of HDL In atheromatous disease - Low levels seen
52
Which type of lipoprotein is seen as Bad cholesterol?
LDL In atheroma you get many small, dense LDL particles in arteries - sdLDL
53
What is the role of cholesterol in the body?
Needed for membranes and source of steroid hormones BUT if high levels - plaque formation and growth - atheroscleroisis
54
What is hyperlipideamia?
High lipid levels in the blood
55
What in high levels leads to a high level of triglyceride?
Chylomicrons or VLDL
56
What in high levels leads to an increase in cholesterol in the blood
LDL/IDL
57
What classification can be used to measure hyperlipidaemia?
Fredrickson classification Used to use: Average overnight serum
58
What is high in FH: Familial hypercholesterolaemia?
High LDL levels But triglyceride levels normal

Lucy Knox - Year 2 (17 decks)

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