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3: MED1 Y3 - Cardiovascular [2] > [21] Myocardial Infarction Part 2 > Flashcards

[21] Myocardial Infarction Part 2 Flashcards

1
Q

my internet is slow so easier to do it on the normal editor, if you start this deck just ask me to merge them first cus i will do eventualy and otherwise you’ll loose your mastery

A

ok

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2
Q

What is meant by primary PCI?

A

It is the term used for the emergency treatment of a STEMI, where coronary angioplasty is performed in order to widen the coronary artery

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3
Q

Why is primary PCI practically challenging?

A

Because it is a potentially complex procedure that requires specialist staff and equipment that not all hospitals have

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4
Q

What needs to be done first to assess suitability for PCI?

A

Coronary angiography

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5
Q

How is coronary angioplasty performed?

A

A balloon catheter is inserted into a large artery in the groin or arm, and passed up to the heart using X-ray guidance. Once the narrowed section of coronary artery is reached, the balloon is inflated to widen it, and a stent is inserted into the artery to maintain patency

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6
Q

How can acute thromboembolic disease be treated in selected patients?

A

With administration of agents that activate the conversion of plasminogen to plasmin

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7
Q

What is plasmin?

A

A serine protease that hydrolyses fibrin, and therefore dissolves clots

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8
Q

Give three examples of fibrinolytics

A

Streptokinase
Alteplase
Reteplase

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9
Q

Which fibrinolytic is most likely to cause bleeding problems?

A

Streptokinase

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10
Q

Why is streptokinase likely to cause bleeding problems?

A

It causes a systemic fibrinolytic state which can cause bleeding problems, whereas alteplase acts more locally on the thrombotic fibrin to produce fibrinolysis

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11
Q

What is the problem with fibrinolytic therapy in STEMI?

A

It is unsuccessful in about 20% of infarcted arteries, about about 15% of arteries that are opened will close again

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12
Q

What is the result of fibrinolytic therapy being a bit rubbish?

A

In an MI, they are reserved for use when angioplasty is not an option

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13
Q

What can be given if patients are at increased risk of recurrent heart attacks?

A

They can also be given glycoprotein IIb/IIIa inhibitors

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14
Q

What do glycoprotein IIb/IIIa inhibitors do?

A

They don’t break up clots, but prevent clots from getting bigger, so stop worsening of symptoms

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15
Q

Why is alteplase said to be fibrin selective?

A

It has a low affinity for free plasminogen in the plasma, but it rapidly inactivates plasminogen that is bound to fibrin in a thrombus or haemostatic plug

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16
Q

Why is streptokinase not fibrin selective?

A

Because it acts on free plasminogen and induces a general fibrinolytic state

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17
Q

How does reteplase compare to alteplase?

A

It is similar to alteplase, but has a different half life and a lower affinity for fibrin binding, improving its ability to penetrate into clots

18
Q

What is the major side effect of fibrinolytics?

A

Haemorrhage

19
Q

What can haemorrhage in fibrinolytics?

A

Previously clinically silent lesions, e.g. peptic ulcer

20
Q

What are the contraindications to fibrinolytics?

A 
Pregnancy
Healing wounds
History of cerebrovascular accident
Brain tumour
Head trauma
Intracranial bleeding
Metastatic cancer
21
Q

What is the most reliable method of administration of fibrinolytics for myocardial infarction?

A

Intracoronary delivery

22
Q

What is the problem with intracoronary delivery of fibrinolytics in MI?

A

Cardiac catheterisation may not be possible in the 2-6 hour ‘therapeutic window’

23
Q

How are fibrinolytics usually administered in MI?

A

IV

24
Q

What is the advantage of IV administration of fibrinolytics in MI?

A

Rapid
Inexpensive
Does not carry risks of catheterisation

25
Q

What is the half life of alteplase?

A

5-30 minutes

26
Q

What is the half life of reteplase?

A

13-16 minutes

27
Q

What information should be provided to people after they’ve had a STEMI?

A

Lipid modification and statin therapy
Prevention, diagnosis, and management of diabetes
Prevention, diagnosis, and management of high blood pressure
Smoking cessation
Diet, weight management, and exercise

28
Q

What should anyone who has had an MI be offered?

A

A cardiological assessment to consider whether coronary revasculariation is appropriate

29
Q

What needs to be taken into account when assessing if coronary revascularisation is appropriate?

A

Co-morbidities

30
Q

What does CABG involve?

A

Taking a blood vessel from somewhere else i the body and using it as a graft to bypass any hardened or narrowed arteries in the heart. One end of the vessel is attached to the aorta, and the other to a coronary artery beyond the blockage

31
Q

What vessels can be used in CABG?

A

Internal mammary artery
Radial artery
Saphenous vein

32
Q

When may a CABG be performed?

A

When coronary angioplasty is not suitable

33
Q

When might coronary angioplasty not be possible?

A

Due to the anatomy of a patients arteries - if there are too many narrowed sections, or if there are lots of branches coming off the arteries

34
Q

What medications should all patients who have had an acute MI be offered for long-term management?

A

ACE inhibitor
Dual antiplatelet therapy
Beta blocker
Statin

35
Q

Which MI patients should be offered a cardiac rehabilitation programme?

A

All, regardless of their age

36
Q

What is involved in the emergency of NSTEMI?

A
  1. Monitor closely, record ECG while in pain
  2. Is SaO2 <90% or breathless, low flow oxygen
  3. Morphine and anti-emetic
  4. GTN spray and sublingual tablets as required
  5. Aspirin
  6. Fondaparinux or LMWH
  7. Second anti-platelet agent, e.g. clopidogrel
  8. IV nitrate if pain continues
  9. Oral beta blocker
  10. Prompt cardiologist review for angiogrpahy
37
Q

What dose of morphine should be given in NSTEMI?

A

5-10mg IV

38
Q

What anti-emetic may be used in the treatment of NSTEMI?

A

Metoclopramide 10mg IV

39
Q

What dose of aspirin should be given in NSTEMI?

A

300mg PO

40
Q

What dose of fondaparinux should be given in NSTEMI?

A

2.5mg OD SC

41
Q

What does of LMWH should be given in NSTEMI?

A

1mg/kg/12 hour SC

42
Q

Give an example of an oral beta blocker that can be used in NSTEMI?

A

Bisoprolol

3: MED1 Y3 - Cardiovascular [2] (19 decks)

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