ACS - myocardial infarction

Question 1

Pathophysiological difference between STEMI and NSTEMI?

Answer 1

STEMI is full thickness damage (ECG, troponin, pain)
NSTEMI isn’t (troponin, pain)
unstable angina (just pain)

Question 2

Presentation of MI

Answer 2

Chest pain, over 20mins at rest
radiates to jaw/neck, no response to GTN
sweating, nausea, vomiting, SOB

Signs of acute heart failure are possible (JVP, extra heart sounds)

Question 3

Investigations for ?MI - acute chest pain

Answer 3

12 lead ECG (ST elevation, new LBBB, pathological Q waves)
troponin - at 6 and 12 hours after pain starts (CK-MB useful if re-infarct is suspected)

Angiography - thrombus
Echocardiogram

Question 4

Definitive treatment of STEMI

Answer 4

PCI within 2 hours
If unavailable - fibrinolysis within 12 hours (LMWH)
ECG 60-90 mins later

CABG - if PCI fails/multivessel disease/cardiogenic shock
ST elevation should half within an hour

Question 5

Immediate treatment of MI

Answer 5

Morphine + anti-emetic
Oxygen - only if sats are low
Nitrates
Aspirin 300mg
B blockers (IV initially)
ACEi

Question 6

Post MI treatments

Answer 6

aspirin

ticagrelor

Question 7

Complications of MIs

Answer 7

Angina
Future MI
heart failure/shock/aneurysms 
arrhythmias 
thrombi
pericarditis 1-3 days later (early) can happen later too

Question 8

What is Dressler syndrome

Answer 8

This is a late-onset post-myocardial infarction pericarditis, usually occurring one to six weeks after the initial event

Question 9

Causes of raised troponins

Answer 9

MI
gram negative sepsis
PE
myocarditis
HF arrhythmias