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Cardiovascular > Acute MI > Flashcards

Acute MI Flashcards

1
Q

How do platelets initiate the build up of atheromatous plaques?

A

They form a monolayer and initiate a cascade which causes platelet clumping to attract other platelets

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2
Q

What do platelets release when they are activated?

A

ADP and thromboxane A2 through the cyclooxygenase system

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3
Q

What is produced at the end of the clotting process?

A

A thrombus

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4
Q

What is the first effect of the build-up of plaque?

A

Stable angina- a fixed stenosis which results in a demand led ischaemia that is usually predictable and safe

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5
Q

Does pain from angina radiate?

A

Yes often down the left arm as well as other sites

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6
Q

What is the second effect of the build-up of plaque?

A

Acute coronary syndrome- a dynamic stenosis with a supply led ischaemia which is unpredictable and dangerous

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7
Q

What are important factors in determining the cause of a plaque rupture?

A

Thickness of the fibrous cap ad lipid content of plaque

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8
Q

Are old or new plaques more likely to rupture?

A

New

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9
Q

What other factors can increase the risk of a plaque rupture?

A

Bending of an artery or sudden change in intra-luminal pressure

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10
Q

What occurs when a coronary artery is completely occluded?

A

STEMI

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11
Q

What will a STEMI ultimately lead to?

A

Heart failure

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12
Q

What are some symptoms of heart failure?

A

Breathless, cough, PND, orthopnoea,

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13
Q

What is typical STEMI pain?

A

Central crushing chest pain radiating to arm and jaw, similar to angina but worse and not relieved by GTN

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14
Q

What are some associated symptoms of a STTEMI?

A

Sweating, nausea and vomiting

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15
Q

What are non-cardiac differentials of STEMI?

A

Pneumothorax (sudden), pleuritic pain of pneumonia, MSK pain or heartburn

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16
Q

What is the first ECG change to occur in a STEMI?

A

ST elevation

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17
Q

What ECG changes may show a bit later on a STEMI?

A

T wave inversion or Q waves

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18
Q

What are Q waves?

A

Downward deflections between the p wave and QRS

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19
Q

What are the rules with regards to ST elevation?

A

ST elevation must be 1cm or greater in 2 adjacent limb leads or 2cm or greater in 2 contiguous precordial leads (or new onset LBBB)

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20
Q

What leads and artery are involved in an inferior MI?

A

II, III, aVF

Right coronary artery

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21
Q

What leads and artery are involved in an anteroseptal MI?

A

V1-4

Left anterior descending artery

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22
Q

What leads and artery are involved in an anterolateral MI?

A

I, aVL, V4-6

Left anterior descending or left circumflex

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23
Q

What leads and artery are involved in an lateral MI?

A

I, aVL +/- V5-6

Left circumflex artery

24
Q

What does a posterior MI show and what artery is involved?

A

Tall r waves in V1-2

Left circumflex or right coronary artery

25
Q

What are further diagnostic tools used for STEMI?

A

Cardiac enzymes (troponin) and protein markers

26
Q

What is the downside of cardiac enzymes and protein markers?

A

Might take too long to wait for results

27
Q

What anti-platelet drugs are used for STEMI and how do they work?

A

Aspirin- switches off cyclooxygenase system to block thromboxane A2
Clopidogrel- blocks ADP receptors
Ticagrelor or prasugrel can be used instead of clopidogrel

28
Q

How much aspirin and clopidogrel is given?

A

300mg

29
Q

When is clopidogrel given?

A

Once there are ECG changes or elevation of cardiac markers to back up your diagnosis

30
Q

How can patients be re-perfused?

A

Thrombolysis (streptokinase) or PCI (preferred)

31
Q

When should patients receive thrombolysis?

A

If PCI cannot be carried out within 90 mins of diagnosis

32
Q

What should happen to patients after receiving thrombolysis?

A

Coronary angiography or emergency angioplasty

33
Q

What is the step by step treatment of STEMI?

A 
Analgesia (IV diamorphine)
Anti-emetic (IV metoclopramide)
Aspirin and clopidogrel
GTN (if BP >90mmHg)
Oxygen if hypoxic
PCI or thrombolysis
34
Q

What medications should patients be put on following a STEMI?

A

Beta blocker, ACE inhibitor, statin and dual antiplatelet therapy (aspirin for life, other for less)

35
Q

Patients with heart failure can also be put on what drug long term?

A

Aldosterone antagonists- spironolactone

36
Q

What lifestyle advice should patients be given following a STEMI?

A

Stop smoking, cut down alcohol, advice better diet (lots of omega 3), exercise 20-30 mins a day

37
Q

What are the rules regarding sex after an MI?

A

Can resume after four weeks and will have no effect on future MIs

38
Q

What advice should be given about driving following MI?

A

4 weeks until you start again and no need to tell DVLA (car/bike)
6 weeks until you start again and do need to tell the DVLA (large vehicle)

39
Q

What is the main arrhythmic complication of a STEMI? How is it treated?

A

VF- defibrillation

40
Q

What are structural complications after a STEMI?

A

Cardiac rupture, VSD, mitral regurgitation with papillary muscle damage, left ventricular aneurysm, pericarditis/Dressler’s syndrome

41
Q

Which STEMI complication would cause recurrent chest pain and shock, low BP and CO?

A

Ventricular septal defect

42
Q

What complication of a STEMI can present as pulmonary oedema?

A

Mitral regurgitation

43
Q

What complication of a STEMI will give persistent ST elevation and LV failure?

A

Left ventricular aneurysm

44
Q

What is Dressler’s syndrome?

A

An autoimmune condition cause pericarditis 2-10 weeks post MI

45
Q

What complications could a new heart sound suggest?

A

VSD or mitral regurgitation

46
Q

What can all STEMI complications lead to?

A

Acute or chronic heart failure and possible cardiogenic shock

47
Q

What is the difference in pathogenesis of NSTEMI?

A

Artery is not completely occluded

48
Q

How is complete occlusion prevented in NSTEMI?

A

By our bodies own thrombolysis- plasmin

49
Q

What is the main feature of an NSTEMI?

A

Chest pain

50
Q

What is the most important thing to remember about an NSTEMI?

A

ECG may be normal

51
Q

What can an ECG of NSTEMI show?

A

ST depression or T wave inversion

52
Q

What is a type II MI?

A

Not caused by a rupture of a plaque but instead by an imbalance of oxygen supply and demand

53
Q

How is the coagulation cascade blocked in NSEMI?

A

LMWH

54
Q

What can be used to prevent progression of NSTEMI to STEMI?

A

2b3a inhibitors

55
Q

Patients who are at high risk with identifiable troponin should undergo what?

A

Coronary angiography and revascularisation

56
Q

What should long term therapy be for NSTEMI?

A

Aspirin (life) and clopidogrel (3 months)

57
Q

What should a patients target cholesterol and BP be following an NSTEMI?

A

<4mmol/l and <140/85

Cardiovascular (23 decks)

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