Acute MI

Question 1

What is troponin (Tn)?

Answer 1

protein marker - highly specific for myocardial damage - can detect tiny amounts of myocardial necrosis

Question 2

What are the ECG changes in a STEMI within the first few hours ?

Answer 2

ST elevation in 2 adjacent limb leads or precordial leads or new onset bundle branch block

Question 3

What are the ECG changes within the first day of a STEMI?

Answer 3

Q wave formation and T wave inversion

Question 4

What is the chest pain described as acute MI?

Answer 4

severe central cheat pain - crushing, squeezing, heavy, gripping, radiates to jaw and arms - especially left, occurs at rest, similar to angina - more severe, prolonged, not relieved by GTN

Question 5

What are the associated symptoms with chest pain in acute MI?

Answer 5

sweating, nausea, vomiting

Question 6

What are the ECG changes of an old STEMI?

Answer 6

Q waves +/- inverted T waves

Question 7

What is the early treatment of acute MI?

Answer 7

MONA + T, morphine + anti-emetic, oxygen, nitroglycerin, aspirin - 300mg, ticagrelor - 180mg

Question 8

What are the contraindications for use of beta-blockers in the treatment of STEMI?

Answer 8

signs of heart failure, evidence of low CO, high risk for cardiogenic shock

Question 9

What are the contraindications for fibrinolytic therapy?

Answer 9

recent surgery, trauma or head injury, bleeding disease, coma, active peptic ulcer, suspected aortic dissection, traumatic resuscitation attempt, severe hypertension - control BP with GTN first

Question 10

What is the treatment for a STEMI?

Answer 10

beta blockers - oral - first 24 hours, anti-coagulant - fondaparinux, reperfusion - primary PCI within 90 mins, if PCI not possible - fibtinolytic therapy within 30 mins

Question 11

What is creatinine kinase (CK)?

Answer 11

enzyme, peaks 24 hours post MI, sign of muscular damage

Question 12

What is the mechanism of action of ticagrelor?

Answer 12

antagonist of P2Y12 receptor - prevents platelet activation

Question 13

In what type of MI is the ECG normal?

Answer 13

non-ST elevation MI (NSTEMI)

Question 14

What are the secondary prevention measures?

Answer 14

lifestyle advice, all patients - ACE inhibitor, aspirin, beat blocker and statin, after NSTEMI, PCI or stents - antiplatelet therapy, symptoms/signs of heart failure or left ventricular diastolic dysfunction - aldosterone antagonists - within 3-14 days of acute MI

Question 15

What is infarction?

Answer 15

death of tissue as a result of ischaemia

Question 16

What leads will show ST elevation in an anterior STEMI?

Answer 16

V1-V4

Question 17

What leads will show ST elevation in an inferior STEMI?

Answer 17

II, III, aVF

Question 18

What leads will show ST elevation in a lateral STEMI?

Answer 18

I, V5-V6, aVL

Question 19

What artery is affected in an anterior MI?

Answer 19

left anterior descending

Question 20

What artery is affected in an inferior MI?

Answer 20

right coronary

Question 21

What artery is affected in a lateral MI?

Answer 21

left circumflex

Question 22

What ate the ECG changes in a posterior STEMI?

Answer 22

tall R waves, ST elevation in V1-2

Question 23

What artery is affected in a posterior MI?

Answer 23

usually left circumflex, may also be right coronary

Question 24

What is acute coronary syndrome?

Answer 24

unstable angina, STEMI, NSTEMI