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Cardio > Acute MI > Flashcards

Acute MI Flashcards

1
Q

What is chronic stable angina?

A

A fixed stenosis
The symptoms of ischemia are relative to the demand of the heart
It is predictable
It is safe

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2
Q

How is the chest pain from chronic stable angina eased?

A

Stopping, sitting and through the use of GTN spray

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3
Q

What characterises cardiac chest pain?

A

A heavy felling, weight or pressure on the chest

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4
Q

What is acute coronary syndrome?

A

The acute present=tion of coronary artery disease - it is a provisional diagnosis which covers a spectrum of conditions

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5
Q

What conditions are covered in ACS?

A

unstable angina
non-Q wave subendocardial MI
Q wave MI

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6
Q

What are the 2 types of acute MI?

A

ST elevation MI (STEMI)

Non ST elevation MI (NSTEMI)

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7
Q

What characterises acute coronary syndrome?

A

a dynamic stenosis either subtotal or complete occlusion
The ischemia is supply led
unpredictable
much more dangerous than stable angina

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8
Q

What factors affect plaque rupture?

A

Lipid content of plaque
Thickness of fibrous cap
Sudden changes in intraluminal pressure or tone
Bending and twisting of an artery during each heart contraction
Plaque shape
Mechanical injury

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9
Q

What intervention helps to protect the plaque against mechanical damage?

A

The placement of a stent

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10
Q

What trigger causes ACS?

A

The pressure in the artery rising dramatically , the plaque rupture exposes the endothelial tissue underneath the fibrous cap
The platelets react to this as an injury they form a monolayer on the site
The circulating platelets then adhere to this monolayer and form the clot through the platelet aggregation this can then break off and potentially occlude the vessel further downstream

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11
Q

What history is associated with the diagnosis of a myocardial infarction?

A

Severe crushing central chest pain
Radiating to jaw and arms, especially the left
Similar to angina but more severe, prolonged and not relieved by GTN
Associated with sweating nausea and often vomiting

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12
Q

What are the differences between the chest pain in angina and the chest pain in MI?

A

It is only about 10 minutes in angina and 30 or < in MI
In angina it’s only on exertion but in MI it’s at rest
The pain is more severe in i and isn’t relieved by GTN spray
In MI it is associated with nausea, sweating & vomiting

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13
Q

What are the ECG changes in STEMI?

A

ST elevation (>1mm in 2 adjacent limb leads or > 2mm ST elevation in at least 2 contiguous precordial leads or a left bundle branch block)
T wave inversion
Q waves

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14
Q

How do you diagnose MI?

A

ECG - STE
Tn (troponin blood test) - the preferred method - highly specific for cardiac muscle damage, can detect even tiny amounts of myocardial necrosis
CK (creatinine kinase) - no longer a routine test

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15
Q

What anti platelet drugs are used to treat STEMI’s?

A

Giving antiplatelets -
aspirin (300mg) & ticagrelor (180mg) given immediately
If patient is undergoing percutaneous coronary intervention aspirin & prasugrel (60mg)
If concerns of bleeding Clopidogrel (300mg) & Aspirin (300mg)
to stop the blocking of the vessels

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16
Q

How does clorpidigrel work?

A

blocks the ADP receptors on the platelet surface and therefore stops the formation of the platelet clots through their adhesion to each other

17
Q

What is thrombolysis?

A

A potent drug which breaks up the thrombus has uses immediately

18
Q

What are the indications for re-perfusion therapy such as thrombolysisi and PCI?

A 
Chest pain suggestive of acute myocardial infarction
More than 20 minutes less than 12 hours
ECG changes
Acute ST elevation
NEW left bundle branch block (LBBB) 
No contraindications
19
Q

When is pre-hospital thrombolysis used?

A

Can be used only ehen primacry angioplasty cannot be given/done within 120 minutes of the ECG diagnosis of STEMI

20
Q

What are the risks of thrombolytic therapy?

A

failure to re-perfuse the coronary vessels
Haemorrhage either, minor or major and intercranial haemorrhage (occurs 0.5-2.0% of the time)
hypersensitivity

21
Q

Why is thrombolysis used so catiously?

A

Because angioplasty has a much higher chance of success and longer term survival rates and so is a more effective method of reperfusion

22
Q

What is the next step when thrombolysis fails?

A

An emergency PCI to open the artery

23
Q

What is the next step when thrombolysis is successful?

A

An elective PCI in order to securely open the artery

24
Q

What is the early treatment of STEMI?

A 
Analgesia - diamorphine iv 
Anti-emetic - iv
Aspirin - 300 mg and Ticegralor 180 mg 
GTN - if BP > 90 mmHg
Oxygen - if hypoxic
Primary angioplasty
Thrombolysis – if angioplasty not available within 120 minutes
25
Q

What are the 3 different types of complications of an acute myocardial infarction?

A

Arrhythmic complications
Structural complications
Functional complications

26
Q

Give an example of an arrhythmic complication of an acute MI?

A

Ventricular fibrillation - intervention of a defibrillator, sticky pads now used instead of paddles

27
Q

Give examples of structural complications (which can occur after 24-48hrs of infarction) of an acute MI?

A 
Cardiac rupture
ventricular septal defect
mitral valve regurgitation 
Left ventricular aneurysm formation
Mural thrombus +/- systemic emboli
Inflammation
Acute pericarditis
Dressler's syndrome
28
Q

What are the potential functional changes caused by a MI?

A

Acute ventricular failure (left, right and biventricular)
Chronic cardiac failure
cardiogenic shock

29
Q

How do you ensure that complications aren’t arising from the acute MI?

A

Routine observations are carried out, perhaps including a cardiac monitor as to ensure that there are no changes and there will be quick intervention if needed

30
Q

What complication of MI is commonly clinically silent?

A

LV dysfunstion

31
Q

What ECG results are expected in NSTEMI?

A

The ECG can be normal

32
Q

What treatment is given for NSTEMI?

A

MONA+C and then a revascularisation technique, PCI or thrombolysis

33
Q

What is troponin?

A

Globular protein complex in thin myofilaments involved in regulating different muscle contraction (Troponin I and troponin T have cardiac specific isoforms)

34
Q

What is the significance of measuring TnT or TnI?

A

They have nearly absolute myocardial specificity and high sensitivity meaning they can be used to measure myocardial damage and necrosis - proves that an MI has occurred

35
Q

What are the loading doses of the drugs used in the acute treatment of MI?

A

Aspirin 300mg
Ticagrelor 180mg
Clopidogrel (used as an alternative to tigrelor and prasugre; when there are bleeding risks) 300mg

36
Q

What is GP IIb-IIIa?

A

The final common pathway to platelet aggregation, GP IIb/IIIa should therefore not be used in patients at risk of adverse CV events at the time of PCI if they haven’t been adequately pretreated with dual anti-platelet therapy

37
Q

How long do you give clopidogrel for?

A

If a drug eluting stent has been placed - 1 year
ACS medical treatment - 3 months
ACS bare metal stent - 3 months
Elective PCI (bare metal) - 3 months
STEMI & no PCI - 4 weeks
If aspirin tolerant can be given indefinitely

38
Q

What conditions other than acute MI can cause raised troponin?

A 
CCF 
hypertensive crisis
renal failure
PE
sepsis
Stroke/TIA
Pericarditis/myocarditis
Post arrhythmia

Cardio (36 decks)

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