Acute Myocardial Infarction Flashcards
What is chronic stable angina?
When there is fexied stenosis of the coronary artery whcih leads to demand led ischaemia.
Angina can radiate through to arms and up to jaw. True or False?
True, it has the possibility of radiation.
What is acute coronary syndome and what is included in it?
Any acute presentation of coronary artery disease. It includes: Unstable angina Acute NSTEMI STEMI
Acute MIs can come in 2 forms, what are they?
ST elevation MI
Non ST elevation MI.
What are the causes for acute coronary syndromes?
They are on a spectrum from the build up of an atherosclerotic plaque. When the plaque ruptures, a thrombus can form and at this moment this is when acute coornary syndomes can occur.
Acute coronary syndromes are unstable and safe. True or False?
Partially true, they are unstable, HOWEVER they are dangerous, due to the unpredictability.
What is the main cause of occlusion of an artery to cause acute coronary syndrome?
The plaque rupturing and a thrombus forming due to the coagulation cascade.
How would an MI present?
Severe crushing central chest pain
Radiation to jaw and arms (particularly left)
Similar to angina, more severe and not relieved by GTN.
Associated with sweating, nausea and vomiting.
What the main differences between angina and an MI?
Angina is a much shorter period of time and occurs on exertion not at rest like an MI.
How would you diagnose an MI and what would you look for?
ECG:
ST elevation
T wave inversion
Q waves.
What classifies as a STEMI?
> /=1mm ST elevation in 2 adjacent limb leads
/=2mm ST elevation in at least 2 continuous precordial leads
New onset bundle branch block.
What are the evolving ECG changes of an acute MI during and after an MI?
First few hrs- ST elevation
First day- Q wave formation and T wave inversion
‘Old’ MI- Q waves and inverted T waves.
What is the anatomical site of an MI is there is ST elevation in leads II, III and aVF?
Inferior MI
What is the anatomical site of an MI is there is ST elevation in leads V1-V4
Anteroseptal.
What is left bundle branch block?
QRS is much broader
What test can be done to diagnose an MI but what has to be considered when using this test?
Troponin levels I and T as they are specific to cardiac muscle and C can be found in skeletal muscle.
The test is very sensitive and a diagnosis should not be made solely on a troponin test (“Troponinitis”).
What is the mode of early treatment for an STEMI?
Analgesia Anti-emetic Aspirin + clopidogrel/ticagrelor GTN if high BP Oxygen if hypoxic Primary angioplasty Thrombolysis if angioplasty not available.
Why and when is thrombolysis used in MIs and what are the risks?
If the clot still hasnt been destroyed thrombolysis can be administered which clears the artery.
If the patient cannot recieve an angioplasty in 2hrs then thrombolysis is given.
However has a major risk of haemorrhage and failure to re-perfuse.
What are complications nof acute MIs?
Death Arrhythmic complications -VF Structual complications -Cardiac rupture -Ventricular septal defect -Mitral valve regurge. -LV aneuryms -Inflammation -Acute pericarditis Functional complications -Acute V failure -Chronic cardiac failure -Cardiogenic shock.
What is the Killip Classification and what is it used for?
It is used to determine in-hospital mortality
I - No signs of heart failure (6%)
II - Crepitations <50% lung fields (17%)
III - Crepitations >50% lung fields (38%)
IV - Cardiogenic shock (81%)
What is the most important thing to remember about ECG in acute non ST elevation MI?
The ECG may appear normal.
What is troponin testing?
Embolisation
Microvascular circulationa
Myonecrosis
What can TnT also be elevated in?
CCF Renal Failure PE Sepsis Stroke/TIA Pericarditis/myocarditis Post arrhythmia
What is a class II MI?
When there is an MI that occurs secondary to ischaemia due to inbalance of O2 with demand from coronary spasm, embolism, anemia, hyper/hypotension, arrhythmias.
What is MINOCA?
Myocardial Infarction with Non Obstructed Coronary Arteries.
ECG of NSTEMI can have T wave depressions. True or False
True.
Once a patient has been treated post MI, as a doctor what should you ensure?
That the patient realises their life isn’t going to be majorly hindered.
That they understand their drug therapy and what to expect.
What are the 4 pahses of cardiac rehabilitation?
Phase 1- In patient
Phase 2- Early post discharge
Phase 3- structured exercise programme
Phase 4- Longer term maintenance of physical activity and lifestyle change.
Who are the cardiac rehabilitation team?
Cardiac rehab nurses Physiotherapy exercise classes Smoking cessation specialists Pharmacists Cardiologists.
