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Cardiovascular 2018 > Acute Myocardial Infarction > Flashcards

Acute Myocardial Infarction Flashcards

1
Q

What is the cause of chronic stable angina?

A

Fixed stenosis

Demand led ischaemia

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2
Q

What is an acute coronary syndrome?

A

Any acute presentation of coronary artery disease

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3
Q

What are the two types of MI?

A

STEMI

NSTEMI

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4
Q

What are the causes of acute coronary syndrome?

A
  • dynamic stenosis (subtotal or complete occlusion)
  • supply led ischaemia
  • unpredictable
  • dangerous
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5
Q

What are the factors affecting plaque rupture/fissure?

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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6
Q

What are the stages in the platelet cascade?

A
  1. Initiation
  2. Adhesion
  3. Activation
  4. Release of activators
  5. Surface receptors
  6. Amplification of activation
  7. Inflammatory Cascade
  8. Fibrin rich thrombus formation
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7
Q

What ECG changes might you see?

A

ST elevation
T wave inversion
Q waves

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8
Q

What are the categories for diagnosis a STEMI?

A

> 1mm ST elevation in 2 adjacent limb leads

> 2mm ST elevation in at least 2 contiguous precordial leads

New onset bundle branch block

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9
Q

When will ST elevation be visible?

A

First few hours

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10
Q

When will Q wave formation and T wave inversion occur?

A

First day

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11
Q

What might be suggestive of an old MI?

A

Q waves +/- inverted T waves

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12
Q

What leads will be affected in an anterior MI?

A

V1-V6

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13
Q

What leads will be affected in an anteroseptal MI?

A

V1-V4

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14
Q

What leads will be affected in an anterolateral MI?

A

I, avL, V1-V6

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15
Q

What leads will be affected in an inferior MI?

A

II, III, AVF

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16
Q

Describe the use of CK enzymes?

A
  • peaks in 24 hours

- also in skeletal muscle and brain

17
Q

Describe the use of troponins?

A
  • Highly specific for cadiac muscle damage

- Can detect tiny amounts of myocardial necrosis

18
Q

What is the mode of action of aspirin?

A

Aspirin inhibits COX preventing the formation of TXA 2

19
Q

What is the mechanism of clopidogrel?

A

Clopidogrel blocks the ADP receptor

20
Q

What are the indications for thrombolysis or PCI?

A 
1. Chest pain suggestive of acute myocardial infarction
More than 20 minutes less than 12 hours
2. ECG changes
acute ST elevation
NEW left bundle branch block (LBBB)
3. No contraindications
21
Q

What are the risks of thrombolysis?

A

-Failure to re-perfuse
-Haemorrhage – Minor
> Major
> Intracranial haemorrhage 0.5 –
2.0%
- Hypersensitivity

22
Q

What is the early treatment of STEMI?

A
  • Analgesia - diamorphine iv
  • Anti-emetic - iv
  • Aspirin - 300 mg and Clopidogrel 300 mg
  • GTN-ifBP>90mmHg
  • Oxygen - if hypoxic
  • Primary angioplasty
  • Thrombolysis – if angioplasty not available within 90 minutes
23
Q

What are the complications of acute MI?

A
  • Death
  • Arrhythmic complications
  • Structural complications
  • Functional complications
24
Q

What structural complications can occur from 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

25
Q

What are the functional complications of MI?

A
  • Acute ventricular failure – left
    >right
    >both (biventricular failure)
    -Chronic cardiac failure -Cardiogenic shock
26
Q

What is the gold standard for cardiac enzymes?

A

Troponin TnI

27
Q

What can elevate TnT

A 
Including
– CCF
– Hypertensive crisis
– Renal failure
– Pulmonary embolism
– Sepsis
– Stroke/TIA
– Pericaditis /Myocarditis – Post arrhythmia
28
Q

What are the four stages of cardiac rehab?

A
  • Phase 1 in-patient
  • Phase 2 early post discharge period
  • Phase 3 structured exercise programme – usually hospital based
  • Phase 4 long term maintenance of physical activity and lifestyle change – usually community based

Cardiovascular 2018 (39 decks)

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