Cardiac emergencies

Question 1

What TnI low likelihood of mycoardial necrosis?

Answer 1

< 40 ng/L

Question 2

What TnI high likelihood of myocardial necrosis?

Answer 2

TnI > 100 ng/L

Question 3

What are criteria for STEMI?

Answer 3

Cardiac sounding chest pain with persistent STsegment elevation (or new LBBB) on ECG
ST elevation should be >1mm in limb leads and 2mm in chest leads
Subsequent TnI will be >100 ng/L

Question 4

What are criteria for NSTEMI?

Answer 4

Cardiac sounding chest pain
ECG may show ST segemnt depression, T wave inversion or may be normal
Subsequent TnI will be >100 ng/L
Previously established ECG changes such as old MI, LV hypertrophy or AF may be present
Hallmark of ACS is labile ECG changes

Question 5

What are criteria for unstable angina?

Answer 5

Cardiac sounding chest pain
ECG may show STsegment depression, T wave inversion or may be normal
Subsequent TnI <40 ng/L

Question 6

Initial management of STEMI?

Answer 6

Oxygen
Morphine
Aspirin 300mg chewable
Prasugrel

Question 7

What is target BP for patients with CAD?

Answer 7

130/80

Question 8

Signs of cardiogenic shock (LVFwith hypotension)?

Answer 8

CO low, dyspnoea may not be dominant
Systolic < 90
Pale, drowsy, cool peripheries, oliguria
JVP elevated
Gallop rhythm

Question 9

Management of cardiogenic shock?

Answer 9

High O2
Diuretics
Inotropes, including dopamine and dobutamine

Question 10

Pharmacodynamics dopamine?

Answer 10

Low dose (2.5 -5 mcg/kg/min): Dopaminergic receptors producing dilatation renal, coronary, splanchnic and cerebral arteries
High dose (5-15 mcg/kg/min): B1 receptors activated with positive inotropic and chronotropic effects

Question 11

Pathophysiology of MR post MI?

Answer 11

Annular dilatation secondary to LV dysfunction
Papillary muscle dysfunction/rupture following inferior MI (posteromedial papillary muscle is supplied by the posterior descending artery branch of the RCAor circumflex)

Question 12

Presentation of MR post MI?

Answer 12

2-7 days post MI
Severe orthopnoea + PND
Hypotension
Large pansystolic murmur at apex/LSE

Question 13

Definition HF?

Answer 13

Heart unable to maintain sufficient cardiac output to meet metabolic demands of the body despite normal venous filling pressures

Question 14

How to calculate ejection fraction?

Answer 14

EF = (EDV - ESV) / EDV