Chest pain

Question 1

Symptoms of MI

Answer 1

Central, crushing chest pain usually radiating to left arm and/or jaw
Diaphoresis
Shortness of breath
Vomiting

Question 2

Describe pain from aortic dissection

Answer 2

Severe
Tearing pain
Radiates to back

Question 3

Types of aortic dissection

Answer 3

A: tear in ascending aorta (can extend to legs)
B: tear in descending aorta

Question 4

Management of type A aortic dissection

Answer 4

Bacron graft

Question 5

Cause of coronary artery spasm

Answer 5

Cocaine overdose

Question 6

Diabetic presentation of MI

Answer 6

Often no chest pain
Palpitations
SOB
Syncope

Question 7

Immediate management for acute MI

Answer 7

IV (Dia)morphine
GTN
Antiemetics 
Oxygen
Clopidogrel 
ECG to determine STEMI/NSTEMI and calculate GRACE score to determine need for re-vascularisation

Question 8

Anticoagulation for NSTEMI not suitable for angioplasty in next 24 hours

Answer 8

Fondaparinux (factor 10 inhibitor)

Question 9

Anticoagulation for NSTEMI suitable for angioplasty

Answer 9

Heparin

Question 10

Blood tests for MI on admission

Answer 10

FBC
Glucose
Troponins (1 hour apart)
Full lipid profile 
U+Es
CRP

Question 11

What can raise troponin

Answer 11

Cardiac ischaemia
Poor renal function
Chemo
Chest infection

Question 12

When is troponin positive for cardiac ischaemia

Answer 12

1st level >12

2nd level higher by >5

Question 13

When should GTN be avoided

Answer 13

Inferior STEMI due to risk of severe hypotension

Question 14

What medications should be initiated after an MI

Answer 14

ACEi to help heart remodelling (prevent arrhythmia) and reduce afterload + preload
Statins
Clopidogrel
Beta blockers?

Question 15

What does TIMI predict

Answer 15

Mortality following ACS

Question 16

Criteria for TIMI score in unstable angina or NSTEMI

Answer 16

Age >65
Coronary artery disease
At least 3 RFs for coronary artery disease
ASA in past 7 days
Positive cardiac marker
Severe angina (at least 2 episode in 24 hours)
ST elevation >0.5mm

Question 17

Criteria for TIMI score in STEMI

Answer 17

Age (up to 3 points)
HTN/diabetes/angina
Systolic below 100mmHg (3 points)
Heart rate above 100 (2 points)
Signs of congestive heart failure (2 points)
Below 67kg 
Anterior ST elevation or LBBB
>4 hours before treatment