Clinical Perspective: Myocardial Infarction

Question 1

True/False. Nitrates reduce mortality due to acute MI.

Answer 1

False - they reduce ischemia and symptoms but not mortality

Question 2

What is a ventricular pseudoaneurysm?

Answer 2

Rupture of the myocardium contained by the pericardium

Question 3

What troponin is myocardium-specific?

Answer 3

Troponin I

Question 4

What is the difference between Type 1 & 2 NSTEMI?

Answer 4

Type 1 is due to a thrombotic occlusion. Type 2 is not due to plaque rupture, but rather injury due to increased metabolic demand

Question 5

These antiplatlets are coadministered with aspirin for 12 months following stend placement.

Answer 5

P2Y12 inhibitors (clopidogrel, ticagrelor)

Question 6

What is the first-line treatment for antiplatelet aggregation in a patient post-MI?

Answer 6

Aspirin (lifelong treatment)

Question 7

What ECG changes may be present with an NSTEMI?

Answer 7

ST depression, T wave inversion

Question 8

When are ventricular and cardiac wall ruptures most likely to occur?

Answer 8

3-7 days post MI - before fibrosis begins, when the wall is weakest

Question 9

A patient is diagnosed with a STEMI. What is the best next setps for treatment?

Answer 9

Cath lab within 90mins. If not possible, begin fibrinolytics in 30mins and transfer to hospital with cath lab

Question 10

What papillary muscle is most prone to rupture?

Answer 10

Posteromedial supplied by the right coronary artery. This may present as mitral regurgitation

Question 11

A patient presents to the ED with chest pain. What is the first action that should be taken?

Answer 11

ECG within 10 minutes of arrival

Question 12

Dressler syndrome is an autoimmune reaction 2-6 weeks post MI. What antibodies are formed?

Answer 12

Antibodies against the damaged myocardium