CVS 10 (Ischaemic Heart Disease 2)

Question 1

Name the 3 serum biomarkers elevated in an acute MI:

Answer 1

1) Cardiac Troponin I (cTnI)
2) Cardiac Troponin T (cTnT)
3) Creatine Kinase (CKMB)

Question 2

How many hours after an acute MI do serum levels of cTnI and cTnT peak?

Answer 2

18-36 hrs after

Question 3

How many hours after an acute MI do serum levels of creatine kinase peak?

Answer 3

24 hrs after

Question 4

cTnI and cTNT are still elevated how many days after an acute MI?

Answer 4

~ 10-14 days after

Question 5

How does a left bundle branch block present on an ECG?

Answer 5

Notched ‘M’ R wave

- Ventricles activated sequentially (R then L)

Question 6

Name some of the treatments for an acute MI:

Answer 6

• Antithrombotics
• IV opioids
• Oxygen if sats <94%
• P2Y12 receptor antagonist
• Emergency Percutaneous Coronary Intervention (angioplasty + stenting)
• IV nitrates
• Beta-blockers
• Statins

Question 7

What is the long-term treatment for an acute MI (to decrease mortality and re-infarction)?

Answer 7

• Lose weight (if obese)
• Increase exercise level
• Decrease alcohol intake
• Stop/ decrease smoking
• Aspirin
• Beta-blocker
• ACE inhibitor
• Statins

Question 8

What complication occurs when >40% of the myocardium is infarcted?

Answer 8

Cardiogenic shock

Question 9

What is the treatment if ejection fraction < 35% 6-12 weeks after an acute MI?

Answer 9

Implantable Cardioverter Defibrillator (ICD)

Question 10

What is the treatment for ventricular fibrillation 24+hrs after an acute MI?

Answer 10

Implantable Cardioverter Defibrillator (ICD)

Question 11

What is an Exercise Stress Test, and why would you perform one?

Answer 11

• Patient asked to perform graded exercise while connected to an ECG machine, until target HR reached, or ECG changes occur, or chest pain etc
• Used is diagnosis of stable angina is uncertain

Question 12

What is a Chemical Stress Test, and why would you perform one?

Answer 12

• Patient connected to ECG machine, and IV adenosine or Dobutamine is administered.
• Used if diagnosis of stable angina is uncertian, and patient cannot do an Exercise Stress Test (ie back/joint pain, unsteady gait, previous stroke, dizzyness etc)

Question 13

What ECG change would be seen in a positive Exercise/Chemical Stress Test?

Answer 13

ST depression > 1mm

Question 14

Define acute pericarditis:

Answer 14

Inflammation of pericardium

Question 15

What are the causes of acute pericarditis?

Answer 15

• Often unknown (idiopathic)
• Infection (viral/bacterial)
• Trauma
• Drugs
• Neoplasms
• Inflammatory disorder (ie Rheumatoid arthritis or Lupus)
• Acute MI
• Aortic dissection
• Renal failure

Question 16

Describe the pain felt during acute pericarditis:

Answer 16

Central sharp chest pain

- May radiate to neck/shoulder/arm

Question 17

What ECG changes may be seen in acute pericarditis?

Answer 17

ST elevation in all leads

No T inversion or pathological Q waves