CVS: MI

Question 1

Outline the physiology of MI

Answer 1

Blockage of a coronary artery = reduced oxygen supply = death of myocardial muscle = MI

Question 2

What are the risk factors of MI

Answer 2

Increasing age

Male

FH of IHD

Smoking

HTN

DM

Hyperlipidaemia

Obesity

Sedentary lifestyle

Question 3

Outline the aetiology of MI

Answer 3

Thrombus in the coronary artery

Question 4

What are the signs and symptoms of MI

Answer 4

Acute central chest pain

Nausea

Sweatiness

Dyspnoea

Palpitations

Question 5

How would you investigate MI

Answer 5

ECG = hyperacute T waves, STEMI, NSTEMI, development of pathological Q waves follow over hours-days

CXR = cardiomegaly, pulmonary oedema, widened mediastinum

Blood = troponin, CK, myoglobin, FBC, U+Es, glucose, lipids

Question 6

How would you manage acute MI

Answer 6

M = morphine – 1mg in 1ml, give a couple of ml

O = oxygen – high flow

N = nitriglycerine = 2 pumps

A = aspirin – 300mg loading dose, 75mg after

• Clpidogrel 600mg/Ticagrelor 180mg/prasugrel 60mg
• Primary PCI → need to alert the cath lab and cardiology
• Beta blockers
• ACEi
• Statins

Question 7

How would you manage an NSTEMI

Answer 7

Beta blocker and nitrates

Antithrombotic

Assess risk = GRACE SCORE
o High = GPIIb/IIIa antagonist ang angiography in 96h
o Low = clopidogrel

Question 8

What are the complications of MI

Answer 8

Cardiac arrest

Unstable angina

Bradycardia or heart block

Tachyarrhythmias

DVT + PE

Question 9

What does cardiac rehabilitation entail?

Answer 9

Exercise training

Emotional support

Education about lifestyle changes

• diet
• healthy weight
• quitting smoking

Question 10

What is the difference between a STEMI and NSTEMI?

Answer 10

STEMI = full lumen occlusion

NSTEMI = partial lumen occlusion

Question 11

What long term meds should be prescribed following MI prior to discharge?

Answer 11

Prophylaxis against thromboembolism = until fully mobile

Aspirin

Long-term beta blocker = bisoprolol

Continue ACEi

Statin = simvastatin

Question 12

What is the TIMI score?

Answer 12

Thrombolysis in MI

Used to determine admission or not

Determine the likelihood of ischemic events or mortality in patients with unstable angina or NSTEMI

Factors used = age >65, aspirin in last 7 days, 2 angina ep in last 24h, ST changes, elevated cardiac biomarkers, known coronary artery disease, 3 risk factors

Question 13

What is the GRACE score?

Answer 13

Global Registry of Acute Coronary Events

Used to determine discharge or not

Scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality

Factors used = age, HR, SBP, serum Cr, congestive HF class, risk factors

Question 14

Which leads correspond to which coronary arteries?

Answer 14

I + aVL = lateral = LCx

II, III, aVF = inferior = RCA

V1 + V2 = septal = LAD

V3 + V4 = anterior = LAD

V5 + V6 = lateral = LAD, RCA, LCx