Deck 2 Flashcards
Q. Which two waves may be suggestive of a MI on an ECG?
A. STEMI – ST elevation MI: diagnosed at time of ECG
B. Non-ST-elevation MI: retrospective diagnosis made after troponin results
C. Q-wave MI: new pathological waves
D. Non-Q wave MI: no new waves
Q. What ECG results are suggestive of larger infarcts?
STEMI and ECGs suggestive of LBBB
Q. What occurs to the heart in LBBB? How does this affect an ECG?
A. In LBBB, the normal direction of septal depolarisation is reversed (becomes right to left), as the impulse spreads first to the RV via theright bundle branchand then to the LV via the septum.
B. This extends the QRS duration and eliminates normal Q waves
C. R waves are tall due to change in direction of depolarisation: left axis deviation (LAD) and notched (M shaped) because the ventricles are activated sequentially (R then L)
Q. Describe four features of cardiac chest pain
A. Unremitting
B. Usually severe but may be mild or absent
C. Occurs at rest
D. Associated with sweating, breathlessness, nausea and/or vomiting
E. One third occur in bed at night
Q. What is the initial management of an MI?
A. (999 call)
B. Take aspirin immediately
C. Pain relief – morphine
Q. Describe the hospital management of an MI?
A. Make diagnosis B. Bed rest – reperfusion C. Oxygen therapy D. Aspirin +/- P2Y12 inhibitor E. ? betablocker, antianginal therapy, urgent coronary angiography
Q. What is troponin?
A. Protein complex regulates actin:myosin contraction, it is a highly sensitive marker for cardiac muscle syndrome, however it may not represent permanent muscle damage
Q. 1. What can troponin be suggestive of?
A. Gram negative sepsis, pulmonary embolism, myocarditis, heart failure, arrhythmias, cytotoxic drugs, others
Q. What does dual antiplatelet therapy consist of?
A. P2y12 inhibitor in combination with aspirin
B. Three oral options of p2Y12 inhibitor: clopidogrel, prasugrel, ticagrelor
C. IV option – cangreol
D. Exclude serious bleed prior to administration due to bleeding risk
Q. What is the most commonly used anticoagulant? How does it work?
A. Low-molecular weight heparin (or fondaparinux)
B. Inhibits fibrin formation and platelet activation
C. Targets formation and activity of thrombin
Q. What adverse effects are associated with p2Y12 inhibitors?
A. Bleeding: epistaxis, GI bleeds, haematuria
B. Rash
C. GI disturbance
D. Dyspnoea
Q. What pain relief should be used in acute cardiac syndromes cases?
A. Opiates (but can delay absorption of PY12inhibitors)
B. Nitrates for unstable angina/coronary vasospasm (may be ineffective for MI)
Q. What is deep vein thrombosis?
A. DVT is the thrombosis of the blood in the vessels of the legs, it can cause swelling and pain but often occurs asymptomatically
B. DVT may settle completely as natural thrombosis can be dissolved by natural processes
Q. What three events may occur if a DVT extends up the deep veins?
A. Thrombus can become dislodged from the vein and lodge in the lungs – pulmonary embolism (small emboli – chest pain, hemoptysis, multiple or large – breathlessness)
B. Chronic blockage in deep veins, damage valves – long term swelling, skin problems at ankle
C. Less commonly, the emboli can also travel through the heart and back to rest of the body including the brain – paradoxical embolism – stroke
Q. What investigations could be done for DVT diagnosis?
A. D-dimer – normally excludes diagnosis (a positive D-dimer does not confirm diagnosis)
B. Ultrasound – compression test of proximal veins
