Heart attack blackboard

Question 1

Platelet adhesion receptors for leukocytes

Answer 1

P-selectin

CD40

Question 2

In STEMI, when do ECG changes show? (ST elevation, Q wave inversion, Q waves)

Answer 2

ST elevation - first few hours
Q wave inversion - first day

“Old MI” - Q waves +/- inverted T waves

Question 3

Needed to show you had STEMI?

Answer 3

> 1mm ST elevation in 2 adjacent limb leads

> 2mm ST elevation in at least 2 contiguous precordial leads

New onset bundle branch block

Question 4

Inferior STEMI (leads)

Answer 4

II, III, AVF

Question 5

Anterior STEMI

Answer 5

V1-V6

Question 6

Anteroseptal STEMI

Answer 6

V1-V4

Question 7

Anterolateral STEMI

Answer 7

I, AvL, V1-V6

Question 8

CK

Answer 8

Peaks in 24 hours

Also in skeletal muscle and brain

Question 9

Protein marker TnT (troponin T)

Answer 9

Highly specific for cardiac muscle damage

Can detect tiny amounts of myocardial necrosis

Question 10

Early Treatment of STEMI

Answer 10

Analgesia - diamorphine iv 
Anti-emetic - iv
Aspirin - 300 mg and Clopidogrel 300 mg 
GTN - if BP > 90 mmHg
Oxygen - if hypoxic
Primary angioplasty
Thrombolysis – if angioplasty not available within 90 minutes

Question 11

Risks of thrombolytic therapy?

Answer 11

Failure to reperfuse
Haemorrhage
Hypersensitivity

Question 12

Arrhythmia you could get after MI?

Answer 12

VF

Question 13

Structural complications of MI?

Answer 13

Cardiac rupture
VSD
Mitral valve regurgitation

Left ventricular aneurysm formation

Mural thrombus +/- systemic emboli
Inflammation
Acute pericarditis
Dressler’s syndrome

Question 14

Killip Classification of heart failure

Answer 14

I - no signs of heart failure
II - crepitations 50% of lung fields
IV - cardiogenic shock

Question 15

Cholesterol target

Answer 15

<130-80