Identifying and Treating MI Flashcards
Define hypoxia.
Lack of oxygen (any cause).
What is ischaemia?
- Restriction in blod supply to the tissues, causing lack of oxygen.
- Reversible.
What is infarction?
Tissue death from obstruction of blood supply to a tissue / organ.
What could chest pain be attributed to when considering a differential diagnosis?
- Cardiovascular - thromboembolic
- Lung - infection
- GI - inflammation
- MSK - traumatic
- Skin - malignancy
- Psychiatric
What are the possible cardiovascular causes of chest pain?
- MI
- Aortic dissection
- Pericarditis
- Myocarditis
What are the possible causes of chest pain related to the lungs?
- Pneumonia
- Pneumothorax
- PE
What are the possible causes of chest pain related to the GI tract?
- Cholecystitis
- GORD
- Peptic ulcer disease
- Boerhaave’s syndrome
What are the possible causes of chest pain related to the MSK system?
- Rib fracture
- Muscle strain
What are the possible causes of chest pain related to the skin?
- Shingles
What are the possible psychological-related causes of chest pain?
- Anxiety
- Panic disorder
What are the potential cardiac complications of MI?
- Heart failure
- Arrhythmias
- Cardiogenic shock
- Rupture
- Papillary muscle -> acute valve insuffciency
- Left ventricular free wall
- Ventricular septum
- Pericarditis
What are the potential iatrogenic complications of MI?
- Bleeding
- Trauma to vessels from angiography
- Vessel dissection
- Stent thrombosis
- Surgical complications
What other kinds of complications can accompany MI (bigger picture)?
- Psychosocial
- Financial
Define heart failure.
Heart muscle pumping ineffectively
Define arrhythmias.
Disruption of normal electrical conduction
Define cardiogenic shock.
Muscle pumping ineffectively
Describe cardiac rupture.
- Soft necrotic tissue tears easily
- Papillary muscle -> acute valve insufficiency
- Left ventricular free wall
- Ventricular septum
What causes pericarditis?
Cardiac complication of MI. It is an autoimmune response.
Give the mnemonic for the complications associated with MI.
Death
Arrhythmia
Rupture
Tamponade
Heart failure
Valve disease
Aneurysm (ventricular)
Dressler’s syndrome
Embolism
Recurrence
Describe the use of ECG in patients presenting with chest pain.
PERFORM AN ECG ASAP IN PATIENTS PRESENTING WITH ACUTE CHEST PAIN.
What are the associated symptoms of cardiac disease?
And of differentials in patients presenting with acute chest pain?
- Of cardiac disease:
- Sweating
- Nausea and vomitting
- Dizziness
- Shortness of breath
- Thinking about differentials:
- Fever
- Cough
- Loss of apetite
- Shortness of breath
- Leg pain / numbness
What are the risk factors for cardiac disease?
-
Modifiable
- Smoking
- Quantify in pack years
- Blood pressure
- Diagnosed when?
- Treated or untreated?
- Cholesterol
- Diabetes
- Weight / diet / lifestyle
- Smoking
-
Non-modifiable
-
Family history
- 55 years for men
- 65 years for women
- Sex
- Ethnicity
-
Family history
-
Think about the risk factors for other differentials:
- PE
- Pneumothorax
- Aortic dissection
What questions do you need to ask when taking a drug history from a patient presenting with chest pain?
- Prescribed:
- Regular - why?
- New - why?
- Changes - why?
- Over the counter
- NSAIDs
- Herbal
- Interactions with prescribed medications
- Illicit
- Cocaine, cannaboids - frequency, route of administration
- Adherence - do you manage to take your medication as they’ve been prescribed?
- Do you ever miss doses? If so, why?
Describe the examination of a patient presenting with acute chest pain.
- End of the bed
- Well of unwell?
- In pain or comfortable?
- Sweaty?
- Vomitting?
- Pale?
- Short of breath?
- Vital signs
- HR
- RR
- BP
- SpO2
- Temperature
- Systems examination:
- Cardiovascular system
- Respiratory system
- GI system
- / - neurological examination
What are the investiations you would do in a patient presenting with acute chest pain?
- Bedside:
- ECG
- Lab:
- hsTroponin
- Radiology:
- Chest X-ray
- CT coronary angiogram
Describe the supportive management of a patient presenting with acute MI.
- Sublingual GTN
- Morphine
- Oxygen if SpO2 is <94%
Describe the specific management of a patient presenting with acute MI.
- Aspirin 300mg PO
- Other anti-platelet agent
Describe the disposition management of a patient presenting with acute MI.
- Transfer to specialist centre for PCI if achievable within 120 minutes of diagnosis.
- Thrombolysis if PCI is not possible in the time frame.
