IHD symposium Flashcards
What causes a thrombus?
Atherosclerotic plaque rupture.
Causes platelets to adhere, activate and aggregate.
Thrombin and fibrin are produced via the coagulation cascade- forming clot.
Cytokines released from platelets cause vasoconstriction- prostaglandins.
ST elevation is a marker of…
Complete coronary occlusion
ST depression is a marker of..
Incomplete occlusion of coronary arteries
What leads show the lateral myocardial territory?
I
aVL
V5, V6
What leads show the inferior myocardial territory?
II, III
aVF
What leads show the antero-septal myocardial territory?
V1, V2
What leads show the anterior myocardial territory
V3, V4
Rapid treatment in STEMI
Antiplatelets- aspirin, clopidogrel.
Fibrinolytics/ Primary balloon stent angioplasty.
Primary angioplasty
Also known as primary PCI:
Method of reopening clogged arteries:
- Catheter is wired into artery.
- Balloon is blown up to open up artery.
- Stent is placed to permanently open artery.
Must be performed within 150 mins of patient’s call of help.
Thrombolysis
Treatment of choice in STEMI that is only performed if PCI cannot be done.
Must be administered in less than 90 mins.
Limitations:
Only restores blood flow in 50% of cases after 90mins
Increases risk of bleeding
Heart attacks in women
Symptoms are more atypical than in that of men.
Still may experience pain or discomfort in the chest.
Atypical symptoms more likely to experience:
Dyspnoea
Nausea/ vomitting
Back/ jaw pain
Delay longer seeking treatment that in men.
Populations that show atypical presentations in MIs.
Women
Elderly
Diabetics
Atypical presentations of MIs in diabetics
May be ‘silent’.
Diabetic ketoacidosis
Dyspnoea
Therapeutic goals in STEMI
Restoration of epicardial vessel patency (reopening of vessel).
Limit myocardial necrosis.
Controlling the symptoms.
Secondary prevention of STEMIs
Preventative methods after one experiences an MI.
Antiplatelets
Statin
ACE inhibitors
Beta-blockers
Smoking cessation
Lifestyle modifications.
