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Y4R7 - Medicine III 🩺 > L4: IHD - MI (Pt 2) > Flashcards

L4: IHD - MI (Pt 2) Flashcards

1
Q

INVx in Acute MI

A
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2
Q

INVx in Acute MI

  • Cardiac Enzymes
A
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2
Q

Cardiac Enzymes in Acute MI

  • CK
A
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3
Q

Cardiac Enzymes in Acute MI

  • CK-MB
A
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4
Q

Cardiac Enzymes in Acute MI

  • LDH
A
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5
Q

Cardiac Enzymes in Acute MI

  • cTnT, cTnI
A
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6
Q

Cardiac Enzymes in Acute MI

  • Myoglobin
A
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7
Q

Cardiac Enzymes in Acute MI

  • Pathophysiology
A

Cardiac enzymes are released into blood from necrotic heart muscle after an acute MI.

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8
Q

Cardiac Enzymes in Acute MI

  • Type of Measurment
A
  • Serial measurements of cardiac markers are essential.
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9
Q

Cardiac Enzymes in Acute MI

  • Early Dx?
A
  • Ck-MB, cnT, or cTl are used for early diagnosis of AMI (3-6h) as a definitive marker.
  • Recent data utilizing (HS-CTnT) assays allow diagnosis of most cases of AM/ within 1-3 hours of presentation and thus the use of other markers is rarely mandatory
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10
Q

Cardiac Enzymes in Acute MI

  • HS-cTnT
A
  • Ck-MB, cnT, or cTl are used for early diagnosis of AMI (3-6h) as a definitive marker.
  • Recent data utilizing (HS-CTnT) assays allow diagnosis of most cases of AM/ within 1-3 hours of presentation and thus the use of other markers is rarely mandatory
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11
Q

Def of CK

A
  • CK is an enzyme present in high activity in cardiac muscle, skeletal muscle and brain tissue.
  • It is not specific for myocardium
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12
Q

Types lof CK

A
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13
Q

Significance of CK in MI

A
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14
Q

Types of Cardiac Troponins

A
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15
Q

What is Troponin C?

A

calcium-binding component

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16
Q

Distribution of Troponin C

A

identical in the skeletal and cardiac muscle

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17
Q

Significanc of Troponin C in MI

A

so, troponia C is not specific for myocardial injury

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18
Q

Function of Troponin I

A

prevents myosin from binding to actin in relaxed muscle

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18
Q

Significance of Troponin I in MI

A
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19
Q

Advantages of HS-cTnT in MI

A
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20
Q

Cardiac Troponins

  • Significance of Troponin T & Troponin I
A
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21
Q
  • However elevated levels of cInT, could be seen in some cases of CRF and myopathy.
  • (In such cases the elevated levels are sustained while in AMI there is rise and fall of cTnT levels).
A

….

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22
Q

the only disadvantage of cardiac troponin is …..

A
  • the late clearance (7-10 days) that makes it difficult to identify a recurrent myocardial infarction. (CK-MB returns to normal by 24 to 36 hours).
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23
Q

Delta troponin

24
Q

ECG in Acute MI

25
Q

ECG in Acute MI

  • ST Segment
26
Q

ECG in Acute MI

  • T Wave
27
Q

ECG in Acute MI

  • Pathological Q
28
Q

Pathologic Q waves are defined as …….

A

as duration >0.04 s or >25% of R-wave amplitude)

29
Q

The first change ECG change during STEMI is …….

30
Q

The ECG may be normal during the first few hours of infarction.

31
Q

In old MI: The only residual change is the ……

A

Pathological Q Wave

32
Q

site of infarction as regard to ECG

33
Q

site of infarction as regard to ECG

  • Anterior MI
34
Q

site of infarction as regard to ECG

  • Lateral MI
35
Q

site of infarction as regard to ECG

  • Inferior MI
36
Q

INVx in Acute MI

  • ECHO & Dubutamine ECHO
A
  • Ventricular wall motion abnormalities.
  • Complications: MR, myocardial aneurysm
37
Q

INVx in Acute MI

  • Nuclear Imaging
A
  • Radioactive Thallium 201, or technetium 99 m)
  • Thallium 201: is taken up by healthy myocardium & not by ischemic myocardium (cold spot)
37
Q

INVx in Acute MI

  • Coronary Angiography
A
  • reveals which vessels have been affected and the extent of damage
38
Q

INVx in Acute MI

  • Lab INVx
A
  • Leukocytosis.
  • Increased ESR: as there is tissue damage.
39
Q

TTT of Acute MI

40
Q

TTT of Acute MI

  • Prehospital
40
Q

TTT of Acute MI

  • Hospital
41
Q

Hospital TTT of Acute MI

  • General
42
Q

Hospital TTT of Acute MI

  • Relieve Chest Pain
43
Q

Hospital TTT of Acute MI

  • Thrombolytic Therapy
44
Q

Thrombolytic Therapy as Hospital TTT of Acute MI

  • Timing
A
  • The earlier that thrombolytlc therapy Is given after the onset of chest pain, the greater the benefit (thrombolytic therapy Is beneficial up to 12 hours)
45
Q

Thrombolytic Therapy as Hospital TTT of Acute MI

  • Drugs
46
Q

Thrombolytic Therapy as Hospital TTT of Acute MI

  • NB
47
Q

Thrombolytic Therapy as Hospital TTT of Acute MI

  • Absolute CI
48
Q

Thrombolytic Therapy as Hospital TTT of Acute MI

  • Relative CI
49
Q

Coronary Revascularization as Hospital TTT of Acute MI

50
Q

Coronary Revascularization as Hospital TTT of Acute MI

  • PCI
51
Q

Coronary Revascularization as Hospital TTT of Acute MI

  • CABG
52
Q

TTT of Acute MI

  • Timeline
53
Q

Hospital TTT of Acute MI

  • TTT of Early Complications
A
  1. Acute heart failure.
  2. Arrhythmia.
  3. Cardiogenic shock
54
Q

TTT of Acute MI

  • Post-Hospital
55
Q

Markers of Opening up of Infarct Related Artery

A
  1. Prompt and persistent relief of chest pain.
  2. ST resolution within 120 minutes.
  3. Arrhythmias such as accelerated idio-ventricular rhythm.
56
Q

Diagnosis of MI

(In Brief)

A

at least 2 of the following
- classic chest pain
- ECG changes
- Positive biomarkers ( cardiac enzymes)

Y4R7 - Medicine III 🩺 (26 decks)

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