MI

Question 1

why does a cardiac arrest occur after MI?

Answer 1

ventricular fibrillation

Question 2

why would a person develop cardiogenic shock after an MI?

Answer 2

if the infarction affects a large part of the ventricular myocardium that the ejection fraction decreases.

patients may require ionotropic support and or intra aortic balloon pump

Question 3

what can help in chronic heart failure?

Answer 3

loop diuretic furosemide will decrease fluid overload. ACE i and beta blockers improve long term prognosis

Question 4

what is more common following an inferior MI?

Answer 4

atrioventricular block

Question 5

besides ventricular fibrillation what other arrhythmias occur following an MI?

Answer 5

ventricular tachycardia

Question 6

in the first 48 hours after a transmural MI what can occur?

Answer 6

pericarditis (pain worse on lying flat)

Question 7

dresslers syndrome pathophysiology?

Answer 7

autoimmune reaction against antigenic proteins formed as myocardium recovers.

Question 8

what is dresslers syndrome characterised by?

Answer 8

fever, pleuritic pain, pericardial effusion and a raised ESR. treated with NSAIDs

Question 9

how does a left ventricular aneurysm develop?

Answer 9

ischaemic damage weakens the myocardium resulting in aneurysm formation- persistent TS elevation and left ventricular failure

Question 10

why does left ventricular free wall rupture?

Answer 10

3% MI, 1-2 weeks after. Acute heart failure due to tamponade (raised JVP, pulsus paradoxus diminished heart sounds)

Question 11

how to treat left ventricular free wall rupture?

Answer 11

urgent pericardiocentesis and thoracotomy

Question 12

ventricular septal defect?

Answer 12

1-2% after 1 week.
pan systolic murmur acute heart failure
echo is diagnostic to exclude mitral regurgitation
urgent surgical correction

Question 13

why do you get acute mitral regurgitation?

Answer 13

infero-posterior infarction due to ischaemia or rupture of papillary muscles,
acute hypotension pulmonary oedmea
early to mid systolic murmur
patients are treated with vasodilator therapy but require emergency surgical repair

Question 14

when should sex resume after MI and what drugs can you take after 6 months?

Answer 14

4 weeks
PDE5 inhibitors sildenafil

Question 15

PDE5 inhibitors are contraindicated with?

Answer 15

nitrates or nicorandil

Question 16

Post MI treatment prevention

Answer 16

post acute coronary syndrome (medically managed): add ticagrelor to aspirin, stop ticagrelor after 12 months
post percutaneous coronary intervention: add prasugrel or ticagrelor to aspirin, stop the second antiplatelet after 12 months

Question 17

patients with acute MI and signs of heart failure should?

Answer 17

eplerenone within 3-14 days of MI

Question 18

for thrombolysis what has clearer mortality benefits over streptokinase?

Answer 18

tissue plasminogen activator tPA

Question 19

after thrombolysis when should ECG be performed?

Answer 19

90 minutes, resolution greater than 50% in ST elevation

Question 20

how to treat hyperglycaemia in ACS

Answer 20

a dose-adjusted insulin infusion with regular monitoring of blood glucose levels to glucose below 11.0 mmol/l