MI

Question 1

What is ACS

Answer 1

acute coronary syndrome

Question 2

what is chem marker of cv necrosis

Answer 2

troponin

Question 3

pain ACS

Answer 3

central crushing chest pain
nausea
impending sense of doom
pain radiating to arm/jaw

Question 4

first line of investigation ACS

Answer 4

ECG

Question 5

why could troponin be elevated but not MI (4)

Answer 5

kidney, sepsis, PE, aortic dissection

Question 6

how many ecgs should you do?

Answer 6

a series (plenty as dynamic situation)

Question 7

ST elevation not MI

Answer 7

pericarditis, digoxin toxicity

Question 8

when think of MI

Answer 8

RISK FACTORS
DM
smoking
overweight
HTN etc

Question 9

stable angina definition

Answer 9

angina on exertion relieved by rest or GTN

Question 10

unstable angina

Answer 10

obviously worsening angina

Question 11

bloods ACS

Answer 11

troponin
FBC
renal

Question 12

gold standard test find ischaemia

Answer 12

coronary angiogram

Question 13

what is reperfusion

Answer 13

percutaneous coronary intervention = balloon stent

Question 14

what tablets initially after MI

Answer 14

anti-platelets - aspirin for all
clopi or ticagrelor
swap in prasugrel after surgery

Question 15

how many ppl unresponsive for clopi

Answer 15

30%

Question 16

higher ischamic risk, which second anti-platelet

Answer 16

ticagrelor

Question 17

give oxygen in ACS

Answer 17

only if hypoxic

Question 18

which antiplatelets are more potent but higher bleeding risk

Answer 18

ticagrelor or prasugrel

Question 19

higher bleeding risk in pts

Answer 19

ticagrelor or prasugrel so prescribe clopi

Question 20

when prasugrel

Answer 20

ONLY AFTER ANGIOGRAM/surgery

Question 21

LV function impaired, what drugs

Answer 21

statin
b blocker
acei

Question 22

what use if v acute tachycardic

Answer 22

short acting b blocker eg metaprolol

Question 23

STEMI timeline

Answer 23

should have balloon with 120 mins

Question 24

NSTEMI timeline

Answer 24

angiography but ballooon quickly if unwell/unstable
within 72h if stable

Question 25

what history v important

Answer 25

family history

Question 26

fondaparinux mechanim of action

Answer 26

inhibits factor Xa

Question 27

compare antiplatelet meds

Answer 27

clopidogrel is weaker but safer for bleeders ticagrelor is stronger but less safe for bleeders prasugrel is better than ticagrelor but needs to be stopped 7d before surgery so only to be used post surgery

Question 28

what is Wellen syndrome? what would you see in ECG?

Answer 28

significant proximal LAD disease. MI in 1-2weeks. Big inverted T waves in anterior leads

Question 29

what do you do if Wellens syndrome + inability to control chest pain medicallly + dynamic ST depressions. WHy?

Answer 29

call cardiology! for immediate catheterisation only 80% of completely occluded CA MIs have elevated ST. This patient is in the 20%

Question 30

what is PCI

Answer 30

balloon angioplasty

Question 31

what scoring system is used in MI

Answer 31

GRACE

Question 32

what are the 3 ACS type 1 sub-types

Answer 32

STEMI NSTEMI UA

Question 33

what is Fondaparinux?

Answer 33

another anticoagulant

Question 34

mechanism of action ticagrelor

Answer 34

reversibly prevents adp binding to platelets

Question 35

mech of action clopidogrel

Answer 35

binds specifically and irreversibly to the platelet P2RY12 purinergic receptor, inhibiting ADP-mediated platelet activation and aggregation

Question 36

mech of action prasugrel

Answer 36

Prasugrel is a thienopyridine, an irreversible antagonist of the ADP P2Y12 receptor. [2] Thienopyridine antiplatelet agents interfere with platelet activation and aggregation induced by ADP. [1] The antiplatelet effect of prasugrel lasts for the lifespan of platelets

Question 37

what complication 7 days after PCI

Answer 37

cardiac tamponade

Question 38

which clotting factors affected by Warfarin

Answer 38

1972 plus protein C

Question 39

main cause of mitral stenosis

Answer 39

rheumatic fever

Question 40

key diagnostic feature of Left HF

Answer 40

Paroxysmal nocturnal dyspnoea

Question 41

origin of Tetralogy of Fallot

Answer 41

neural crest doesn't migrate properly

Question 42

arterial ulcer looks like...

Answer 42

pale ulcer which has a 'punched out' appearance

Question 43

which cardiac anomaly Patau

Answer 43

VSD

Question 44

in HF, which drugs provide prognostic advantage

Answer 44

ACE i

Question 45

chest pain relieved by leaning forwards

Answer 45

pericarditis

Question 46

left renal artery originates at which level`

Answer 46

T1 - slightly inferior to right renal artery

Question 47

propanolol is lipid soluble so it can...

Answer 47

cross the BBB

Question 48

Parathyroid glands are supplied oxygenated blood by the..

Answer 48

by the superior and inferior thyroid arteries.