MI Flashcards
What is ACS
acute coronary syndrome
what is chem marker of cv necrosis
troponin
pain ACS
central crushing chest pain
nausea
impending sense of doom
pain radiating to arm/jaw
first line of investigation ACS
ECG
why could troponin be elevated but not MI (4)
kidney, sepsis, PE, aortic dissection
how many ecgs should you do?
a series (plenty as dynamic situation)
ST elevation not MI
pericarditis, digoxin toxicity
when think of MI
RISK FACTORS
DM
smoking
overweight
HTN etc
stable angina definition
angina on exertion relieved by rest or GTN
unstable angina
obviously worsening angina
bloods ACS
troponin
FBC
renal
gold standard test find ischaemia
coronary angiogram
what is reperfusion
percutaneous coronary intervention = balloon stent
what tablets initially after MI
anti-platelets - aspirin for all
clopi or ticagrelor
swap in prasugrel after surgery
how many ppl unresponsive for clopi
30%
higher ischamic risk, which second anti-platelet
ticagrelor
give oxygen in ACS
only if hypoxic
which antiplatelets are more potent but higher bleeding risk
ticagrelor or prasugrel
higher bleeding risk in pts
ticagrelor or prasugrel so prescribe clopi
when prasugrel
ONLY AFTER ANGIOGRAM/surgery
LV function impaired, what drugs
statin
b blocker
acei
what use if v acute tachycardic
short acting b blocker eg metaprolol
STEMI timeline
should have balloon with 120 mins
NSTEMI timeline
angiography but ballooon quickly if unwell/unstable
within 72h if stable
what history v important
family history
fondaparinux mechanim of action
inhibits factor Xa
compare antiplatelet meds
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
what is Wellen syndrome? what would you see in ECG?
significant proximal LAD disease. MI in 1-2weeks. Big inverted T waves in anterior leads
what do you do if Wellens syndrome + inability to control chest pain medicallly + dynamic ST depressions. WHy?
call cardiology! for immediate catheterisation
only 80% of completely occluded CA MIs have elevated ST. This patient is in the 20%
what is PCI
balloon angioplasty
what scoring system is used in MI
GRACE
what are the 3 ACS type 1 sub-types
STEMI
NSTEMI
UA
what is Fondaparinux?
another anticoagulant
mechanism of action ticagrelor
reversibly prevents adp binding to platelets
mech of action clopidogrel
binds specifically and irreversibly to the platelet P2RY12 purinergic receptor, inhibiting ADP-mediated platelet activation and aggregation
mech of action prasugrel
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
what complication 7 days after PCI
cardiac tamponade
which clotting factors affected by Warfarin
1972 plus protein C
main cause of mitral stenosis
rheumatic fever
key diagnostic feature of Left HF
Paroxysmal nocturnal dyspnoea
origin of Tetralogy of Fallot
neural crest doesn’t migrate properly
arterial ulcer looks like…
pale ulcer which has a ‘punched out’ appearance
which cardiac anomaly Patau
VSD
in HF, which drugs provide prognostic advantage
ACE i
chest pain relieved by leaning forwards
pericarditis
left renal artery originates at which level`
T1 - slightly inferior to right renal artery
propanolol is lipid soluble so it can…
cross the BBB
Parathyroid glands are supplied oxygenated blood by the..
by the superior and inferior thyroid arteries.
