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302 - Content > MI > Flashcards

MI Flashcards

1
Q

Why does MI occur

A

Due to myocardial ischemia

Permanent necrosis

(High oxygen demand and/or low oxygen supply)

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2
Q

Sign and symptoms?

A

• chest tightness
• pain of arm, chest, neck, back and epigastric
• syncope
• N&V
• sweating

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3
Q

What test would you preform?

A

• ECG
• chest examination
• troponin test

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4
Q

What do you know about troponin

A

• Biomarker in MI
• release when injury to myocyte cells
• shouldn’t be interpreted alone - need clinical presentation to support diagnosis
• highly sensitive, even at low concentrations

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5
Q

How long after onset of pain, should troponin be measured to exclude myocardial injury

A

6 hours

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6
Q

Troponin can be used to predicate the response of which drugs?

A

• LMWH
• anti platelets (tirofiban)
• anti platelets used in adjunctive you PCI

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7
Q

Creatinine kinase elevates when….

A

Injury to muscle fibres

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8
Q

What is the management of acute chest pain in an ambulance?

A

M - morphine (IV)
O - oxygen
N - nitrates
A - anti platelets / antiemetics

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9
Q

Characteristics of STEMI?

A

• persistent ST elevation
• new left bundle branch block

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10
Q

Complications of management of STEMI?

A

• pain
• cardiogenic shock
• LV failure
• arrhythmia

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11
Q

What factors should not be taken into account when assessing eligibility for PCI

A

• age
• gender
• ethnicity
• level of consciousness

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12
Q

Who is eligible for PCI?

A

Patients with:
• presenting chest pain within 12 hours & PCI can be done within 120 mins
OR
• presenting with cariogenic shock

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13
Q

What is the first step in management STEMI

A

Offer 300mg loading dose of Aspirin

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14
Q

If patient is eligible for reperfusion therapy, what are the 2 options

A

Angiography with follow up PCI
OR
Fibrinolysis

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15
Q

If patient is not eligible for reperfusion therapy, what is the other option

A

Medical management

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16
Q

What is the step by step management for some eligible for angiography with PCI?

A

Step 1: angiography, the PCI
Step 2 (drug therapy for PCI):
• prasgurel with aspirin OR clopidogrel with aspirin

If over 75 and prasgurel bleeding risk is too high - replace with ticagrelor or clopidogrel

Step 3 (antithrombin) - two options
• 1: unfractioned heparin + bailout GPI + dual antiplatlet - for radial access
• 2 bilvalirudin + bailout GPI + dual antiplatlet

Step 4: stenting
Step 5: asses LV function
Step 6: secondary prevention (rehabilitation)

17
Q

When will fibrinolysis be recommended?

A

When presenting with 12 hours of pain onset but PCI cannot be gone with 2 hours

18
Q

What is the step by step management for someone for fibrinolysis

A

S1: offer antothrombotics, then ECG after fibrinolysis
S2: offer ticragrelor with Aspirin OR clopidogrel with Asprin OR Aspirin alone

If reperfusion fails, then:
• do not repeat fibrinolysis
• angiography then PCI

Assess LV function

Secondary prevention

19
Q

If someone with STEMI cannot undergo perfusion, what is the step by step procedure for medical management

A

Offer ticagrelor with Aspirin, but if high bleeding risk then given Clopidogrel with Aspirin. But if still higher bleeding risk just give Aspirin

Assess LV

Secondary prevention

20
Q

What are the characteristics of NSTEMI?

A

• No ST elevation
• chest pain

21
Q

GRACE is a scoring system to?

A

Predict 6 month mortality rate

22
Q

What does the risk assessment include?

A

• medical hx
• ECG
• physical examination
• bloods: troponin, creatinine, glucose, heamoglobin

23
Q

What is the step by step management for someone with <3% mortality risk?

A

Step1: 300mg aspirin
Step 2: fondaparinux
Step 3: grace and risk assessment
Step 4: ticagrelor (or clopidogrel) + asprin or asprin alone
Step 5: assess LV function
Step 6: secondary prevention

24
Q

What is the step by step management for someone with >3% mortality risk?

A

Step1: 300mg aspirin
Step 2: fondaparinux
Step 3: grace and risk assessment
Step 4: angiography and PCI within 72 hours.
Step 5: prasugrel + aspirin
Step 6: assess LV function
Step 7: secondary prevention

25
Q

List the drugs used for cardiac rehabilitation & secondary prevention

A

• dual antiplatlets (12m)
• BB
• ACEI
• statins

Including: lifestyle

26
Q

Which drugs are used pre and post PCI, for VTE prophylaxis

A

PRE PCI
• fondaparinux 2.5mg OD
• for 8 days
• SC

POST PCI
• LMWH

27
Q

Fondaparinux moa

A

Neutralises factor Xa - inhibiting thrombin formation

28
Q

What other drugs are Xa inhibitors

A

• apixaban
• edoxaban
• rivaroxaban

29
Q

What class of medication do you give if HF occurs with reduced left ventricular ejection fraction

A

Aldesterone inhibitor - spiractalone

302 - Content (44 decks)

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