MI Flashcards
Why does MI occur
Due to myocardial ischemia
Permanent necrosis
(High oxygen demand and/or low oxygen supply)
Sign and symptoms?
• chest tightness
• pain of arm, chest, neck, back and epigastric
• syncope
• N&V
• sweating
What test would you preform?
• ECG
• chest examination
• troponin test
What do you know about troponin
• 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
How long after onset of pain, should troponin be measured to exclude myocardial injury
6 hours
Troponin can be used to predicate the response of which drugs?
• LMWH
• anti platelets (tirofiban)
• anti platelets used in adjunctive you PCI
Creatinine kinase elevates when….
Injury to muscle fibres
What is the management of acute chest pain in an ambulance?
M - morphine (IV)
O - oxygen
N - nitrates
A - anti platelets / antiemetics
Characteristics of STEMI?
• persistent ST elevation
• new left bundle branch block
Complications of management of STEMI?
• pain
• cardiogenic shock
• LV failure
• arrhythmia
What factors should not be taken into account when assessing eligibility for PCI
• age
• gender
• ethnicity
• level of consciousness
Who is eligible for PCI?
Patients with:
• presenting chest pain within 12 hours & PCI can be done within 120 mins
OR
• presenting with cariogenic shock
What is the first step in management STEMI
Offer 300mg loading dose of Aspirin
If patient is eligible for reperfusion therapy, what are the 2 options
Angiography with follow up PCI
OR
Fibrinolysis
If patient is not eligible for reperfusion therapy, what is the other option
Medical management
What is the step by step management for some eligible for angiography with PCI?
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)
When will fibrinolysis be recommended?
When presenting with 12 hours of pain onset but PCI cannot be gone with 2 hours
What is the step by step management for someone for fibrinolysis
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
If someone with STEMI cannot undergo perfusion, what is the step by step procedure for medical management
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
What are the characteristics of NSTEMI?
• No ST elevation
• chest pain
GRACE is a scoring system to?
Predict 6 month mortality rate
What does the risk assessment include?
• medical hx
• ECG
• physical examination
• bloods: troponin, creatinine, glucose, heamoglobin
What is the step by step management for someone with <3% mortality risk?
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
What is the step by step management for someone with >3% mortality risk?
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
List the drugs used for cardiac rehabilitation & secondary prevention
• dual antiplatlets (12m)
• BB
• ACEI
• statins
Including: lifestyle
Which drugs are used pre and post PCI, for VTE prophylaxis
PRE PCI
• fondaparinux 2.5mg OD
• for 8 days
• SC
POST PCI
• LMWH
Fondaparinux moa
Neutralises factor Xa - inhibiting thrombin formation
What other drugs are Xa inhibitors
• apixaban
• edoxaban
• rivaroxaban
What class of medication do you give if HF occurs with reduced left ventricular ejection fraction
Aldesterone inhibitor - spiractalone
