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AY Cardiovascular > MI > Flashcards

MI Flashcards

1
Q

What is chronic stable angina?

A

Fixed stenosis
Demand led ischaemia
Predictable
Safe

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2
Q

What is an acute coronary syndrome?

A

Acute presentation of coronary artery disease (is a provisional diagnosis)

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3
Q

What are the 2 types of acute MI?

A

STEMI

NSTEMI

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4
Q

What is the pathogens is of acute coronary syndromes?

A 
Normal 
Fatty streak 
Atherosclerotic plaque 
Fibrous plaque 
Plaque rupture/fissure & thrombosis
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5
Q

Risk factors for MI

A 
Smoking 
Alcohol stress 
Hypertension 
Drug abuse 
High cholestrol 
Age 
Obesity 
Gender 
Family History
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6
Q

Factors that can cause an atheroma plaque to rupture?

A

Sudden changes in infra luminal pressure or tone
Bending & twisting of an artery during heart contraction
Lipid content of plaque
Thickness of fibrous cap
Plaque shape
Mechanical injury

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7
Q

What are the stages of the platelet cascade?

A 
Initiation (vascular damage) 
Adhesion 
Activation 
Release of activators 
Surface receptors 
Amplification of platelet activation 
Activation triggers inflammatory cascade
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8
Q

Clinical presentation of MI

A 
Severe crushing central chest pain 
Radiating to jaw and arms (esp. left)
Similar to angina but more severe, prolonged 
Not relieved by GTN 
Sweating 
Nausea 
Vomiting
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9
Q

What changes does a STEMI cause in an ECG?

A 
ST elevation (first few hours) 
Q wave formation and T wave inversion (first day)
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10
Q

What leads does a inferior STEMI affect?

A

II
II
aVF

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11
Q

What leads does an anterior MI affect?

A

V1 - V6

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12
Q

What leads does anteroseptal MI affect?

A

V1 - V4

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13
Q

What leads does am anterolateral MI affect?

A

I
aVL
V1 - V6

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14
Q

Investigations to diagnose MI

A

CK

troponin T

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15
Q

How does an MI affect CK?

A

Peaks in 24 hours

Also in skeletal muscle and brain

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16
Q

How does an MI affect troponin T?

A

Highly specific for muscle damage

Raised after MI

17
Q

Early treatment of STEMI

A 
Analgesia - diamorphine IV 
Anti-ometic IV 
Aspirin 300mg and clopidogrel 300mg 
GTN - if BP > 90 mmHg 
Oxygen if hypnosis 
Primary angioplasty 
Thrombolysis (if angioplasty not available within 90 mins)
18
Q

What are the indications for reperfusion therapy?

Thrombolysis or PCI

A

Chest pain suggestive of acute MI
ECG changes (ST elevation - NEW LBB)
No contraindications

19
Q

What are the risks of thrombolytic therapy?

A

Failure to re-perfuse
Haemorrhage
Hypersensitivity

20
Q

Complications of an MI

A

Death
Arrhythmic complications
Structural complications
Functional complications

21
Q

Most common arrhthymic complication of an MI

A

Ventricular Fibrillation

22
Q

Structural complications of an MI

A 
Cardiac rupture 
Ventricular septal defect 
Mitral valve regurgitation 
Left ventricular aneurysm 
Inflammation 
Acute pericarditis 
Dressler's syndrome
23
Q

Functional complications of an MI

A

Acute ventricular failure (left, right, both)
Chronic cardiac failure
Cardiogenic shock

24
Q

What are the 4 phases of cardiac rehab?

A

Phase 1 - in-patient
Phase 2 - early post discharge period
Phase 3 - structured exercise programme (hospital based)
Phase 4 - long term maintenance of new lifestyle (community based)

25
Q

Immediate treatment of acute MI

A

MONA + C

  • morphine (with antiemetic)
  • oxygen
  • nitroglycerin
  • aspirin 300mg + clopidogrel 300mg
26
Q

Treatment of STEMI

A

Oral betablocker
(Not if heart failure, low output, increased risk of cardiogenic shock)
Reperfusion (PCI)
Thrombolysis (streptokinase)

27
Q

Complications of MI

A 
Arrthymias 
Ventricular septal perforation 
Ischaemic mitral renege 
Papillary muscle rupture 
Systemic embolism 
Ventricular aneurysm 
Pericarditis 
Cardiogenic shock
28
Q

Patient has had MI and VT but after return to sinus rhythm has become hypotensive and shows signs of pulmonary oedema.
Treatment?

A 
MONA 
No nitrates because hypotensive 
No beta blocker because in heart failure
IV furosemide
IV inotropic agents (dopamine) 
Intra aortic balloon pump
29
Q

What drugs therapy should all patients who’ve had an MI be taking?

A

ACE inhibitor
Aspirin
Beta-blocker
Statin

30
Q

ST elevation in leads II, III and aVF is indicative of what?

A

Inferior MI

31
Q

ST elevation in leads V1-6 is indicative of what?

A

Anterior MI

AY Cardiovascular (28 decks)

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