MI Flashcards
Name 5 non- modifiable factors for MI/ CVS disease?
Increasing age, male, family history, ethnicity I.e. Indian, premature menopause
Name 5 modifiable factors for MI/ CVS disease?
Smoking, DM, metabolic syndrome, hypertension, hypercholesterolaemia.
What are the symptoms of MI
Chest Pain: crashing, radiating to jaw and shoulder
N&V
Sweating
SOB
Who gets atypical MI pain
DM, women, elderly
What findings can you expect on examination when MI SUSPECTED?
Cool calmly skin/ fever
Hypo or hypertension
Systolic murmur
Signs of congested heart failure
What are the parameters for diagnosis of MI on ECG, WHER are the changes in anteroseptal, lateral, high lateral, and inferior MIs?
1mm in limb and 2mm in chest leads New LBBB ANETROSEPTAL: V1-4 I.e. LAD LATERAL: V5-6 Cx High lateral: I and aVL I.e. Cx Inferior: II, III, aVf I.e. RCA
What bloods are impotent to be checked in acute MI and why?
FBC: anaemia
U&E: eGFR and kidney function, potassium level,
CRP : infective causes
Troponin: peaks at 3-12h with peak at 24-38h and drop 5-14 days
Creatine kinase: raise 3-8h peak at 24h and drop 48-72h
Glucose: risk profile
Lipids: risk profile
What investigations other than bloods are important to consider with MI
CXR: role out HF and lung pathology
ABG: asses perfusion
ECG: extent and presence of infart
What are the key steps in management of acute MI ?
ABC APPROACH including IV access, oxygen (15l aim for 94-98% or 88-92% in COPD)
12-lead ECG
Aspirin 300mg
Dimorphine 2.5-10mg IV + antiemetics
What is the definitive treatment for STEMI? What are the indications ?
PCI if available: if can be done in
What are the absolute contraindications for thrombolysis
Stroke
What are the relative contraindications for thrombolysis
Warfarin, pregnancy, advanced liver disease, infective endocarditis
What are the major complications of thrombolysis
Bleeding, hypotension, intracranial haemorrhage, repercussion arrhythmia, systemic emboli, allergic reactions
What is the management of late presenting STEMI
Aspirin, copidogrel, anti thrombin agents
What are the main complications of STEMI? Hint: SPRERAD
Sudden death Pump failure and pericarditis Ruptured papillary muscle or septum Embolism Aneurism, arrhythmia Dresser's syndrome
What is the discharge regiment for STEMI?
Antiplatelet: aspirin and clipidegrel ACEi Beta blocker Statin Address RF No driving for 4weeks
What are the 4main parts and their components in management of NSTEMI
Analgesia: morphine
Anti-ischiaemia: GTN/nitrogen, ACEi, beta blocker, statin
Antiplatelet: aspirin and clopidogrel
Anti thrombotic: LMWH, Fondaparinux
What are the indications for PCI in NSEMI/UA
High troponin Recurrent ischiaemia with optimal management Heart failure Poor LV function Haemodynamical instability Recent PCI Previous CABG
What are the indications for CABG
Failed PCI OR not emendable by it
Presence of symptoms post PCI
MULTIVESSEL DISEASE
What is the prevalence of CVS deaths in males and females?
Male 1/5 and female 1/6
what is the mortality from acute MI
1/5M 1/6F
what is the incidence of MI
6 and 2/1000 M and F
What is the sequence of events that leads to thrombus formation
Injury →lipoprotein oxidation (macrophages→ Foam cells)→ cytokines ↑→fat accumulation &SMC →plaque→ rupture→ platelet aggregation →thrombosis
what are the indications for PCI
what is the preparation for PCI
glycoprotein IIb/IIIa and LMWH
What are the risk fcators that determine CAD
Age dependent, DM, smoking, ↑cholesterol
what are the criteria for referral in someone with angina
- Pain at rest/minimal exertion
* Rapid progress despite treatment
what lifestyle advice can be given to someone with angina
- Driving: no symptoms at rest/stress
* Diet exercise and weight loss
what is the advice that should be given to patient if they are experiencing angina pain
GTN (1 puff every 5 min call ambulance after 3)
what is the main management for angina
- Calcium channel antagonists reduce afterload
- β-blockers => reduce HR&contractility
AND secondary prevention i.e. statin, aspirin ACEi re-vasculisation depending on risk profile
what is the prognosis in angina
1/10 will suffer MI
