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phase 2 cardio > MI > Flashcards

MI Flashcards

1
Q

Name 5 non- modifiable factors for MI/ CVS disease?

A

Increasing age, male, family history, ethnicity I.e. Indian, premature menopause

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2
Q

Name 5 modifiable factors for MI/ CVS disease?

A

Smoking, DM, metabolic syndrome, hypertension, hypercholesterolaemia.

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3
Q

What are the symptoms of MI

A

Chest Pain: crashing, radiating to jaw and shoulder
N&V
Sweating
SOB

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4
Q

Who gets atypical MI pain

A

DM, women, elderly

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5
Q

What findings can you expect on examination when MI SUSPECTED?

A

Cool calmly skin/ fever
Hypo or hypertension
Systolic murmur
Signs of congested heart failure

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6
Q

What are the parameters for diagnosis of MI on ECG, WHER are the changes in anteroseptal, lateral, high lateral, and inferior MIs?

A 
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
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7
Q

What bloods are impotent to be checked in acute MI and why?

A

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

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8
Q

What investigations other than bloods are important to consider with MI

A

CXR: role out HF and lung pathology
ABG: asses perfusion
ECG: extent and presence of infart

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9
Q

What are the key steps in management of acute MI ?

A

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

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10
Q

What is the definitive treatment for STEMI? What are the indications ?

A

PCI if available: if can be done in

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11
Q

What are the absolute contraindications for thrombolysis

A

Stroke

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12
Q

What are the relative contraindications for thrombolysis

A

Warfarin, pregnancy, advanced liver disease, infective endocarditis

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13
Q

What are the major complications of thrombolysis

A

Bleeding, hypotension, intracranial haemorrhage, repercussion arrhythmia, systemic emboli, allergic reactions

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14
Q

What is the management of late presenting STEMI

A

Aspirin, copidogrel, anti thrombin agents

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15
Q

What are the main complications of STEMI? Hint: SPRERAD

A 
Sudden death
Pump failure and pericarditis
Ruptured papillary muscle or septum
Embolism
Aneurism, arrhythmia
Dresser's syndrome
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16
Q

What is the discharge regiment for STEMI?

A 
Antiplatelet: aspirin and clipidegrel
ACEi
Beta blocker
Statin
Address RF 
No driving for 4weeks
17
Q

What are the 4main parts and their components in management of NSTEMI

A

Analgesia: morphine
Anti-ischiaemia: GTN/nitrogen, ACEi, beta blocker, statin
Antiplatelet: aspirin and clopidogrel
Anti thrombotic: LMWH, Fondaparinux

18
Q

What are the indications for PCI in NSEMI/UA

A 
High troponin
Recurrent ischiaemia with optimal management
Heart failure
Poor LV function 
Haemodynamical instability
Recent PCI 
Previous CABG
19
Q

What are the indications for CABG

A

Failed PCI OR not emendable by it

Presence of symptoms post PCI
MULTIVESSEL DISEASE

20
Q

What is the prevalence of CVS deaths in males and females?

A

Male 1/5 and female 1/6

21
Q

what is the mortality from acute MI

A

1/5M 1/6F

22
Q

what is the incidence of MI

A

6 and 2/1000 M and F

23
Q

What is the sequence of events that leads to thrombus formation

A

Injury →lipoprotein oxidation (macrophages→ Foam cells)→ cytokines ↑→fat accumulation &SMC →plaque→ rupture→ platelet aggregation →thrombosis

24
Q

what are the indications for PCI

A
25
Q

what is the preparation for PCI

A

glycoprotein IIb/IIIa and LMWH

26
Q

What are the risk fcators that determine CAD

A

Age dependent, DM, smoking, ↑cholesterol

27
Q

what are the criteria for referral in someone with angina

A
  • Pain at rest/minimal exertion

* Rapid progress despite treatment

28
Q

what lifestyle advice can be given to someone with angina

A
  • Driving: no symptoms at rest/stress

* Diet exercise and weight loss

29
Q

what is the advice that should be given to patient if they are experiencing angina pain

A

GTN (1 puff every 5 min call ambulance after 3)

30
Q

what is the main management for angina

A
  • Calcium channel antagonists reduce afterload
  • β-blockers => reduce HR&contractility

AND secondary prevention i.e. statin, aspirin ACEi re-vasculisation depending on risk profile

31
Q

what is the prognosis in angina

A

1/10 will suffer MI

phase 2 cardio (5 decks)

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