MI

Question 1

Non modifiable risk factors

Answer 1

Age, Sex, Family History, EThnicity

Question 2

Diagnosis

Answer 2

12 Lead eelectrocardiogram elevation of ST implies cell death

Question 3

Biochemistry indicators

Answer 3

Troponin - but too sensitive
Creatinine kinase the best one for guidance

dont use CK initially best after 6 hours and if troponin still lower after 6 hours send home

Question 4

Symptoms

Answer 4

Chest pain = tightness around chest, nausea (vomitting may be common), sweating and perspiration, shrotness of breath

Question 5

Percutaneous coronary intervetion

Answer 5

PCI is a non
-
surgical procedure 
that uses a catheter (a thin 
flexible tube) to place a small 
structure called a stent to open 
up blood vessels in the heart 
that have been narrowed by 
atherosclerosis

Question 6

which stent

Answer 6

Bare metal or drug eluting stent

PCI is a non
-
surgical procedure 
that uses a catheter (a thin 
flexible tube) to place a small 
structure called a stent to open 
up blood vessels in the heart 
that have been narrowed by 
atherosclerosis

Question 7

Fibrinolysis drugs

Answer 7

used if there was pronlonged ischaemic pain in the last 12 hours in the presence of a signficant ST segement elevation

Question 8

Which reperfusion strategy?

Answer 8

The 
benefit of
PCI
over fibrinolysis is greater as the time between 
symptom onset and presentation 
increases 
Australian 
guidelines 
recommend 
that
PCI
should be performed within:
•
60
minutes for patients presenting within the first hour of symptom onset
•
90
minutes for patients presenting between 1
and 3
hours after symptom 
onset
•
90
to 120
minutes for patients presenting between 3
and 12
hours
If these targets cannot be reached, fibrinolysis should be given within 
30
minutes of arrival in 
hospital

Question 9

Coronary angiography

Answer 9

A procedure 
in which a special X
-
ray 
of the
coronary arteries 
is taken to 
see if they are narrowed or 
blocked
•
Should be done within 48 hours if 
possible after fibrinolysis
•
Sooner 
if there is failure to 
reperfuse
after fibrinolysis

Question 10

Coronary Artery Bypass Graft

Answer 10

Bypass with artery

Question 11

Long term management

Answer 11

Dual therapy for 12 months then single antiplatelet lifelong (usually aspirin)
•
Beta blockers
•
Not to be started in decompensated 
heart failure, heart block, or significant 
bradycardia
•
ACE inhibitors (or ARBs)
•
Evidence for reducing ventricular remodelling and improving outcomes
•
For ARBs valsartan has the best evidence 
•
Statin
•
irrespective 
of lipid levels 
•
PRN sublingual nitrates
•
Cardiac rehabilitation

Question 12

Dual antiplatlet therapy

Answer 12

Aspirin 75
-
100mg daily for everyone
•
Unless real contraindication
Three 
choices for the 
second agent
•
Ticagrelor
•
Clopidogrel
•
For 
the elderly and those with prior TIA or stroke
•
Prasugrel
•
For 
select patients only

Question 13

Ticagrelor

Answer 13

direct adenosine receptor antagonist
•
Quicker onset that 
clopidogrel
or 
prasugrel
•
Less bleeding than with 
clopidogrel
in all age 
groups

Question 14

Statin

Answer 14

helps reduce inflammation to reduce future plugs forming

Question 15

Beta blocker and choices

Answer 15

reduce infaraciton and sudden death

reduce oxygen demand

Atenolol
•
Metoprolol
•
Tartarate
is 
often the first choice 
agent due to 
wuick
onset of action and 
short duration 
•
Succinate can be used only if patient has heart failure
•
Carvedilol
•
Especially 
if there is considerable reduction in EF
•
Bisoprolol
•
Heart failure

Question 16

ACE inhib

Answer 16

Aim to maximise dose to:
•
reduce 
the stress on 
the ventricular 
wall
•
increase the cardiac output
•
decrease 
the reflex reduction in 
GFR
Aim for a minimum of 2.5mg perindopril or 
equivalent on 
discharge
•
Aim 
for dose increase every 4 weeks
•
Each dose increment is a doubling of the 
dose

Question 17

ARBS - sartans

Answer 17

valsartan highest dose possible