Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CVS > MI > Flashcards

MI Flashcards

1
Q

What 2 conditions come under Acute Coronary Syndrome?

A
  • Unstable angina

- MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can you clinically differentiate between MI and unstable angina?

A

MI causes a rise in troponin T due to myocardial cell death, unstable angina does not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 2 types of MI?

A

STEMI

Non-STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the clinical features of MI?

A
  • Chest pain > 20 mins
  • Nausea, sweating and palpitations
  • Distress, anxiety
  • Pallor
  • Pansystolic murmor
  • Low grade fever
  • Signs of heart failure - (MI can render either the left or right ventricle non functional)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is ACS without chest pain referred to as?

A

Silent MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the clinical features of silent MI?

A
  • Syncope
  • Acute confusional state
  • Vomiting
  • Pulmonary oedema
  • Epigastric pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the differential diagnosis of MI?

A
  • Unstable Angina
  • Pericarditis
  • Myocarditis
  • Takusubo cardiomyopathy
  • Aortic dissection
  • PE
  • Pneumothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the risk factors of MI?

A
  • Smoking
  • Cocaine use
  • Hypertension
  • Hyper-lipidemia
  • Age
  • Gender
  • Family History
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the pathophysiology of MI?

A
  • Occurs as a result of fatty deposits and thrombus formation on top completely blocking the coronary vessels (coronary artery atherosclerosis)
  • Lack of oxygen causes myocardial cell death

=> Arteries most likely affected by MI

  • Left Anterior Descending (LAD) - supplies the anterior LV (V1, V2, V3, V4)
  • Right coronary artery - supplies RA, RV and inferior LV (II, III, aVF)
  • Left Circumflex artery - supplies lateral LV and LA (I, aVL, V5, V6)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the short term complications of MI?

A

=> Ventricular Fibrillation (most common cause of death):

  • Presents clinically as a cardiac arrest
  • Necrotic myocytes release K+ causes hyper-excitability of surrounding tissue
  • Other arrhythmias include: bradycardia, tachycardia, VT, SVT

=> Muscle Ruptures:

  • Rupture of free wall of ventricle - Cardiac tamponade
  • Rupture of interventricular septum - Ventricular septal defect
  • Rupture of papillary muscle of mitral valve - Mitral regurgitation

=> Pericarditis:
Transmural infarct spreads causing inflammatory response of pericardium

=> Mural thrombus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the long term complications of MI?

A
  • Progression of Chronic Heart Failure
  • Recurrent MI
  • Ventricular Aneurysm
  • Dresslers syndrome (self limiting autoimmune Pericarditis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the investigations carried out in suspected MI?

A

=> Bloods
Rise in troponin
CK-MB is most useful for re-infarction

=> ECG
Pathological Q ways
STEMI
Non-STEMI

=> Echo
Regional wall abnormalities

=> CXR
Cardiomegaly, pulmonary oedema, widened mediastinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the emergency management of STEMI?

A
  1. Attach ECG leads
  2. Establish IV access and take bloods
  3. History and Examination
  4. GTN spray, IV Diamorphine + metaclopramide
  5. Aspirin + 2nd anti-platelet (Ticagrelor, Clopidogrel, Prasugrel)
  6. Determine if PCI is available within 120 mins?
  7. Unfractionated heparin or LMWH given if patient going to have PCI

PCI AVAILABLE WITHIN 120 MINS:
- Do Primary PCI

PCI NOT AVAILABLE WITHIN 120 MINS:

  • Thrombolysis. Do an ECG within 90 mins to see if there is an improvement
  • Transfer for PCI if fibrinolysis not successful

IF MI CONTINUES POST PCI, CABG MUST BE PERFORMED

=> Oxygen therapy:

  • For those with SaO2 < 94% and not at risk of hypercapnic failure
  • For those with COPD who are at risk of hypercapnic failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the emergency management of NSTEMI?

A

All patients should receive:

  1. Aspirin
  2. IV morphine or nitrates in cases of pain

Oxygen should only be given if the patient is hypoxic

=> Considering a second anti-platelet:

  • Fondaparinux only given if patient not at high risk of bleeding and does not have angiography within the next 24 hours
  • Ticagrelor and Prasugrel preferred as the second anti-platelet over clopidogrel. Continued after initial treatement for at least 12 months
  • IV glycoprotein receptor antagonists (eptifibatide or tirofiban) given to patients with intermediate or higher risk of cardiovascular events and who will undergo angiography within 96 hours

=> Coronary angiography should be considered in patients within the first 96 hours of admission. And in patients who are clinially unstable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the main options for anti-platelets in a clinical setting?

A

=> Aspirin
Inhibits production of thromboxane A2

=> Clopidogrel
Inhibits ADP binding to its platelet receptor

=> Enoxaprain
Activates antithrombin III

=> Fondaparinux
Activates antithrombin III

=> Eptifibatide, Tirofiban
Glycoprotein receptor antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the adverse affects of Aspirin?

A
  • Bleeding
  • Indigestion
  • Haemoptysis
  • Jaundice
  • Swollen hands and feet
17
Q

What are the adverse affects of Diamorphine?

A
  • Drowsiness
  • Mental clouding
  • Nausea + vomiting
  • Constipation
  • Sweating

ADDICTIVE

18
Q

What is the secondary prevention of MI?

A

=> All patients should be offered the following drugs:

  • Dual anti-platelet therapy (Aspirin + 2nd anti-platelet therapy)
  • ACEi
  • B blockers
  • Statin

=> More on dual anti-platelet therapy:

  • ASPIRIN ALWAYS FIRST
  • Aspirin + Ticagrelor (Ticagrelor stopped after 12 months)
  • Post PCI, Aspirin + (Ticagrelor or Prasugrel), second anti-platelet stopped after 12 months

=> Lifestyle advice

  • Mediterranean diet
  • Exercise (20 to 30 mins exercise until slightly breathless)
  • Sex may resume 4 weeks after uncomplicated MI
  • PDE5 inhibitors may be used 6 months post MI

=> Aldosterone antagonists:

  • Acute MI and signs of heart failure + left ventricular systolic dysfunction
  • Prescribed within 3-14 days of MI when ACEi already given
19
Q

What is a persistent ST elevation after a previous MI suggestive of?

A

Left Ventricular Aneurysm

  • This results in blood stasis hence thrombus formation
  • Thrombus may embolise leading to a stroke
20
Q

What drugs are commonly used in thrombolysis?

A
  • Alteplase
  • Teneceteplase
  • Streptokinase
21
Q

What are the contraindications of thrombolysis?

A
  • Active internal bleeding
  • Recent trauma, haemorrhage or surgery
  • Coagulation or bleeding disorders
  • Intracranial neoplasm
  • Stroke < 3 months
  • Aortic dissection
  • Recent head injury
  • Pregnancy
  • Severe hypertension

CVS (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions