MI Cases- Leah (3)

Question 1

Initial management of chest pain in the ER?

Drugs + what should you DO?

Answer 1

MONA

Morphine
Oxygen
Nitroglycerin; (unless HYPOtensive patient/inferior wall infarct)
Aspirin

+ EKG, troponins, Call cath lab

Question 2

When are thrombolytics the standard of care for acute MI?

Answer 2

• Only when you cannot get the patient into a cath lab within two hours
• Otherwise, cath/angioplasty are the standard of care

Question 3

What are long term treatments for MI?

Answer 3

SAAB
(^^^Winning - this makes me so happy :) )

• Statins (prevent plaques, prevent inflammation)
• Anti-coagulants (if patient got stent)
• ACEi (prevents ventricular remodeling)
• B-blockers

Question 4

Acute coronary syndrome criteria

Answer 4

Must meet 2/3:

• Chest discomfort
• • troponins
• EKG changes

Question 5

TMI Risk score for NSTEMI

Answer 5

THREATS

T-timing in last 24 hours 
H- history of CAD known 
R- risk factors for CAD (3 or more) 
E- EKG change 
A-aspirin use in last 24 hours 
T- troponins elevated 
S-sixty five or older 

Each risk = one point

Question 6

Difference between unstable angina and MI:

Answer 6

Just troponins (bc cell death)
-unstable angina will have normal troponins, MI will not

Question 7

What is broken heart syndrome?

Answer 7

Stress cardiomyopathy; diffuse vasospasm
Thought to be brought on by hormone surge
Does not increase risk of MI
**Do spill troponins and see EKG changes
Treat like MI until proven otherwise.

Question 8

What are “reciprocal” changes on EKG in a STEMI?

Answer 8

-ST depression in leads V1-3, if elevation is in leads 1-3, or vice versa.
(Location of elevation/depression depends on location of infarct)

Solidifies diagnosis