MI diagnosis and treatment Flashcards
What is required for a diagnosis of MI?
- A rise (or fall) or troponin with at least 1 value >99th percentile + at least one of the following
- Identification of a thrombus
- Pathological changes to ECG
- Damage to myocardium on the echo
- Symptoms of MI
ST segment depression indicates…
Multivessel disease and therefore a poorer prognosis
When does ST elevation begin, and when does it end
Within minutes
Persists for up to 2 weeks
A persisting ST elevation indicates..
LV aneurysm
What are the inferior leads?
What artery is this?
II, III, aVF
RCA
What are the lateral leads?
What artery is this?
1, aVL, V5, V6
Circumflex
What are the septal leads?
What artery is this?
V1, V2
LAD
What are the anterior leads?
What artery is this?
V3, V4
RCA
Troponin is a marker of…
Cardiac Necrosis
Highly specific and selective
Describe the timeline of troponin
May be elevated within 6 hours
Usually detected 7-10 hours
Can remain elevated for 7 days
When is creatinine kinase level categorised as abnormal
When double the baseline
Is creatinine kinase specific to cardiac tissue?
No
Describe the timeline of creatinine kinase levels post MI
Rise 4-6 hours post STEMI
Peak 24 hours
Fall in 3-4 days
Emergency management of STEMI?
- Morphine
- Oxygen is O2 SATS <94%
- Nitrates
- Aspirin 300mg, Clopidogrel/ ticagrelor 300mg (esp if going for PCI)
- Go to primary PCI asap
When is thrombolysis indicated?
When PPCI can’t be done within 120 minutes of chest pain
What drugs are given to the pt for secondary prevention of MI?
- Ace inhibitor
- Beta Blocker
- Statin
- Aspirin
- Clopidegril/ ticagrelor
Does an inferior, anterior, or posterior site have the worst prognosis
Anterior
What drugs should a patient be on if they are going to have PCI
- Aspirin
- A2Y12 inhibitor
- Unfractionated LMWH
What ECG changes indicate PCI
- ST >2mm in 2 consequetive anterior leads
- ST >1mm in 2 consequetive inferior leads
- New LBBB
