MI Secondary Survey

Question 1

Questioning Sections

Answer 1

HPC
SOCRATES
PMH
Meds
Allergies
SHx

Question 2

Cardiac HPC

Answer 2

• CP
• Arm/jaw/shoulder/abdo pain/numbness
• SOB/DIB
• Nausea
• Vomitting
• Diaphoresis
• Syncope
• Fatigue
• Leg cramps
• Impending doom

Question 3

SOCRATES

Answer 3

Site
Onset
Character
Radiation
Associations
Time
Exacerbating/Alleviating
Severity

Question 4

Cardiac RMH

Answer 4

Previous MI
Angina
Hypertension
Family history
Cardiovascular disease
Heart failure

Question 5

Cardiac Meds Questioning

Answer 5

Any cardiac meds such as

• Beta Blockers,
• Calcium Antagonists,
• Nitrates,
• ACE Inhibitors,
• Angiotensin Receptor
• Blockers,
• Diuretics,
• Antiarrhythmic Drugs,
• Anticoagulation

!!ALLERGIES!!

Question 6

Cardiac Inspection

Answer 6

Pallor
Diaphoresis
Signs of chronic heart disease (e.g. oedema)

Question 7

Cardiac Palpation

Answer 7

• Heaves and thrills,
• Pulses
• PMI

Question 8

Cardiac Ausculation

Answer 8

Adventitious sounds:

• Murmurs
• Bruits
• Extra heart sounds

Question 9

Cardiac ECG Shows Possible

Answer 9

• STEMI
• Arrythmia
• Block
• Ischameia
• Hypertrophy
• Strain

Question 10

Differnatial Diagnosis of Cardiac CP

Answer 10

• Comes on over seconds or minutes rather than instant
• Central Pain
• Crushing or constricting in nature
• Lasts >15 mins
• Can be present in abdo, shoulder, neck and jaw
  (JRCALC 2013, p128)

Question 11

ECG for MI

Answer 11

• Do not exclude ACS where patients have normal ECG
  (NSTEMI)

ECG =

• STE >=2mm in 2 adjacent precordial leads or standard leads
• LBBB with clinical features of ACS
• STDep = high risk and need urgent specialist assessment

Diabetes = higher risk of no chest pain, but SOB or collapse