Myocardial infarction

Question 1

Myocardial injury

Answer 1

• at least one of the cardiac troponin levels is above the 99th percentile.
• no clinical evidence

Question 2

Myocardial infarction

Answer 2

• elevated troponin levels

- clinical evidence

Question 3

Types of MI

Answer 3

Type 1-5

Question 4

Types of MI

-Type 1

Answer 4

• classical
• caused by atherosclerotic plaque disruption or acute coronary thrombosis
• usually manifests as STEMI
• rise and/or fall of troponin levels + at least one: symptoms, new ischemic ECG changes, pathological Q wave, imaging evidence, identification of a coronary thrombus by angiography
• Symptoms: central chest pain, tightness, nausea, vomiting, pain radiates to left arm, dyspnea.
• duration: >20min.
• relieving factors: nitroglycerine partially effective, opioids.
• atypical symptoms: palpitations, cardiac arrest –> may happen in diabetic patients.

Question 5

Types of MI

-Type 2

Answer 5

• short- and long- term mortality rates is generally higher.
• due to oxygen supply/demand mismatch
• most common in women and people with comorbidities
• rise and/or fall of troponin levels + evidence of an imbalance between myocardial oxygen supply and demand unrelated to coronary thrombosis + at lest one: symptoms, new ischemic ECG changes, development of pathological Q wavs, imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology.

Question 6

Types of MI

-Type 3

Answer 6

-results in death when biomarker values are unavailable

Question 7

Types of MI

-Type 4

Answer 7

-related to percutaneous coronary intervention

Question 8

Types of MI

-Type 5

Answer 8

-related to coronary artery bypass grafting

Question 9

MI

-clinical features

Answer 9

• classic presentation: acute retrosternal chest pain (dull, squeezing pressure and/or tightness)
• radiates to left chest, arm, shoulder, neck, jaw and/or epigastrium
• dyspnea, pallor, diaphoresis, anxiety, syncope
• more common in inferior wall infarction: epigastric pain, bradycardia

Question 10

MI

-diagnostics

Answer 10

• ECG
• cardiac biomarkers: cardiac troponin (troponin T)
• elevated inflammatory markers: increased WBC, CRP
• Brain natriuretic peptide may be elevated
• LDH and AST - may be elevated due to cell necrosis
• Coronary angiography –> definitive diagnosis
• transthoracic echo
• cardiac CT with IV contrast

Question 11

MI

-treatment

Answer 11

• Revascularization –> percutaneous coronary intervention (PCI)
• antiplatelet therapy and anticoagulation –> aspirin + ADP receptor inhibitor (prasugrel, ticagrelor, clopidogrel)
• nitrate –> pain relief
• statins
• oxygen