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PHASE 2 cardio conditions > myocardial infarction > Flashcards

myocardial infarction Flashcards

1
Q

define myocardial infarction

A

Necrosis of cardiac tissue due to prolonged myocardial ischaemia due to COMPLETE occlusion of an artery by thrombus.

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2
Q

pathology of MI

A
  1. plaque rupture
  2. development of thrombosis
  3. total occlusion of coronary arterY
  4. myocardial cell death
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3
Q

ECG of STEMI

A

ST elevation
Tall T waves
Might present as a new LBBB (WilliaM)
Pathological Q waves

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4
Q

ECG OF NSTEMI

A

ST depression and/or T wave inversion

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5
Q

what do both STEMI and NSTEMI have

A

increased troponin

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6
Q

risk factors for MI

A

Age
Male
History of premature coronary heart disease
Diabetes mellitus
Hypertension
Hyperlipidaemia
Family history

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7
Q

symptoms of MI

A
  • Crushing central chest pain similar to that occurring in angina – described as “elephant sitting on chest
  • Sweating
  • SOB/Dyspnoea
  • Fatigue
  • Nausea
  • Vomiting
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8
Q

can MI occur at rest

A

yes

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9
Q

how long does MI last

A

anywhere from few mins to several hours

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10
Q

can MI be relived by GTN spray

A

no

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11
Q

where can MI pain radiate to

A

to left arm, neck and/or jaw

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12
Q

are pulse and bp high or low in MI

A

may vary between being up or down

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13
Q

how does a patient with MI appear

A

pale, sweaty and grey

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14
Q

what can you hear in MI

A

4th heart sound – due to forceful contraction of the atria to overcome a stiff or dysfunctional ventricle

Pansystolic murmur – due to papillary muscle dysfunction or rupture

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15
Q

who is at highest risk of silent infarction

A

elderly patients, diabetics or those with hypertension.

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16
Q

what symptoms occur in silent infarction

A

either nothing
or
hypotension, arrhythmias or pulmonary oedema

17
Q

differential diagnosis for MI

A

Stable/unstable angina
Pericarditis
Aortic aneurysm
Endocarditis
Pulmonary Embolism
Pneumothorax

18
Q

investigations for mI

A
  1. clinical history
  2. ECG
  3. cardiac enzymes
  4. CT angiography
  5. CXR
  6. FBC
  7. U&E
  8. Blood glucose and lipids
19
Q

what is the acute (initial) managment for MI

A
  1. Get to hospital immediately
  2. MONA
    Morphine
    Oxygen (if sats are <94%)
    Nitrates – typically fondaparinux in Sheffield
    Aspirin 300mg – chewed in order to increase absorption
  3. 12 lead ECG and cardiac monitor
  4. Beta blocker IV – contraindicated in hypotension, HF, bradycardia and asthma
  5. Refer for PCI, thrombolysis (IV alteplase) or CABG ASAP as long as it’s not contraindicated
20
Q

what is the subsequent secondary prevention for MI

A
  1. modification of risk factors
  2. aspirin 75 mg daily
  3. Clopidogrel/ticagrelor (for dual antiplatelet therapy)
  4. Statins
  5. Beta blocker – if contraindicated give ACE-I
  6. ACE inhibitors – use angiotensin receptor blocker if intolerant e.g. valsartan
  7. Advice
21
Q

what advice to give someone whose had an MI

A

Return to work after 2 months – not all professions e.g. airline pilots,
divers, air traffic controllers

No air travel for 2 months

No sex for 1 month

22
Q

complications from MI

A
  1. Myocardial rupture
  2. Arrhythmias
  3. Pericarditis
  4. Dressler’s syndrome
  5. Death
  6. Mitral incompetence
23
Q

3 types of myocardial rupture

A

Rupture of ventricular septum 🡪 right HF

LV wall 🡪 cardiac tamponade

Papillary muscle rupture 🡪 mitral regurgitation/prolapse

24
Q

2 types of arrhythmias

A

Tachycardia – Sinus, VF, AF

Brachycardia – Sinus, AV block

25
Q

what is dresslers syndrome

A

pericarditis following cardiac intervention/surgery

26
Q

why does mitral incompetence occur after MI

A

due to myocardial scarring

27
Q

differential diagnosis of chest pain

A

Cardiac – ACS, Aortic dissection, pericarditis, myocarditis

Respiratory – PE, pneumonia, pleurisy, lung cancer

MSK – rib fracture, chest trauma, costochondritis (inflammation of the cartilage between the ribs and sternum)

GORD

Oesophageal spasm

Anxiety/panic attacks

28
Q
A

PHASE 2 cardio conditions (20 decks)

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