myocardial infarction

Question 1

when does MI occur?

Answer 1

when the plaque within the coronary artery ruptures, exposing a lipid-rich core.

This forms a thrombus, and temporarily or permanently blocks the coronary artery.

In a MI, the coronary artery is permanently blocked, leading to the death of part of the Myocardium

Question 2

what are 6 risk factors?

Answer 2

Smoking, Diabetes, Hypertension, Pulmonary Vascular Disease, Previous History of CVD, Family History of CVD

Question 3

what are 7 symptoms?

Answer 3

Acute Central Chest Pain

Breathlessness

Cough/Wheeze

Pain from chest, radiating to one or both arms, the jaw, neck, back, or stomach

Sweating

Nausea

Dizziness

Question 4

what are signs?

Answer 4

Pallor

Raised Pulse Rate

Raised or Reduced Blood Pressure

Raised JVP

Anxiety

Question 5

what are 8 investigations to diagnose MI?

Answer 5

CXR
ECG
Exercise Test
Raised Troponin
Bloods = FBC, U&E’s, Glucose, Lipids, Cardiac Enzymes
Liver Enzymes
Muscles Enzymes
Angiography (in order to perform PCI)

Question 6

what are some changes on an acute myocardial infarction ECG?

Answer 6

Hyperacute T waves are often the first sign of MI but often only persists for a few minutes.

ST elevation may then develop

T waves typically become inverted within the first 24 hours, can last for days to months

pathological Q waves develop after several hours to days, usually persists indefinitely

Posterior MI typically presents on ECG with tall R Waves on V1 and V2

Question 7

what is the immedidate treatment?

MONA

Answer 7

Morphine
Oxygen
Nitroglycerine (GTN - spray or tablet)
Aspirin (300mg Orally)

Question 8

what is the general outline in management of MI?

Answer 8

1. Sit patient upright
2. Establish IV access
3. Oxygen via a mask
4. Analgesia
5. Aspirin (300mg)
6. Confirm diagnosis based on history, examination, ECG, and Cardiac enzymes
7. Thrombolysis (if no contraindications)
8. In the next 24-48 hours, consider secondary prophylaxis - eg. ACEI, B-Blockers etc…

Question 9

what are some complications of MI?

DARTH VADER

Answer 9

Death
Arrhythmia (Ventricular Fibrillation - most common cause of death after having an MI)
Rupture (free ventricular wall/ventricular septum/papillary muscles)
Tamponade
Heart failure (acute or chronic)
Valve disease
Aneurysm of ventricle
Dressler’s syndrome
thromboEmbolism (mural thrombus)
Recurrence/ mitral Regurgitation