myocardial infarction

Question 1

What comes under acute coronary syndromes?

Answer 1

chest pain that doesnt improve with nitroglycerin, or rest. and atheromatous plaque rupture

unstable angina, NSTEMI, STEMI

Question 2

incomplete occlusion, no appreciable infarction, no ST elevation, and cardiac markers are not elevated

Answer 2

unstable angina

Question 3

subendocardial infarction, no ST elevation. cardiac markers elevated

Answer 3

NSTEMI

Question 4

transmural infarction, ST elevation, q waves. cardiac markers elevated

Answer 4

STEMI

Question 5

definition of myocardial infarction

Answer 5

complete occlusion of coronary vessel (left anterior) , plaque rupture creates acute thrombus

Question 6

anterolateral MI which leads

Answer 6

I, avL, V1-1V6

Question 7

Right ventricular wall dysfunction, which leads

Answer 7

II, III, AVF

Question 8

supply of inferior wall MI

Answer 8

Right coronary, PDA

Question 9

what do you avoid in right ventricular dysfunction

Answer 9

venodilators, diuresis

Question 10

anteriorlateral MI- which artery supply

Answer 10

Left Main, LCX, LAD

Question 11

Decreasing the preload would make right sided heart failure worse or better?

Answer 11

worse, because right side is very preload dependent.

Question 12

myocardial hibernation- what is it?

Answer 12

chronic ischemia and involves left ventricular adaptation to the ischemia through eccentric hypertrophy. This can lead to left ventricular systolic dysfunction

Question 13

post MI acute phase (first 24 hours)

Answer 13

no abnormal changes in 12 hours (gross)
increased neutrophils
bordering wavy fibers

Question 14

inflammatory phase (hours-days)

Answer 14

macrophages and neutrophils start eating the necrotic tissue–>release cytokines
coagulative necrosis, loss of nuclei

Question 15

proliferative phase (days to weeks)

Answer 15

fibroblasts (repair) collagen type I and III-, electrical conductivity decreased through areas of fibrosis

Question 16

remodelling phase- weeks to months

Answer 16

matrix metalloprotienase: collagen crosslinking. scar tissue, increased collagen.

Question 17

complication during acute phase (24 hours) in MI

Answer 17

ventricular arrhytmias
papillary muscle rupture (posteriormedial muscle) PDA occlusion leads to acute mitral regurg
interventricular septal rupture–>VSD

Question 18

complication during inflammatory phase (hours to days)

Answer 18

perinfarction pericarditis, diffuse STE, pleurtic chest pain (can also have papillary muscle rupture and interventricular rupture)

Question 19

proliferative phase (days- weeks)

Answer 19

left ventricular pseudoaneurysm- (Rcoronary)>thrombus
left ventricular wall –>cardiac tamponade

Question 20

remodelling (weeks to months) complication

Answer 20

dressler syndrome, antibodies against myocardium.

Question 21

list the MI and the leads

Question 22

peak of troponin and ck-mb

Answer 22

trop: 12–48
ck-mb: 24