Myocardial Infarction

Question 1

Classification of MI??

Answer 1

Acute increase and/or fall of troponin, and at least one of the following:

• symptoms consistent with ischaemia (lasting >20 mins)
• new, or presumed new, significant St-T wave changes or left bundle branch block (LBBB) on 12-lead ECG
• new, or presumed new, pathological Q waves on ECG
• new, or presumed new, loss of viable myocardium or regional wall motion abnormality on imaging
• intracoronary thrombus (clot) on angiography

Question 2

What is troponin?

Answer 2

A protein found in the heart muscle, released when the heart muscle is injured but can also indicate other things e.g. clot in leg at DVT

Question 3

Clinical features?

Answer 3

Main complaint chest pain, usually;
→ severe
→ lasts at least 20 mins
→ tight, crushing or heavy band-like in nature
→ retrosternal in location (behind sternum)
→ may radiate to left arm, throat or jaw
→ associated features include sweating, nausea and breathlessness

Question 4

Medical management of acute coronary syndrome?

Answer 4

IV access + cardiac monitoring
GTN spray
If in pain:
- morphine IV
- metoclopramide

Question 5

Cardiac risk factors?

Answer 5

→ smoking
→ hypercholesterolaemia
→ hypertension
→ diabetes mellitus

Question 6

What are potential physiotherapy problems for a patient post-MI?

Answer 6

• reduced exercise tolerance
• chest pain
• SOBOE
• if post-surgery ( risk of retained secretions)

Question 7

Definition of MI?

Answer 7

Acute myocardial infarction is myocardial necrosis resulting from acute obstruction of a coronary artery.