Myocardial infarction

Question 1

Diagnosis

Answer 1

Any two of the following

a, Typical hisotyr of ischaemic chest pain

b. evolving ECG changes
c. Rise in cardiac markers

Question 2

Tests

Answer 2

ECG - acute anterior ST elevation or ischaemic changes

CXR- Heart size normal, Lung fields- evidence of pulmonary oedema

Troponin I or troponin T - cardiac marker to diagnose MI 6-12 hours after chest pain

Question 3

Immediate treatments

Answer 3

ACOMA

A-aspirin (300mg anti-platelet treatment)
C- clopidogrel (300mg anti-platelet prevents re-infarction, given once ACS diagnosis)
O- Oxygen (imporve oxygenation of ischaemic heart + pulmonary oedema)
M- morphine (10mg IV for pain relief)
A- Anti emetics (metoclopramide) (10 mg to ease nausea with MI and morphine)

Question 4

ACS

Answer 4

STEMI

• ST elevation MI + elevated troponin
• Cause: acute thrombotic occlusion of coronary artery
• TBx- re-open artery PCI or thrombolysis

Non-STEMI

• No ST elevation MI + elevated troponin + ST depression
• Cause: intracoronary thrombus without total occlusion
• TBx: no benefit of thrombolytics

Unstable angina
- History of ACS + no detectable troponin

Question 5

Stage 2 treatment

Answer 5

Primary PCI

Percutaenous coronary intervention

• invasive to open blocked artery
• restores coronary blood flow, minimizes coronary blood flow
• Within 90 minutes ie journey

Question 6

If PCI not initally performed can it be performed later?

Answer 6

YES

Coronary angiography with a view to revasculrisation proves beneficial

Angioplasty- A wire is passed down the artery to cross the stenosis, and an angioplasty baloon is advanced and deflated, deploying a drug-eluting stent

Question 7

What further tests should be done Post PCI

Answer 7

Repeat cardiac troponin 
Cholesterol 
Glucose 
Chest X ray 
Echocardiogram

Question 8

Secondary prevention treatment

Answer 8

A - ace inhibitor- rampirpil 
C- clopidogrel - prevent reinfarction 
A aspirin - prevents re-infarction 
B- Beta blocker - bisoprolol
S- simvistatin- statin

Question 9

Lifestyle changes

Answer 9

• exercise
• smoking cessation
• Diet
• sexual activity (briskly climb two flights of stairs- sex okay 2-3 weeks after heart attack)
• Driving- DVLA (following ACS or MI treated by angioplasty, the patient should not drive for a week, if not succesffuly treated with angioplasty or LV dysfunction - no driving for 4 weeks)
• returning to work 1-2 months post op
• rehabilitarion classes - education and support 4-6 weeks after discharge from hospital