Myocardial Infarction Flashcards
STEMI criteria?
> 1mm ST elevation in 2 adjacent limb leads
> 2mm ST elevation in at least 2 continuous chest leads
New onset Left bundle branch block
ECG changes in NSTEMI?
ST depression or T wave inversion; troponin rise
ECG changes in unstable angina?
ST depression or T wave inversion; no troponin rise.
Chest leads for anterior MI
V2 - V5
ECG leads and artery for anteroseptal MI?
V1-V3, left anterior descending artery
ECG changes for anterolateral MI and artery
I, aVL, V5 and V6 (circumflex)
Posterior MI ECG changes and artery
ST depression and upright T waves in V1-V3 (right coronary artery) [reciprocal changes]
Dominant R wave in V1 and V2
Inferior MI ECG changes and artery
II, III, aVF (right coronary artery)
Management of STEMI:
MONAC
IV morphine Oxygen GTN spray (nitrates) Aspirin 300mg Clopidogrel / Tiacagrelor
Give some IV metoclopramide too.
Primary PCI should be given within 120minutes if presenting within 12 hours of symptom onset, otherwise use fibrinolysis.
If patient has undergone fibrinolysis, an ECG should be performed 90mins after this:
- if not > 50% resolution of ST elevation then transfer to PCI lab
Management of NSTEM?
GTN Spray, IV morphine, IV metoclopramide can be given
Aspirin 300mg
Clopidogrel should be given and continued for 12 months
Fondaparinux should be offered. (Factor Xa inhibitor)
Coronary angiography
List the common complications of MI:
Arrhythmias:
- Ventricular fibrillation (most common cause of death post MI)
- Bradyarrhythmia (AV block)
- left ventricular aneurysm (persistent ST elevation and LVF)
- Pericarditis / Dressler’s syndrome
- Heart failure.
Managament of angina?
All patients should receive aspirin and a statin in the absence of any contraindications.
1st line = beta blocker (atenolol) or calcium channel blocker
If CCB used a mono therapy = verapamil or diltiazem
If used in combination with B blocker then change CCB to nifedipine.
Other therapies include isosorbide mononitrate, nicorandil, ivabradine
