Myocardial Infarction Flashcards
List symptoms of MI?
- sweaty/clammy
- SOB
- jaw pain
- chest pain
- back pain
List signs of MI?
- tachycardia >100bpm
- distress
- HF (crackles, raised JVP)
- shock
- arrhythmia
Why is troponin measured to check for MI?
Part of the cardiac myocyte which is released to the bloodstream.
It is a marker of cardiac necrosis.
High sensitivity so can detect even small MI’s
Define an MI?
An elevated troponin in a clinical setting consistent with MI.
Explain the types of MI.
- Spontaneous MI due to a primary coronary event.
- Increased O2 demand or decreased O2 supply. e.g HF, sepsis, anaemia, hypertension.
- Sudden cardiac death.
4a. MI associated with percutaneous coronary intervention.
4b. MI stent thrombus documented by angiography or PM. - MI associated with CABG.
List non-coronary causes of MI (type 2)?
- acute congestive HF
- tachy-arrhythmias
- pulmonary embolism
- sepsis
- apical ballooning syndrome
What is apical ballooning syndrome?
(takotsubo cardiomyopathy)
- due to stress you get ballooning of the heart apex.
What are chronic non-MI causes of elevated troponin?
- renal failure
- chronic HF
- infiltrative cardiomyopathies e.g. amyloidosis, haemochromotosis, sarcoidosis.
What is unstable angina?
an acute coronary event without a rise in troponin
- clinical presentation of MI and ECG changes.
What is Glagovian remodelling?
When an artery remodels to increase cross-sectional area to accomodate plague without reduction in lumen.
How do the coronary arteries differ in NSEMI and STEMI?
NSTEMI: CA is not fully occluded.
STEMI: CA is fully occluded.
Describe ECG patterns in a STEMI?
- ST elevation
Where would a posterior infarct be seen on ECG?
Wouldnt as no leads here, but can see reciprocal depression in anterior leads? (CHECK THIS)
What is the immediate management of a STEMI?
- ABCD
- Take ambulance to cardiac centre
- Have defib attached while in ambo
- Give 300mg of aspirin PO
- Give 5000u of unfractionated heparin
- Morphine 5-10mg IV for pain
- Anti-emetics
- Clopidogrel in ambulance
- Ticagrelor in hospital
- Activate PPCI team
Why is PCI better than thrombolysis?
- improves survival
- reduces stroke
- reduces chance of further MI
- reduces change of further angina
- speeds up recovery
- shortens time spent in hospital
What care would be given as subsequent management of STEMI?
- Monitor in coronary care unit for complications of MI
- Echocardiogram too look at LV function and cardiac structure
- Cardiac rehabilitation
- Secondary prevention drugs.
What drugs can be given for secondary prevention of STEMI?
- ACEi: For all
- B-blockers: For all
- Statins: For all
- Eplerenone: In diabetes, LVSD or HF (K+-sparring diuretic).
What complications of MI can occur?
- Arrythmias: VT/VF/AF
- Heart failure
- Cardiogenic shock
- Myocardial rupture:
- Septum - VDS
- Papillary muscle - mitral regurg.
- Free wall - tamponade.
- Psychological: Anxiety/depression
What is the subsequent management of NSTEMI’s?
- Monitor in coronary care unit for complications.
- aspirin
- clopidegrel/tricagrelor
- LMWH or fondaparinux
- Drugs (same as STEMI).
- Echo
- Cardiac rehabilitation.
Describe a ACS risk model?
GRACE model
- Used to calculate risk of ‘in hospital death/MI’ and ‘death in 6 months/MI’
- Based on
- Age, HR, BP, Creatinine
- If cardiac arrest at admission
- If ST segment deviation
- If elevated cardiac markers
- CHF (rales and JVD)
If low risk: discharge on medical treatment.
If intermediate risk: discharge to be readmitted for angiogram in 1-2 weeks.
If high risk (GRACE >140): urgent inpatient angiogram.
